P - 48648Building
Inspections
763-572-3604
DATE a�D rn0�.�
SITE ADDRESS �O� �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATIQN
CITY OF FRIDLEY
Permit
Received By:z ' "'r
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YOUR E-MAIL ADDRESS �SQ`��� C� It��kY�i h, �+t� �./v�
_ v. � S � � v a
� OWNER OCONTRACTOR
ADDRESS: ^ C1TY STATE ZIP
PHONE:�Ip 3 -- S } � " } �S�
NAME:
STATE L[CENSE f!
ADDRESS:
SIIVGLE
��
1920 County Road "C" West
Roseville, MN 55113 STATE z�p
License #BC130983 �
651-264-4777 _
❑ BASEMENT FIN[SH O ROOF
D DECK O SIDING
I�
DESCRIBE WORK BEING I
SIZE OF IMPROVEMENT
SQUARES
cARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
ADDiTION
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
u wiNnvws
O DRAIN TILE
❑ OTHER
BASEMENT RFMODEL.ING SUBMIT_
1. Existing Floor Pian
2. Proposed floor plaa
3. List of structural members to be used
Ft.
SIDING - FOR NEW CONSTRUCTION INCLUDiNG DECKS, '
❑ Vinyi DSoffit ADDITIONS_ & PORGHES SUBM{T:
O Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure
❑ Other 0 Fascia and proposed project,
W��y�,S 2. Two sets ofconstruction plans
IN EXISTING OPENINGS �Yes ONo LOCAT[ON OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE S1ZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE 1NSTALLED 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 � ° 5��'1 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
���:_�
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��i�'1�5�►
� --�" �
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 rimes the total job valuation
.0005 x Permit Valuation Minimum $.50
$S.QO (State Licensed Residential Contiactors)
$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 payabie to: City of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is compiete and accurate; that the work will be 'v
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is not :
permit but only an applicarion r a permit and work is not to start without a permit; that the work wili be in accordance with the approvec
plan in the case of ali work w' h uires re e and approval of plans.
SIGNATURE OF APPLICANT NAME� Q[�t y�St� Y�.7 DATE �lU 1� E��l � p-