Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 04/17/2018
Permit No.:______________
Received By:____________
Date Rec’d:_____________
DATE_____________________________________________ YOUR E-MAIL ADDRESS __________________________________________________________________
SITE ADDRESS ________________________________________________________________________________________________________________________________
THIS APPLICANT IS: OWNER CONTRACTOR
NAME:______________________________________________________ PHONE:_____________________________________________
ADDRESS:___________________________________________CITY____________________________STATE______ZIP_____________+
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
NAME:___________________________________________________________________________________________________________
STATE LICENSE #_______________________________________________ EXP DATE ________________________________________
ADDRESS:_______________________________________________________CITY____________________STATE_____ZIP__________
PHONE ________________________________________________ FAX _____________________________________________________
SINGLE FAMILY/NEW CONSTRUCTION SIZE______________
TWO FAMILY/NEW CONSTRUCTION STORIES__________
ADDITION GARAGE/SHED WINDOWS
BASEMENT FINISH ROOF DRAIN TILE
DECK SIDING OTHER
SWIMMING POOL
NEW HOME CONSTRUCTION ADDITION
MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE:____________________________________________________________________________________
SIZE OF IMPROVEMENT______________________________LENGTH ________________ WIDTH______________ HEIGHT _______________ SQ FT _____________
ROOFING HOUSE ONLY
NUMBER OF SQUARES __________ HOUSE & GARAGE
GARAGES ATTACHED GARAGE
PROPOSED SIZE:__________ DETACHED GARAGE
PROPOSED HEIGHT: __________
SIDING
Vinyl Soffit
Aluminum Trim
Other ____________ Fascia
WINDOWS
IN EXISTING OPENINGS Yes No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF __________________________________________
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED__________________ NUMBER OF WINDOWS__________
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS, & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
4. Letter of Structural Engineering for imposed loads
on existing foundations.
FOR WINDOWS – PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.C FEE SCHEDULE)
TOTAL JOB VALUATION $_____________________________________ OCCUPANCY__________ TYPE___________
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2485 per SAC Unit (Plans to MWCC for determination)
______ft + 6 ft = ________ ft x $36 = $_______
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach Stipulations
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 for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT ______________________________________PRINT NAME________________________________DATE____________________________
APPROVAL INSPECTOR SIGNATURE_______________________________________ DATE_______________________________________________________________
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK