P - 35787I lding
It� pections
763-572-3604
763-502-4977 FAX
DATE 1 I � � � i
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-201 I
E-MAIL ADDF2ESS
❑ OWNBR
NAME:
ADDRESS: CITY
CONTRACTOR NAME:�
SUBMIT A COPY OF STATE LICENSE #
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: �35c
INSURANCE pHONE � rJ Ia �
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF [MPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HE[GHT:
I�Vinyl
❑ Aluminum
❑ Other
❑ SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
� ADDITION ❑ GARAGE/SHED
❑ BASEMENT F[NISH �
❑ DECK �,SIDiNG
� SWIMMING POOL
❑ NEW HOME CONSTRUCTION q ADDITION
❑ MAINTENANCE/REPAIR �REMODEL:
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�offit
nm
ascia
WINDOWS
IN EXISTING OPENINGS es �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS- CRIBE SIZE OF
OPENING CHANGES &
TYPE_OF WINDOW TO BE INSTALLED NUMBER OF G
Permit No.: � l � -� f � � �
Received By: c
Date Rec'd: � �-� � �
EAD CERT NLJMBER 1� � .1.'"
CiTY MAPL� C?
F�vc ''7Co3 �W 5 �)
S[ZE
STORIES
�w�DOws
❑ DRAIN TILE
❑ OTHER
G
�t ('�
'H HEIGHT
ATE ZIP
� 1.7 — IU — I(�1�0 /
STATE �"� �IP � 3 I I
FT
BASEMENT REMODELING SUBM[T:
L Existing Floor Plan
2. Proposed floor plan
3. List of structurai members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
l. 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.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
r�'M �USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ I'"{�X.7 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���
i ��
i�
i
See Back Page for Fee Schedule
65% of Building Permit Fee
.00I times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa_yable 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 in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application f permit work is t start without a permit on site; that the work will be 'n ac ordance with the
approved plan in the case of all ' ich s e'e an approval of p an . �J
SIGNATURE OF APPLICANT PR T E��S �LIC� I�.� �-� DATE ' 6 � I
APPROVAL INSPECTOR SIGNATURE
� ��