P - 39994From: 6126781987 Page: 2/2 Date: 9/15/2011 2:31:43 PM
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Building 1�LT,�I�DING Perm;t �ro.:y,
Inspections �E,SILlE1Vl'TrA� APPLICATI41� �eceived sy.
7�3-572-3604 CITY t��' ���I,EY � c��.
7����0���� !� 1� 4cCrFmttirv � i �ni i
DATL•"
SITE AU1712G5 �
TH1S AYPLICANT IB:
TENANT
SUBMTT A CQPY b!�
YOUR STAT6 L,TC�NSE
ANA CERTiFICAT� Or
INSURANC�
P'ROPERTY TY1':L
TYP'E OF
nFSGRISE WOlttC 13LINCr
ROOFING
NUMSLR Of SQUARFS
C:AIiAG"
PEt+O!'451iD SI�E:�
PROPtlSL'•D I3EIGTiT: _
srn�rrc
�yl
�I Aluminum
� Uther
� 1 l Y4L1R E-�VIA1L A17i7ltLSS
"�'� %� 1!P 1/? ,r� L.. r� � � �.AL/ _%�lL
qCON7'tzacTOR
�l
�
NAME:
STATE LICENS� Il _ 1.EAD CIf;RT 1�1L1MBftR
APDRESS: CTTY STATE 2lY
PFIQIVE rnx
�SLNGLE FAMTI.YR3PW CONST1tuC'TIu'N 4
0't'WQ FAMI�Y/lYEW CONS'CRUC"I'lON 3
❑ IIASLML•NT L'IN13(�L CX 1tOaF
o nLC� IId�SIDING
Ll NEW HOM� CONSTRUCI"ION ❑ AADiT[AN
�Mlt1TITENAN�B/RLPAtR ❑ RRMOA�LI
Q li4l1S� OM.Y
C] i-inU3E 3c GARAGL'
G ATTAGHED GAKAGL
❑ DL�TALk[til7 CACtAG�
II�. o11'it
CI Trim
�aSC1II
WI1Vi)OWS
lN GXt3'1"iNG OPENIN�4 I7Ycs OIWo LOCATION OF WINDbWS
[7K t�OTt NEW OPF,NIN�;S-DLSCRIDC SIZE OF
4PL'•N1Nfii'CIiANCFg &
ALL
�
Permit �ae
P1an Revi�w
Fire 5urchar�e
Surciaarge`
Licens� SurchArge
SAG Ch�e
Curb Cut Escro�v
Eresion GonA•ol
Park Fee
Sewer Main Charge
C] DRAiN T[i-E
Q OTHER
BA9fiM�NT�{�+r�n(�F.j.)N� S11'RMiT:
1. � Cxiatin� f loor I+l�in
2. � Pmpvacd 11UOr pl�in
3, ' Lis� of str��etWral n�embara m 6a uecd
i,:. ,
�Olt NLW CONSTRUCTfON INCI.tIDING DE.CItS,
AL�bf"I'T[SNS: Re Pt7nC`tTF..�' SiJf3MIT�
1. Site �'Iun/Survey showing the oxi:rting structures
und propoacd pr�jCCt.
2, Two snts of construcxion plans
3, lncrgy G�1kui�tloAs
FOR WINUOW5 T PROVtJ)� U-VALUL- AND
MANU�ACTURF CTTCTf�jt ON WfNDOW.
r#RE �ASED� Ol'V Ye1�LUA`�'iUN, iNCLUDING TH� COS7' OF LABOR AN;D MA
�_ [USYI�I+C THE 1997 U.B.0 I'��' SC��pULE)
'$ "fi �__� � See 13ack Page for Fee Scheclule
$ 6S�lo ofBuilding Permit Fee
$ ' � .U01 times the total }ob valu3tion
$ F� � .UOOS x Permit V�lu�tian Minimum $5_00
� $5,OU (Staze L,icensed Resadenn�f Cantractors}
$ �2230 pe�• SA� Unit (Pl�ns w M'WCC for determinatian)
$ ft + b fC -__�___ ft x$25= $
$ $45Q Conservation Plan Review
$ �ee Aeterrnined by �n�ineerins
$ Agrc�m�nt n�eessa►y ( ) Non Necc�ssary { )
� �` ' ") Make checks oava�ble tos Ciiv of'�nidlev Attac
TIiiS IS AN APPL3CA770N rOR A PERMIT-NOT vALID UNTIL PROC.GSSk�A
T hereby apply for a building permit and t acknowledge tl�at the informatioi� abovc i� oomplete and accurate; that the work will be in
confflrmattce with the ordinanCes snd codes of the City of Fridley and with tlte MinnesoCa Conamtctian Cades; that I unc3�rstand this is nat a
permit but anly an applicatio a a pe ' snd arlc is nat to start without a permit on si#e; tl�at tlac work will be in accordance with the
approved plan in th� case af rk r review and apprav�l of pla �I
SIGNA'IUttE OF A�PLICANT PRTh1T'�iAM'� �,��" ��'�J.,.--� DAl'E ! �_
ennnnV�i if�te�+ceYt�nn C�r`u . . .
• A'i.F,AS1�1�Td'[?R. •fiF.A�A•IZA•'I''1xPER11�TS'ARF.R'�I�iIT�tEi)F�OR'AL:iT�+1B1N.G..ELEG''FRIGAT,�;Al�T�}:M.iCHAl�iIi.i4L`W�OR��."'�.;c.�.