P - 59356Building
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 IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-2012
YOUR E-MAIL
❑ OWNER �CONTRACTOR
STATE LICENSE
ADDRESS: L�
CITY
PHONE �/ � I � I � i � ,�'�I � � ) FAX _� � 1 >
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ RAIN TILE
❑ DECK � SIDING ❑ OTHER
❑ SWIMMING POOL
�EW HOME CONSTRUCTION . ❑ ADDITION -
MAINTENANCE/REPAIR ❑ REMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit SIDING/SOFFIT/FASCIA
❑ Trim REMOVED? ❑ YES ❑ NO
❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
� TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS 1� I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(�S N�THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
°ermit Fee $ �, `i See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum or .50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2365 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 -$ �r Agreement necessary O Non Necessary O
Total Due � i� Make checks payable to: City of Fridle_y Attach_
HEIGHT
Permit No. �
Received By:
STA
� � ! �
ATE�ZIP
i/�/ (.i�
O FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
]. Site Plan/Survey showing the existing structures
and proposed project.
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 an codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application perm' and work is not art without a permit on site; that the work will be in accordance with the
approved plan in the case o o ch re re vie d approval of plan�/� I�,�� � I r��E Z
SIGNATURE OF APPLICANT PRINT NAME —
APPROVALINSPECTORSIGNA URE