P - 39908Building
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:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECI'IVE 1-1-2011 /1
Permit No.: v�' � '� I �� �--�
Received By� ► ` G� ���
Date Red�� � `
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INGLE FAMILY/NEW CONSTRUCTION
TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑ GARAGE/SHED
❑ BASEMENT FINISH �ROOF
❑ DECK ❑ SIDING
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
�MAINTENANCE/REPAIR ❑ REMODEL
� �
FAX
SIZE
STORIES
❑ WINDOWS
❑ D�rr TTLE �} -� SG� A.�
❑ OTHER
ZIP
�
DESCRIBE WORK BEING DONE: �'' �'—' °(— L.- V L�
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SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES � ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION 1NCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
and proposed project.
❑ Other �Fascia 2. Two sets of wnstruction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE SIICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED 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 $ " t OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ a .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$25= $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge —$ �� Agreement necessary O Non Necessary O
Total Due � 1'c�c � Make checks aavable to: City of Fridlev Attach Stiuulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID IJNTIL 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 ordi s and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an ap 'catio r a permi d work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the e 11 rk whic quires review d approval of p�?n,s,. ��� f//
SIGNATURE OF APPL N PRINT NAME KYI ��, %'�/� )�_DATE
APPROVAL INSPECT ��`�'�' ��"`��