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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