P - 45754Building
Inspections
763-572-3604
7f3-�02-4977 FAX
BUILDING
RESIDENTIAL APPLIG'ATION
CITY �F FRIDLEY
�FF6CT[VE t-1-2011
DAT'E (y �r/ I l
scTe,�nn�ss �
FHIS APPLIC�INT'(S � , O OWNER
PROPERTI' �WNEW hAME t
TENA�fT ,�nxass: �%�
CONTRACTOR
sunn�rr,a coPV oF
YQUR S'fAT6 LiCFNSE
A�1D CERi'IFIC.4T� OF
CVSURANCE
PROPER'IY TYPE
PERMIT
�F WORKc
S"TATF LICEI�SE+?
YOI:RE-MAILAO I�F2, SS
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�C�NTRACTOR
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LF I�.AM1[lI,Y'1t�EVY CONS:'RUCTI�
FAA3ILY/NEV.' CONSTRtiCT10N
❑ BAS�!�:EN�� I'1NISH �tOOF
❑ DEC!{ 0 SIDiNG
❑ S�'JIN.hSING POO:.
❑ NL�' HOh1C CONSTRUCTIO�f ❑ ADDITId1�
1�A:1AIT�TF.NANCE`REPA:R O RL'ti10DEL1[VG
DESCRIBE v;ORK BE1VG DONE: �! -. .
Sf'LE OF IMPRQdEMEVT
ROOFIIYC
Nt;MBER pF SQUARES_�
GARAC.N 6
PROP�SED SIZE:
PROPOSLD HElGHT:
SInING
❑ V im•l
p Alumincm
❑ O:h^r
W'i\DO�i'S
IN EX[S'I`1NGOPL-TTINGS ❑Yes O�o
OR FOR T:EIY �PEIVSI�GS-D�SCRI$E 517_L OF
OP EN CNG CHAV G ES &
TT'PE OF WINDOW TO BE 1\STALLED
}� HOUSE OiVLY
� �f HOUS� & GARAGE
O ATTACHED G.4RAGE
❑ DETr1C!-iED GARAGE
❑S�fE"it
❑ Trim
❑ Fascia
LOCATION OF WLNDO��'S
CERT YU
X
❑ DRA[K T4LE
0 flTi-IER
Perm it N'o.
Received By;,
B4SEM£hT RE,1�]ODEL.In`G ��ZIT
1. Existing Fl�or Pfart
2. Proposed fl�or plun
3. L�st of struc.ural mernbers to be used
FOR NL-t1' CONSTRUC.ION INCLI.�DITvG DECKS,
ADDITIONS. & PORCHES SU8'�i[T:
1. Sitc P1an/Sura•cy showing th� eaistir.g siructures
and pr�poszdp-ojo�i
2. Twco se� oi corstruction pla�s
3. E�ergy Calcu(ations
FOR 1�'] V DOW'S — i'RO VIDE L�-VALUL• AT b
M.4VUFACTllRE STICKER QN WINQ04Y.
ALL FEES ARE BASED O� YALUATIO�I, INCLUDII�C THE COST OF L.4.BOR �'�ID M:�
UB �'ALI; A
Permit Fee
Plan Review
Fire Surcharge
SurcharDe
License Surchar�e
SAC Charge
Curb Cut EscroH�
:Er�sion Control
Park Fe�
Sewer hlain G'haege
$
�(U�SI�G,J'HE 299? U.B.0 FEE SGIiEDULE)
. � UCCUPANCY TY'PE
�3��ij u See Back Pa�e for Fee Schedule
$
65% of Building Permit Fee
.441 times the iotal j��+ valuation
.0045 x Permit Valuation h�inimum S5.00
�5.00 (Srata Licensed Residential Contractors)
$2230 per SAC Unit (Ptans to h�f�u'GC for deterrnination)
ft-r6ft= ftx$25=$
$450 Conser�•ation Plan Review
Fee Determined by Engineerin�
A�rezment necessary { ) \on l�ecessary ( )
Vlake c�ecks aavable Eo: Citv ofFridie�+ Attac
THIS IS AN APYL]Ce+.TION FOR A PERN•IT-NOT VALID U'�TIL PR�CESSED
I hereby applg for a building permit d I acicnoy,�ledge that the information above is complete and accurate; that the work will be in
conformance wiCh the ordinances eod� th .• it}� of Fridley and with the tilinnesota Consvuction Codes; that [ understand this is nat x
permit but onlp an applicati.on;- r rm�t ark is not to start without a permit on site; that the work �vill be in aceordance with t}re
approved plan in the cas�o �j,iwa � ich e s revie�v and approvat of plans. ,, ��j�j;� �,?���/� f
SIGI�ATURG OF APPLICA / PRiNT NAME G� °� (�FArTE �r
Ak'PROVAL [VSPEC7'OR SI � TL�RE' '
ivOTE:
ARE REQUIREQ
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