P - 42363From: 763 862 7412 Page: 1/2 Date: 8/1 3/201 0 1 2:44:10 PM
Building BUILDING Permit No.:�'�� -• �'�
Inspections IZESI�.,iENTIAL APPLICATIUN Received By:
763-572-�604 �jZ'� (�F F���,�+ � Date Rec'd:
763-502-4977 FAX EFFECTfVC7-1•2010
DATC �-12 - 2 fl 10 YpL1RE-MA]L ADpRESS toddwestphalCmsn . COIlI
SITEADDRESS ��-�1 6th St ��'; 55432
THISAPPLiC.A[VTIS: OOWNER CII�ONTRACTOR
PRCIPERTY OWIYER! �;,a�,E. Dave rnTa gren
TE�TAIYT ADDR�SS: C 1 G G 1 6�. t�l S t ClTY_ _ �i 1 dl G'.jr STATE�� ZIP �'rJ li 3 2
pHaxe: '��3-571-3Q53
co�r[t,a►croR N.�MC_ Todd We s t�ha 1 Roof incr
SUBMI'T A GOPY OP STATE LICBIVSE # 2 Q 2 4 4 7 5 9 �� ^
YOiJR STATE L[CE1�SE s�cr a,azE 2 012
AND CERTIF[CATE OF ADDRE,SS= �- �� O 1- �. 8 tn Lane C�y $ 1 ne STATE �7.1P 5 5 4 3 4
INSI: R.4NC� pHONE FAX & 3� -
FROPERTY TYPE O�INGLE FAMILYRJEW CONSTRUC'770N g�zE
L7 TWO FAMlLYM�W CONSTTtUCTION 5TbRIES
PERMIT TYPE L7 ADDITION C1 GARAG£lSHED ❑ WINOOWS
❑ BASEMEAT F[N{5H C�RQOF ❑ DRr1[N TILE
❑ DECK ❑ SIDING ❑ OT}iER
O SWIMM[VG POOL
rv�E o� wowc: ❑ r,EV�' HOME CONSTRUCTIO�t Q ADDIT(ON
�Ili[VTENANCE/REPAlR 0 REMODELIIVG
DBSCKIBE WORK BEING DONE: Tear o New R.00
SIZEaF1MPROVEMEVT LENGTFI WIDTH HEIGHT S FT
ROOPINC, � ., ❑ HOUSE QNE.Y
NUMBER OE SQUARL$ 1�Q-ipUSE & GARAGE �ASEMENT REMODFt ING SlJBMIT•
1. �xisting Ploor Plan
GARdCES ❑ ATTACHCD GARAGE 2. Proposed 11oor plan
PROPOSCD SIZE: O DSTACHED GARAGE 3. List of struciural membcrs to be used
PROPOSCD 1iEIGH'E';
1D1NG POR NEW C�NSTRUCTION INCLUDING DECK3,
� V1dY� ❑Spffit tLDD[T70NS & AOItChtES SUBMIT-
❑ Aluminpm ❑�r� 1. Site PIanlSurvey showing the existing smtetures
❑ Other ❑ Fascia and proposed project
2. Tw•o sets ofconstruction plans
W'1ND0'WS 3. Energy Calculations
IN EXISTING OPENINGS OYcs ❑No LOCATION OF 4VIND�WS POR WIND�WS - PROV]DE U-VALUEAND
�R FOR NEW OPBNIrEGS-DESCRIBE SIZE OF MANUFACTURE STICKER Oid WIND01V.
�PENING CHANGES &
TYPE OF WINDOVV TO SE INSTALLED NUMBER OF WINDOWS
AGL F�ES ARE BASED �N VALUA7'IO1V, T1�TCLUDTNG THE COST OF LASOR AND MATER[ALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL 30B VALCJAT10l�T � $ 2 9� g• 0 d OCCUPANCY TYPF.
Permit Fee
Plan Review
Fire Surcharge
Surcha�ge
License Surcharge
SAC Charge
Curi� Cut Escro��
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ S��
$
$
$
$
� �. �
See Back Pa.ge for Fee Schedule 5 O 2— 4 9 7 7 FaX
65% of 8uilding Permit Fee
.0� 1 times the total job valuation
.0005 x Parmit Valuation Minimum $5.00
$S.OQ (State Licensed Residential Contractors)
$2140 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24—S
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary { )
Viake checks payable to: City of F'ridles Attach Stinul9t
THIS IS AN APPI,ICA7'ION FOR A PERM[T-NOT VAL[D UNTIL PROCESSED
I hereby apply for a buildi.ng petmit and I acknowledge that the information above is complete a.nd accurate; ihat the work will be in
conformance ��ith the ordinances and cades of the City of Fcidley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a perrnit and work is not to start without a perrrsit on site; that the work will be in accordance with the
approved plan in the case of all Krork which requires revievv and approval of plap�Odd WE, S� �'1S a.,
SIGNATURE QF APPLTCANT p��'�' N,q� '1� dpFE g-12 -1 p
APPDAVee �wicoar�m�n ��r_�e.�r.�nn __ ..
PLEASE':VOTE: S6PARATE PERM[TS ARE REOUIRED FOR PLUMBING, ELECTRICAL A�ID MECHANICAL WORK