P - 41773Building
Inspections
763-572-3604
763-502-4977 FAX
DATE %�..i
SITE ADDRESS /
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
BUI�DING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER �CONTRACTOR
ADDRES
STATE LICENSE # EXP DATE
ADDRESS: �/LOD� �/�SDI7 �%� CITY�
�-���..�
FAX
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRLTCTIOI�i STCRIES
PERMIT TYPE � �DITION ❑ GARAGE/SHED ❑ WINDOWS
O BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK $[SIDING ❑ OTHER
❑ SWIIbIlvIING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTTION
�(MAINTENANCE/REPAIIt ❑ REMODELING
DESCRIBE WORK BEING DC
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
�Aluminum
❑ Other
❑ HOUSE ONLY
� HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
,�(Trim
❑ Fascia
WINDOWS
IN EXISTING OPENIDIGS OYes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
ALL FEES ARE
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Permit No.:`Z�
Received By:
n
���
ATE�!LIP,
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
D ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 U.B.0 FEE SCHEDULE)
�7 OCCUPANCY TYPE
� 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)
$ $2000 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ (0 S"f /1 Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of work which requ' es review and approval of plans.
SIGNATURE OF APPLICAN'������ � ��%/��PRINT NAME��/'J� ��DATE �
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHA1vICAL WORK