P - 44969Building
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:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011 _
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INGLE AMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
O ADDITION ❑ GARAG
❑ BASEMENT FINISH �ROOF
O DECK � SIDING
❑ SWIMM
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
HOME CONSTRUCTION
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Permit No.:s��
Received By.
;
���R� ��� ;
LEAD CERT NU �
� CITY 1 STAT � ,
� 7 FAX
SIZE
STORIES
i/SHED � WINDOWS
� DRAIN TILE
❑ OTHER
NG POOL
❑ ADDITION
O REMODELING
W�I�TH HEIGHT SO FT
C] HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT RFMODELING SUBMIT�
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMiT:
❑ Aluminum ❑ Trim 1. Site Plan/Sucvey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes �No LOCATION OP WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALiJATION, INCLUDING THE COST OF LABOR AND MATERIALS•
(USIN� THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB wALUATION $ S� � OCCUPANCY YPE �
Permit Fee $ , 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 $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$25= $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ 0• S Make checks payable to: City of Fridl� Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge th the information above is complete and accurate; that the work will be in
conformance with the ordin and codes of City of F' ley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applic ion r a permit to start without a p rmit on si ; t t the work will be in accordance with the
approved plan in the case all w' q' s and ap roval of pla � f (/_ „�
SIGNATURE OF APPLICANT N � �` DATE ��� �((,L �
APPROVAL INSPECTOR SIGN +1