P - 44224�3uilding
Inspections
763-572-3604
DATE 0 �U`�IO
SITE ADDRESS C
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.:
Received By: � �
Dat���'dvC � �,... 2 �. ���
YOUR E-MAIL ADDRESS t�5c�,,;�dd@ a e nol �r o c� C.C�YY1
.i . Ca 1f� �O`SS
CIOWNER 7�ONTRACTOR
ADDRESS: '� CITY STATE ZIP,
PHONE: �� J" O� ^ I � �
NAME:
STATE LICENSE #_
ADDRESS:
ra.�
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777 __
ATE ZIP
PERMIT TYPE ❑ ADDITiON ❑ GA1tAGE/SHED ❑ WINDOWS
O BASEMENT FINISH 0 ROOF ❑ DRAIN TILE
D DECK ❑ SIDING ❑ OTHER
TYPE OF WORK: I� NEW ❑ a�
O MAINTENANCE/REPAIR ❑ RE
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GAItAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O V inyl
O Aluminum
O Other
LENGTH
❑ HOUSE 8c GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WIlVDOWS
IN EXISTING OPEIVINGS OYes ONo LOCATION OF WINDOWS
OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
��
HEIGHT
BASEMENT RFMODELING SUBM[T:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUD[NG DECKS,
ADDITIONS_ & PORCHES SUBMiT:
1. Site Plan/Survey showing the existing structurc
and proposed project.
2. Two sets ofconstraction plans
3. Energy Caiculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR A1�TD MATERIALS:
(USING TIj,� 1�97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ I$ 1. �5 See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �-�' .001 times the total job valuation
$ i� (�r� .0005 x Permit Valuation Minimum $.50
$ 5UC3 $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ _ Agreement necessary ( ) Non Necessary ( )
$ 1 � Make checks aavable to: Citv of Fridiev Attac
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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application f r a permit d work is not to start without a permit; that the work will be in accordance with the app�ve
plan in the case of all work wh h r ueA ires r' w and a t�royal of plans. ��u`�' �
SIGNATURE OF APPLICANT ��i��'�� �v PRiNT NAME�Qf�,�� V�S� If�`� DATE