P - 39985Building
Inspections
763-572-3604
DATE , +C
SITE ADDRESS `
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL
❑ OWNER OCONTRACTOR
ADDRESS: � � CITY
PHON�� -- �,—' I ' �
NAME:
STATE LICENSE #^
ADDRESS:
PHONE
❑ SINGLE FAMILYJNE�
❑ TWO FAMILY/NEW C
❑ BASEMENT FINISH
O DECK
�❑
DESCRIBE WORK BEING L
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
NE W
Renewal By Andersen
1920 County Road "C" West
Roseville, MN S S l l 3
License #20130983
651-264-4777
❑ GARAGE/SHED
� EtOOF
❑ SIDING
❑ ADDITION
LENGTH
❑ HOUSE ONLY
O HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑ WINDOWS
❑ DRAIN T[LE
� OTHER
�
� �� �
Permit No.:
Received By:
Date Rec' d: ''
ATE_ZIP
ATE ZIP
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
SIDiNG FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim i. Site Plan/Survey showing the existing structure
❑ Other ❑ Fascia and proposed project.
WINDOWS 2. Two sets ofconstruction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCAT[ON OF WINDOWS 3. Energy Calculations
OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE iNSTALLED NUMBER OF W[NDOWS
ALL FEES ARE BASED ON VALUATION,INCLUDING THE COST OF LABOR AND MATERIALS:
(USI`� T� 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�7( I,-�C �"� � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Contro)
Park Fee
Sewer Main Charge
Total Due
$ 54`i .�S See Back Page for Fee Schedule
$ _ 65°to of Building Permit Fee
$ � � .001 times the total job valuation
$ %�, �� .0005 x Permit Valuation Minimum $.50
$ S, CJT� $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 uayable to: Citv of Fridlev Attach
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 i�
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 and ork is not to start without a permit; that the work will be in accordance with the approve�
plan in the case of all work whi�i requires revi�w,�nd approval of plans. _ ._-_� �
SIGNATURE OF APPLICANT