P - 42160Builc�ing
Inspections
763-572-3bp4
763-�02-4977 FAX
From: 18006805796 Page: 2/2 Date: 3/30/2011 326:53 PM
BUIIIDING
RESID►ENTIAL AFPLICATIO�
CITY OF F��ID►LEY
Perrnit No.:
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SITE AnURESS .'�'���if7 � �� 7'�' ��{ �.���': f�� t z u�.� Vk4lli J'� �' �I � �-. _ _...._, __....- --.
TH1S APPl.iCt1NT 1S: C7 OWN.ER; -IC�CON7'RACTOR
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SUBMIT A COPY QF
YOU[i STA'T� LTCLt�TSE
AND CEIZT'1FI.CATE Ok
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t'ROPERTY TYPE
i'ERN�1T TYPE
TYPE OF WOIiK:
DE,SCR1IiE WOR:K IiEiAIG
ADDRESS:�'�"t��i(� r��`� N� CITY,
PFIONF,; �D f:�' �r�C[� ° ��+'��-:_._.,.,_,,,,,�„
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STA'I'E LICEATSE tl_ :. �.
aDn�ss: I I a�l (�„rv.e�c:�,f;��
ryrior� �t.� - �33� 5 � � �i � �s
1FISTNGi.�i FAMILYlNLW C'UNST'RL7C1'tON
L] 'I'WQ FAMII.Y/�TE�7V CONSTRUCT[OId
C] BAS�Mb'NT Fil�lISH O ROOF
L7 DECK C1 SiDTNG
0 SWRvII�i
❑ NEW HQMB CONSTRUCTT(?N
❑ MAINTENA}VCFJli�PAIR
�L�AD CERT
Si7,E ......
O ADDTI'TQN
9R,12EMQDBLING
,v'i Inl�n t.ss � I
� F � I-TOUSF. ONLY
NUMB.r:R OF SQl1A.RES ❑ HUUSE dt GARAGE
�a� Q ATTACHED GAitAG.E
P120.POSED SfZF.: CI DETAC�..�Ai2AGE . . . .
PROPaSED HEItiHT ---.._......, .-,-
31AING
❑ Vinyi
L7 Atwninnm
Cl.Octter
}�NDOWS
iN E)C!$TING OPENTNGS fi8'1'� l7No
OR FOR NEW OPEI3TNGS-DE$GRI1�G. SIZE QF..
QP�:NING CHAN(3E5 &
TYl'E OF WINDOW TO BE INSTALLED y�!ti.
AL,i FEES ARE BA.SED C/N V:
TOTAI:. JOB VALI7AT[ON
Penmit Fee
Pian lt�view
Fire 5urchatge
Surcharge
1.icense Surcharge
SAC Charge
Curb Cut Escrow
Erosian Control
Park Pee
Sewer Main Charge
Totat Due
L7soffrt
� Txim
Q Fa:S�ia
L(7CAT10N QF WINDOWS
4TA'i'E Yh►.i 7IP S �i �i.3'�-
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r��.S u� I I� S'CATE�7,IP �� � 3�
.- /.� S� ri .. �' "7 �'� f�
❑ DRACN Tfi..�
O OT[�}:R
a 4� ou•� C"�a�
nc� �:�z�
BASF��_RLM.ODEI.IN�,�,�t;UAIvItT�
l . L•'xisting Floor Plen
2. Proposaf Aoor pi�►
3. Lest of structurai members to be used
NOR NEW CONSTRIIC'f101d iNCI,UDiIVG DECKS,
A�n , rr��r�s �rc>xcr-�sus�rr
1. Sitc PlanlSwvey siwwing the oxistin$ sdrucaur�s.
azui propasad project
� . 2. TwasetsofconslructionpIans
3. F.nergy Calculations
FOR WINllUWS - P1tOVIDti U-VAGL7E AND
MAN[7FAG"i'C7IiC Sl1(:TC�R.C)N WINDQkV,
ClON, INCLUDING THE COST OF l.,ABOI2 AND MATERIALS:
THE 1997 U_B.0 �+EE SCH.EDtJI:E)
$�=SL�,.e�'"" _ See Back Page for Pee Schedule
$ 6S% of Building Permit Fee
$ �^ p�T A01 times the total job vatuation
$ �. _0005 x Permit Valuation Minimum $5.00
$ $5.00 (State Licensed Residenlaal Contractors)
$ $2234 per SAC Unit (Plans to MWCC for determination)
$ f�+6fl= ftx.$24=$_
$ $454 Conservatian I'1an Review
$ Pee Determined by Engine,ering
$ � A�reesnent necessary ( ) Non IVe�essary ( )
����►'�t� Make checks oavable to: Citv of Fridley Attai
TtllS IS AN APP%1CA'IYON FOR A PERMIT-NOT VALID UNTtI. PRQCESSED
I heceby apply for a building permit and I. acknawledge that the inf.onmaticm abave is complete and accurate; tlast the wwic wi11 bc in
confexmance with th� oniinanr.es and c;cwdes of the City af Fricttey and wiih the Minnesota Construction Codes; that 1 unc%rstand this is not a
permit but only an applic�an for a�St and wark is not to start wiche�ut a nermit on site; that the work will bc in accardance with thc
approved plan in the c�se of a[ �'k� ci����� urxes review and appraval of plans, ti
SIGNA'F[11tE OF APPLICANT �Y'7�:,t\ 1�6��:,,,��, „� P12IS1T iVA14tE x,,� l_„y�.�_pATE_ 4' -� i� "'II ,