P - 43633Building BUILDING Permit No.:`��J ��L'' t%'
In,3�ections RESIDENTIAL APPLICATION R� d�y:�
763-572-3604 CITY OF FRIDLEY D�����°d: ��: ,
763-502-4977 FAX EFFECTIVE 1-1-2010
DATE YOUR E-MAIL ADDRESS �-E It,�+n Q�Sa.i , Lz�m
SITE ADDRESS bO � S�v+~ �M� • 1� • E
THIS APPLICANT IS: ❑ OWNER `�iCONTRACTOR
PROPERTY OWNER/ NAME; �I�,Q e,� Q 'Sp►vi �S
TENANT ADDRESS:� S��' F�I? 1J_ �. CITY �� =� (a..� STATPNM�1 ZIP 55 `t 3l
PHONE:�Pl2-Z�l -�a2t)
CONTRACTOR NAME:_��,,. ,�:��r � �,�,��;��5
SUBMIT A COPY OF STATE LICENSE #_ "Z,d� �j o21 EXP DATE �� 31 � Z„� \ 1
YOUR STATE LICENSE S
AND CERTIFICATE OF ADDRESS: 3�- �I �l�. - C�v (ciE.�. rod S-�. � kl• CITY�,w�p� �.� _STATE�+^�-- 2IP Ss�R
INSURANCE pHONE �♦ - 2� '^o Io FAX
PROPERTY TYPE i�SINGLE FAMILY/NEW CONSTRUCTiON SIZE
❑ TWO FANIILY/NEW GONSTRUCTION STORIES
PERMIT TYPE ❑ ADDrt�otv ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FITIISH ❑ ROOF ❑ DRAIN TILE
❑ DECK O SIDING ❑ OTHER
0 SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR A9"REMODELING
DESCRIBE WORK BEfNG DONE: �rns+a.11 (JC..� ¢a� Ss ,,.�aw v- w��c.,.3 k r� �
�—
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES 0 HOUSE & GARAGE RASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE 2., Proposed fl or plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDITIONS_ & PORCHES SUBMIT:
0 Aluminum ❑ Trim 1. Site Planl3urvey showing the existing structures
and proposed project.
O Other ❑ Fascia 2, Two sets of consuuction plans
�'�'���'�'S 3. Energy Calculations
IN EXISTING OPENINGS 11�Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION S 3. � p,� IN�G THE 1997 U.B.0 FEE SCH�D �i P>A�vrv TVPF.
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
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)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks �avabie to: Citv of Fridlev 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 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 a1 work whic ires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ��fC.�j A+ �/l DATE
—�
�
t
C
�'�1\ c�v✓ �1G �j ,�
�1���- �:�^- �---�
.� �� �- -----�
�p�0�d13�v
REVIEWED
�_� 1� G��
/,�/��aUJ ���
�-�'j--'' ��-'�� -
�
�
.��i�
����-'�.���`� "��/`'�-c�'
/
� �
! ��� 1 �,G�G'/�'� b�C� � �
;�.%�'��'S
MENARDS "
GUEST: ,
MENARDS QUOTE
2355 SECOND AVENUE SE.
CAMBRIDGE, MN 55008
Phone: (763)691-1271
Fax: (763) 691-1345
Store Number: 3154
Store Code: CAMB
TEAM MEMBER:
f
DATE: 06/02/2�10
0
�►�
1��
Cresttine
NSndowsi0a«s
�� � g�� IOCATION / TAG PRODUCT DESCRIPTION v UNIT PRICE TOTAL PRICE �
# 0001 — - --�_—�_,._._---_...___ ---___...___..------_...._ _____...------�...
�, _y_.—. _--.._ ____._.__
Qty. =1
Job Number =
CTSize=3'0"Wx3'6"H
ROSize=3'0"Wx3'6"H
Frame Size = 2' 11 1/2" W x 3' S1/2" H
TAX REBATE: This product does NOT meet requirements
for residential federai tax credit in replacement
application.
lRRlNifyM�ItkMRRkkIrttlMif�Off�flt�llrFk�!lHWt4M1rRf�lNftRtlV'N
30 x 36 Select 300 Casement
Standard
Tax Rebate: Non-Qualiying Products
Configuration: 1 Wide 1 High
Exterior Finish: Vinyl
Hinging Group: Right viewed from exterior)
Egress: E ress S'
Exterior Co or: White
Interior Finish: White
Giazing: EasyCare (Low-E2)
Tempered Giass: No
Air Space Option: Inert Gas
Grille Style: No Grille(s)
Hardware Type: Standard
Hardware Operation: Standard
Handle Type: Folding
Lock Type: Mutti-Point
Hardware Finish: White
Scraen: Fiberglass
Screen Color: White
Screens Shipped Loose: No
Fxtension Jamb: 3 1/4" Frame Extrusion
Exterior Trim: No Exterior Trim
Drywail Retum: No Drywa�l Retum Needed
Nailfin: Yes i
�,
F
Base Price EasyCare (Low-Ez)
Inert Gas Add-on
$ 261.49
$ 4.74
$ ----M-266.23 $ 266.23
TOTAL $
265.23
Q�g * pppp5q Page 1 Of t SmartQuote Version 3.OM