P - 44900Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
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DATE� ( % `"� �/ ` .f k.! � � YOUR E-MAIL ADDRESS � 6�1 !�/_(�%�,Q_GL"� �' � �� ��1���,. %�_2._"�
SITE ADDRESS / ���; /.�!/(/ `� � ��_�, �d' .1�)�� �
--(�� � o---o—
THIS APPLICANT IS: � OWNER ❑CONZ'RACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STAT'E LICENSE
AND CERTIFICATE OF
INSURANCE
.�n�ss: i� � � � r��v Y � � N� CITY ,Cj�/, j� ��-�_sT,
PHONE:_� � � %/ -„� SJ•�� �fiG�- Y-�� le %�. " ��Q� 'O�
NAME:
STATE LICENSE # LEAD CERT NUMBER
ADDRESS: CITY STATE ZIP
PHONE FAX
PROPERTY TYPE ( �SINGLE FANIILY/NEW CONSTRUCTION
O TWO FAMILY/NEW CONSTRUCI'ION
PERMIT TYPE O ADDITION ❑ GARAG
O BASEMENT FI1dISH � ROOF
$DECK ❑ SIDING
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMEN'T
ROQTING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
O Aluminum
❑ Other
CJ NEW HOME CONSTRUCI'ION
$ MAINTENANCE/REPAIR
�' - - - - �
❑ ADBITION
❑ REMODELING
�
O HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EX[STING OPENINGS �Yes ❑No LOCA1'ION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE 5IZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTAi.i.FD rrrn�ruFU nF �
❑ DRAIN 1TLE
❑ OTHER
HEIGHT � �% �� SQ FT
�ASEMEhTT REMObELING SUBMIT:
1. E�tisting Floor Pl�
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. &c PORCHES SUBMIT:
1. Site PladSurvey showing the existing struc7ures
and ProP�� P�.1�
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS - PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDpW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING T 1997 U.B.0 FEE SCHEDULE)
TUTAL JOB VALUATION $ O� �L�-o2� OCCUPANCY TYPE
Permit Fee
PIan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curl� C�t Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
$
$
$
$
i
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( ) �
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that information above is complete and accurate; that the work will be in
conformance with fhe ordinances and codes of the City o ri y d with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and w rk is n to without a permit on site; that the work will be in accordance with the
approved plan in the case of a ork q' i appmval of plans. ,/
SIGNATURE OF APPLICANT �A (//,I,�iir� ���/ %�'J/y DATE �� "�O/�
e nnnnc � � r nrnnnnm�n or�,�. .�.�.....�
. • CFPARAT'F PRRMTT°.0 A R F� �(} Pi.iiMRTNC. Fi.F?f`TRT("Ai. ANil MF('NANi('AT:
�esi � �v � 9595 � ' ' `' 1 a�101201 �
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*�� Take this sheet to the Building Materials desk to purchase your materials. ***
�ou s�lected a 1 level deck with: Below is a section of the railing style and
�ressur2 Trea��ed Framing Material options you have selected for your deck.
� x 4 Framing Posts
�edar Northdex Deck Boards �
'oured Footin�s 8" Tube 4' de p ��
�edar Ultra .� crews
�tainless Steel �raming Fasteners M �
-landrail selections:
36" White Ulir�deck Fusion Railing
1-1/2° � 3/4° �r!!hite Fusion Spindles
�" x 4" x 38" White Fusion Railing Posts
r-1/2" :c 3" x 6' !�lhite Fusion Hand Rail
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Spindle placement is approx, 4" apart depending on sty�
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Illustration intended to show general deck size and shape.
Some options selected may not be shown for picture clar� .
Toda 's ���� for materials estima�ed in this design with options: 1,989.26
Y
"The �ase pnce includes: 40 PSE deck live (0�1, AC2 treated • horizontal 2x6 '(BASE price): �477.81
deck Goards, 4x4 post�, 2x8 joists and b�ms, galvanited framing fasteners, ,� "'�fpu�d today �OU save: 124.�'`*`
os MoMhly B1G Card Paym� would be: �55.�'"'
AC2 treated 36° Verticai handrai! to joist without posts, and premtum screws.
You may buy all the materials or any part at low cash and carry prices. Because of the wide variable in codes, Menards cannot guarantee that materials listed
will meet your cotle requirements. Gheck with our local murncipality for plan campliance antl builtling permit. These plans are suggested designs and material
lis� only. 5ome �tems may vary from those pic�uretl. We do not guarantee the completeness or prices of these structures. Tax, la6or antl delivery not includetl.
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