P - 84301Building `
Ins�ections
763-572�-3d{�4
7��-sa�-4977 FAX
Sxi'S ADDRFSS C�1 � �
THIS APPLICANT IS:
TENANT
SU�MIT A GOPY fJF
�'QY7it STATE I�ICENSE
AND CER'TIFiCATE 0�'
lNSC71tANCE
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From: unknown Page: 1/2 Date: 10l25/2012 2:40:44 PM
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'�T�4'G) FAMiLY/NL'W CONSTRUGTION
� BAS�M�T�'Y PTNTSH O ROtjF
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NUMBER OF SQUATL�S
GARAGES
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OR FOR NEW QPBNIN(#3•AESCRIBE 9bT•8 OF
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p�an Raview
Fire 5urchsrge
Surcharge
License Surcharge
SAC Charge
G'�rb Cut lEscrow
Erpsion Co�al
P�k Fee
Sewee Main Charge
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Received By:
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i. Existing Fioot Plan
2. Proposed $oor plati
3. List oi sttuctacal menabe�s to be used
FOR NEVJ CQN'S'�iWC�'x0� �I+iC[.UDINGD8CK5,
OSvffit Si�1�TGlSUFF[T/RASCIA ,0.DDPi'[ONS_ ffi Pt�1tt:FTES StJBMlT:
IJ Trim �1VItY1T�D? O YES p 1�t0 I, 3ite �attlSurvey stww�g tLe �aetin� struchuea
O F�acia end proposed p�rO,�eCt.
2. 'F'�vo sets of �rion ptans
,3. Energy Calculacions
L4CA;'x'�ON O� vv�NDbwS Ft7 WINDOW5 — PRQVIDE U•VAi+UE AND
AC'TIfItE 5T[CK,L''R GN W[N�NJW.
rruhss�z aF w�now's
�X,.XJA,�UI"�T, �TCLUD�I�TG THE COST OF LABOR IAND MA'T�RIALS:
�NG'X'HE 1997 [J.B.0 FEErSCHEl?ULE) I
_� �4" UU See Back Page €or Fee Schedule
$ ' 65% of'Building Fermit Fee
$ 5 .001. times the total job valuation
$ ��—� 0005 x Permi# Valuation Minim�
$ - b'",.�() V _ $5,00 (Statc Licensed Residential
$ $2365 �er SAC Unit (Plans tio M
� ift-�6�i= �ix�
$' $450 Conservation Plan Reviow
$ - - -- Fee l7etermrtied by �;ngineering
$ Agreemetit neeassary ( j Non N
� C D Make checks d�vsble to: Citv a
�. Tt�s �s arr a�r�xcAmr�rr �o� a��r-xor v��r.,�n r�rrrYr. �x
I hezeby apply �ar a bui�dA�g peanc�at ar�� � ac�owkedge that t}�e �n�oxxnation above �s co�
can�foz�aaance vr�th tlae az�clana�ces �nd cvdas. tk�e City o���idley a�d witl� tb�e lv�mnesvta Con
pe�nait but o�y axa applicatia� #'or a pe�nnait wox n,rat to start w�itlaout a pe�n�it or� s�te;
aa
approved plan iGa the case of�f,l,w oric�V�6chy�yu s ew and approval of pla1ps,.
SiGN'A'Y+UR� Ox APp�CAN'f ��Ll'�Ln.G.(� , _ pl�l�'1' NAt� /�l IC�f E'��% ,
.50
� for detexmin.a#�on)
�
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� a�ad accucate; tlaat the work w��l be �za
qton Codes; tiaat I wudezstan;d tk�i� is nvt a
t�e woir�c wi11 be iu� a�ecvzdauce w�t� the
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