P - 48569Building
I�spections
763-572-3604
763-SQ2-4977 FAX
5iT6 ADDRF.S3 �
THIS APPLICANf IS:
PROPERTY OWNER/
T�:IVANT
coN�cTOR
SUi3MIT A CUPY UF
Y(3UR STAT� LiCLTiSL
Arrn cNRTr�icaT� or
INSURANCE
PROPERTY TYFE
l'�:RMI:T TYPE
TYP.E OF WORK:
:BUILDING
RESIDENTIAL APPLICATIQN
CITY OF FRIDLEY
YULIlt F..-MAI:1:, AI).T�.kESS L� � �
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ADDRI:SS: � ( �7 ►,{ S �' . �,.,- v Y� � �x° CtTY
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STAT(: LIG'f:NSF,
�,t2--od�
Permit No.:
Received By:i^
Date Rec' d;� � �
� �mail,c'��
ATL"�1I� .ZIP__� . 'r.:+',. �' Z.�I
AD GERT 1VUR78�R 1V �� -- +51 �`'I_�..�,__._ ......... .. ...............
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�SINGLE FAMTI.,Y�NEW CONSTRUL'TIOIV S3ZE
O TWO FAMILYlNEW CONSTRUL"TIflN SFqRlES
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DF.SCRI.BF Wp.R.lC. BFINCi DONF..;
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NUIvfHL^'IZ OF SQU11RIi5 ... __-
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PItOPOSED S1T_E:
PRUPOSF.A HF.IC}FIT:
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CI tiOUSE ONLY
❑ 11QUSE & GARAGB
❑ A7"FACI-ILD GARACiE
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WINDOWS
1N EXISTIIJG OP1iNINGS ,�Yav ,�'pb IACA1'ION OF WINDOWS
ORFOR NF..W OPENfiVC3S-DESCR[BE SIZ,h p:F
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OPI:NING CIiANGBS c@
7'YPE UF W1:N1�W 7'O BF INST'ALLED NUM'E3E:R OF V
rr
i��.,4�M�Ns.�&MQ�?�:4dNG SUI3MIT:
1. I�:xisting rloor Plan
2. Propc�sed flcxx plzn
3. List aF structtval members co be usai
FO.R NF.W CUIVSTRUC7TOM [NCLU1�Rda DIiCKS,
ADDI'�IOI�iS. �. P(?RC.�.�,,�T;,
1. Siie Plun/Survey sh�rwin� the existing �lsuctvras
and praposed prvjcct,
2. 'Cwo sets of ccrostn�ction plaus
3. Bnergy Galculutions
i�OR �VINDQWS — PROVID� U-VALiJL AND
MA2vUFACTtJRk S7`fCKTR AN W[NDOW.
ALL FEES ARE BASED ON VALiJAT101V, iNCLUDING'i'NE COS'T OF LABOR A:VD MATEIitALS:
(D�IN(i T'IiE:199'7 I1.B.0 F1�:E SCIiFDULU+')
'07'AI, JOB VALUA'1'ION $�� b� � G�C� OCCGiP'ANCY TYE'E
Permit Fee $ See Baek Page for Fee Scheduie
Plan iteview $ " ' b5% of I3uilding Permit 1�'ee
Fire Surchtuge $ �;���.001 rimes the total job va.tuation
Sutcharge $ . .(H}OS x Permit Valuation ivlinimum $S.QU
License Sureharge $ $5.00 (State Li.censed Residcntial Contraetors)
SAC Chazge $ $2230 per SAC [.Jnit (Plans to MWCC; for determination)
C,brb Cut Escrow $ ft+ 6 ft = ft x$24 =$
f.?msion Control $ ��$454 Conservation Plun R.eview ^
Parls Fee $ Fee De#errnineci by :�ngineoring
Sewer Main Charge $ Agreement necessary (} Non Necessary O
Tatal Due $ � Make checks pavablc to: Citv af Fridiov Attach
TIi1S IS AN APPLlCATiOAI FOR A PEIiMfC-NOT VALID UNTII. PRUCESSED
I hereby apply for a building permit and I acknowledge tt�at the information above is complete and accurate; th�t the work will be in
coRa.fonnance with t�e orciinances and codcs af thc Ciiy of �'ridley and with the Mmnesota ConstrucNan Codes; that i understan.d this is not a
permit but only an applicatian fvr a Pem�it and work iS nat tn stxrt withuut a pernut on site; that the work will be in accordancc with the
appro�ved ptan in the case of E � T�.� vi and approval of p�lans. , �
SlCc1VA'1'[JR}: UF A.PPLiCANT . ... . / !--.�C��!�PRTtJT NAM$.....i.:.�\Y.� ��I— ��0� ��� .. DATI; ���!- 1- Z"T-- ...._.._
AFPROVAL I'NSP�;C"I'QR S[GNA T.
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