P - 46288Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
S[TE 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
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
❑ OWNER
NAME:
A.DDRESS:
PHONE:_� J
NAME:
STATE LICENSE #,
ADDRESS:
E-MA[L ADDRESS
DCONTRACTOR
LE FAMILY/NEW CONSTRUCTION
FAMILYJNEW CONSTRUCTION
❑ BASEMENT FINISH
❑ DECK
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
ROOFING D
NUMBER OF SQUARES �+ �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ �IDING
❑ SWIMMING
L
HOUSE ONLY _
HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
D Trim
❑ Fascia
WINDOWS
M EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
CERT NUMBER
FAX
SIZE
STORIES
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
G
� �3"
H (-IEiGHT
Permit No.: Zii
Received By:���/ _
�.-�- � �•, i
STATE,�ZIP_9�����
STATE ZIP,
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION MCLUDiNG DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. 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.
TYPE OF WINDOW TO $E 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)
TOTAI. JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ?i.s.zs
$
$ o
$
$
$
$
$
$
$
$ ,
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 Residentiai Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
fc+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( }
Make checks pavable to: Citv of Fridlev Attach
THIS [S AN APFLICATION 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 d s of the City of Fridie and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a e i and work is n start without a permit on site; that the work will be in accordance with the
approved plan in the case of all o ch r ires review and approval of plans. �� / �/
StGNATURE OF APPLICANT PRINT NAME� `" D�DATE (/�%/ I j �
APPROVAL INSPECTOR SIGN TiJ