P - 45208Building
Inspections
763-572-3604
DATE � � \�
SITE ADDRESS _�
THIS APPLICANT IS;
PROPERTY OWIVER/
TEIYANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER ❑CONTRACTOR
— �����
Permit No.:
Received By;
Date Rec'd:
ADDRESS: � � CITY STATE ZIP
PHONE: ��� — J �
NAME:
STATE LICENSE #_
ADDRESS:
SINGLE FAMILY
❑ TWO FAMILY/NEW
❑ ADDITION
❑ BASEMENT FINISH
O DECK
TYPE OF WORK: � NEW
L] MAIN
DESCRIBE WORK BEING DONE
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vieyl
❑ Aluminum
❑ Other
Renewal By Andersen
1920 County Road "C" West
Roseville, MN SSll3
License #20130983
651-264-4777 __
� ROOF
❑ SIDING
❑ SWIMMING POOL
❑ ADDITION
PAIR ❑ REMODELING
�c�z.1 c�c�c�' c..�11;
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
� Trim
� Fascia
WINDOWS
IN EXISTING OPEMNGS L1Yes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
ATE ZIP,
❑ DRAIN TILE
❑ OTHER
WIDTH
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCI.UDING DECKS,
ADDITIONS_ & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structure
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
� WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�, 3LIo� -- _ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �i�-_ a
$ � �-�
$
$ s,m�
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$I550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridlev Attac
THIS IS AN APPL[CATION FOR A PERM[T-NOT VALID UNT[L PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be 'v
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand tiiis is not ;
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approve�
plan in the case of all wor which req �r s review and approval of plans.
SIGNATURE OF APPLICA PR[NT NAME/i �o�f�+�,� Y'� V1'�� 1f�7 DATE U� V I