P - 45280Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADDRESS _
THIS APPLiCANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF [MPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-2011
❑ OWNER
�.—
NAME:
ADDRESS:_�
PHONE:
NAME: /^
STATE LICENSE #
ADDRESS:_��
YOUR E-MAIL ADDRESS
❑CONTRACTOR
�
PHONE' '' " �' "
INGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION �.
❑ ADDITION .�ARAGE/SI-
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING
CITY
Permit No.�.�l� � �
Received B .
(��[����� � 4 2 i111
STA
LEAD CERT NUMBER
CITY STAT�/ZIP��
FAX
SIZE
STORIES
❑ NEW HQME CONSTRUCTION L�l'1� DIT10N
❑ MAINTENANCE/RBPAIR ❑ REMODELING
;: �� �- �o s.���
LENGTH /�1 WIDTH
❑ HOUSE ONLY
O HOUSE & GARAGE
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF
❑ DRAIN T[LE
❑ OTHER
HEIGHT
FT
BASEMENT REMOD�LING SUBMTT:
1. Existing F(oor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION fNCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
I. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $_��D?� °L-- OCCUPANCY TYPE
Permit Fee $
Pian Review $
Fire Surcharge $
Surcharge $
License Surcharge $
SAC Charge $
Curb Cut Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $
Total Due $
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 aavable 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 the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio r a pe ' nd work is not to start without a permit on site; that the work will be in acc danc with the
approved plan in the case uires review and approval of �
SIGNATURE OF APPLICAN PRINT NAM,������9!/'� DATE O
APPROVAL INSPECTOR SIGNATURE
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