P - 45760Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
DATE ' ��` � O � I �
SITE ADDRESSi Q�
THIS APPLICANT IS: ❑ OWNER
PROPERTY OWNER/ NAME:�Q„�
TENANT ADDRESS:� !
PHONE:.��„
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
STATE LICENSE #,
CITY OF FRIDLEY
F.FFECTIVE 1-i-2011
YOUR E-MA1L
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�ONTRACTOR
t �_
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_�E�,�- �3L'
IONE iL0 �' o��"J�„�"' �, � -�
S�.INGLE FAMILY/NEW CONSTRUCTfON
TWO FAMILY/NEW CONSTRUCTION
❑ BASEMENT FINISH ��F
❑ DECK ❑ SIDING
❑ SWIMM
�s�sy/
Permit No::
Received By:
Date Rec'd:
CERT NUMBER K ! / "
FAX ��Y 3'
SIZE
STORIES
❑ WINDOWS
❑ DRAIN TILE
� OTHER
Tl'PE OF WORK: ❑ NEW HOME CONSTRUCTION � EMOUbLING
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BEING DONE:�� %_v��
SIZE OF IMPROVEMENT
LENGTH W[DTE
ROOFIN ��j ❑ HOUSE ONLY
NUMBER OP SQUARES �(s7�7 �OUSE & GARAGE
GARAGBS -�ATTACHED GARAGE
PROPOSED SiZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT:
�
ATEVYI� IP5643�
;'/�-v�
ATE i'll�l�P.
a+�3�
HEIGHT "��'"" '
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ID[NG pDDITIONS & PORCHES SI B�
S---- ❑Soffit 1. Site Plan/Survey showmg the existing structures
❑ Vinyl ❑ Trim and proposed project.
❑ Aluminum ❑ Fyscia 2. Two seis of construction plans
❑ Other 3. Energy Calculations
WINDOW5 LOCATION Of WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
IN EXISTWG OPENINGS �Yes ONo (vtpNUFACTURE ST(CKER ON WINDOW.
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES & NUMBER OF W[NDOWS
TYPE OF WINDOW TO BE INSTALLED
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIAL :
�� USING THE 1997 U.B.0 FEE SCH OCCUPANCY T�'P�
TOTAL JOB VALUATION $ i1I
Permit Fee $ '' See Back Page for Fee Schedule
P�� $ , 65% of Building Permit Fee
Fire Surcharge $ . .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $5.00
License Surcharge $ .� a $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$ ft+6ft= ftx$25=$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement necessary ( ) Non Necessary ( )
Total Due $ l� � Make checks a able to: Ci of Fridle Attach Sti ulat�ons
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowl ge that the information above is complete and accurate; that the work will be in
conformance with the ordinanc foand eo� ��d work isf Fr't es� �N'hout a pe�rmit on s en thattthe wor�kswi 1 be un acco danceswith�he
permit but only an appl�cation P roval of lans. �..
approved plan in the case of all w w ich requires revi d PPp T MEP -�b�^ �„ •-'"�"^�� DATE
SIGNATURE OF APPLICANT , � ✓J
APPROVAI, INSPECTOR SIGNATU
PLEASE NOTE: SEPARATE PERMITS A QU RED FOR PLUMBING, ELECTRICAL AND MECHANiCAL WOR