P - 37430Building BUILDING
Inspections RESIDENTIAL APPLICATION
�63-s�2-3604 CITY OF FI�IDLEY
763-502-4977 FAX EFFECTIVE 1-1-2011
DATE �' � S-- �� YOUR E-MAIL ADDRESS �"—
SITE ADDRESS -�'"�� .�/ � �'--�'.3�� ,�. S% /1/G'�' /-";�. . 2�%a .� /�'� Z
THIS APPLICANT IS: ❑ OWNER ��CONTRACTOR
Permit No.:
Received By:
.�� �e� ;�,
PROPERTY OWNER/ N�E: � �,. �" �.-y�U.� �.�. �--
TENANT �
ADDRESS: G ,_j' `�� �i�%�.-�� S'� ^� S��C CITY ��'' ' ��� y STATE ��°LIP � �� �
PHONE: ��:j �� � o� � �'�
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
��?�C—� ,��� r /y'�-,..�. � .- v- -
STATE LICENSE # /i���%' �' j/ F LEAD CERT NLIMBEI��c_°/'3� � S���G��`��
ADDRESS: � r/�� � � .G �` � r'- /P/ CITY �, s�'.�-.i' � STATE��P �,j ��
PHONE __ C� /.,� i .-l� � .3 � � � FAX
�SINGLE FAMILY/NEW CONSTRUCTION 3[ZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �tOOF ❑ DRA[N TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
,J�MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: %C�.e. ,,/�'o �
OFIMPROVEMENT
ROOFING � C
NUMBER OF SQUARES ��
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
1N EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF WINDOWS
HEIGHT
FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION iNCLUDTNG DECKS,
ADDITIONS. & PORCHES SUBMIT:
l. 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 LAB�R AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
I Erosion Control
' Park Fee
: � Sewer Main Charge
' Totat Due
$
$ 3
$
$ 5 �)�
$
$
$
$
$
$ ( _,
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 Residentia( 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 pavable 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 1 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 all wor hic equ' es review and approval of plans.
SIGNATURE OF APPLICANT �-,� PRINT NAME �� /�-� DATE� �_�' ��
APPROVAL INSPECTOR SIGNATURE