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P - 44569Buil�ing Inspections 763-572-3604 763-502-4977 FAX DATE 30�£� 3L�li 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 IMPROVEMENT ROO IN NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING O Vinyl ❑ Aluminum � Other BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 �OWNER ADDRESS: STATE LICENSE YOUR E-MAIL ADDRESS ❑CONTRACTOR ADDRESS: PHONE ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ BASEMENT FINISH ❑ DECK ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & � TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ING T 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ �_ 65% of Building Permit Fee Fire Surchazge $ .001 times the total job valuation Surcharge $ .0005 x Pernut 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$24 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Deternuned by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ . Make checks uavable to: Citv of Fridlev Attach ❑ ROOF ❑ SIDING ❑ SWIMMING POOL ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE � DETACHED GARAGE OSoffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS CERT NUMBER. CITY ❑ DRAIN TILE �OTHER Permit No.: � � � � Rece�e�v�AR i�. �O 1 Date Rec'd: �� STATE�ZIP � Z ATE ZIP, BASEMENT REMODELING SUBMIT: I. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: i. Site Plan/Survey showing the existing shuctures and proposed projeck 2. Two sets of conshuction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. 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 code f the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicati r a pe i i not to start without a permit on site; that the work will be in accordance with the approved plan in the case of 1 hi r s ev w roval of ans. . SIGNATURE OF APPLICANT PRINT AM$� /�(Q�'�A.�eil'� DA �E � �� APPROVAL INSPECTOR SIGNA PL�ASE NOTE: SEPARATE PERMTTS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK �� 0 � � � � �� `� .� . � � �� k � � � �. � � � �.. � � � � �" � SC �--- � ' � � t� � �#✓ �. �A � � f � � w� �� -� , � -- �- � I� ,r; �� `°� _ `� `��, , J � w � �� _� ' U � . �� 4�.�� { �i � 7 � � �� :� � � � � �� . � �. � �� .� � �n� W �C � c � �-� w � � � �� . � � �� w� � � � �-- � _ � � � � � � � � r � � � � � � ` C� � --� � �, � � �� ; .-u,��.,,�...� ,.-.,::.�.,,x �. ,.,�,��.,:.,�..��«:-�,° � � � � � r � , � :� � � r � S � ( � �. \ � � � � k �� / ; � �� ' : � �