P - 84322Building
Inspections
763-572-3604
DATE �( ( � �L�'
S1TE ADDRESS ��
TH[S APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.
Received By: I 1
����� � �
YOUR E-MAIL ADDRESS �SC�,`��t� '� L° ,� `�/� ,% � _�U � . �v�
❑ OWNER [�ONTRACTOR
ADDRESS: � CITY
PHONE:�3 -� �- I ^� ' ZO
NAME:
STATE LICENSE #_
ADDRESS:
H.
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #BC130983
Y�E 651-264-4777
.,�..,
❑ BASEMENT FINISH ❑ ROOF
O DECK ❑ SIDING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMFNT
NUMBER OF SQUARES
GA�
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDI�,
O Vinyl
O Aluminum
❑ Other
,�
�
LENGTH
O HOUSE ONLY
❑ HOUSE & GARAGE
O ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWc
IN EXISTING OPENINGS OYes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPEOF WINDnW TnRF rUCT'e� r cn _..._ ____ __ _
�
ATE_ZIP,
TATE_ZIP
_ _❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
WIDTH
BA�EMENT RF.MOD IN. ct rgh•IT•
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITION & POR H ctIRMIT•
1. Site Plan/Survey showing the existing structure
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
-----•- �. ......,.,...,
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 9� I(p(o OC� OCCUPANCY TYPE
Permrt Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ • 1 �-
$ '-t. S8
$ •�
$
$
$
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)
$1550 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 pa abie to: Cityo uf Fridlev Attnr
THIS IS AN APPUCATION 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 i�
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not ;
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approvec
plan in the case of all work wh'ch requires review and approval of plans.
SIGNATURE OF APPLICANT li �'� PRINT NAME� � ��'1�1,
�`'�G'.� • �^<<'+ � DATE