P - 40833Buzlding
Inspections
763-572-360�
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From: 763 783 1385 Page: 1/2 Date: 9/26/2011 7:20:28 AM
BUILDING
R��IDE�TTIAL APP�ICATION
CITY UF FRIDLE�
Permit No. � � ( �
Received By:�
nat :,���
DatE 9�Z�'2� Yo�mE-n��Lannx�ss �oddwestphalQmsn.com
S[TE ADDRES3 15 9 0- 94 7 3 i/ 2 Ave
THIS AI'PiiCAVTlS: ❑ O�YNER [7�ONTRA£'['OR
PRUPERTYOWIYERJ NAn�E: Gc1� MUS e
TENAI�IT ADDEtE55: SdiYle
r�oNE: �].2-78J.-1340
Fridle
� 55432
���v r ec.ac: rux xAMS: Todd Westpha3. Roo f inc�
SUBMIT A Cpp7' OF STATE LICENSE �I 2 0 2 4 4 7 5 9 �-
YOUR 3TATE LICENS� EXP DATC 2 O 12
AND CERTIPICATE OF ADDRESS' �- � 6� 7.18 t Lane CITY B i ne STATE �Z1P 5 5 4 34
INSI➢RARiCE PHON$ _ F4x 7 �`���5
TYPE
LH FAMII.YMEW CONSTRUCTION
fAMILY�NEW CON5TRUCTfO}V
❑ &0.S6MENT F1NIS1-[
0 DECK
TYP� OF WORK: ❑'NEUV HOI�E
O SIDING
❑ StiV1MM
❑ ADDITION
❑ REMOD�L]
0 flRAII� TILE
❑ OT13ER
llESCRIBE WORK SEING DO1�E: 1�c�Z' OL L iVEW KOO i _
SIiEOFIMPROV&ML•TtT [.�VC�TH Wfl7"CH E•IEIGHT FT
ROOFbYG Ci HOUSE QiVLY
N[JMBER OF SQUARES 2� D�ii7USE& GAAAGE B+�Ey�T �1NOD [N . c��i�;
I. Existing Eloc�r Platt
GARA�E$ 0 A'i`CACHED GAILAGE 2. Propased floor plen
�'����� S�E� ❑ DETAC}lE-D GARr1GE 3. List of smrcwral cnembers to be used
PRflP()SED HF]GHT:
SiD1iYC
❑ Vin,vl
❑ Alum'vwm
0 Othcr_
DSoffit
O Trim
O Fascia
WINDOWS
INEXiST�tGOPENINGS DYes QNo LOCATIOYOFV��NflOWS
ORFOlZ NEW �PEN[.�fGS-pESCIiIBE SiZE OP
OPENING CHANCiES &
TYFE OF W[NDOW TO 8E iNSTALLfiD MIMBER aF WLNDpWS
ALL FEES ARE Bt1SED ON �'ALUATION, I�iCLUDING THE COST OF
(USING THE 2997 U.B.0 FE� SCIiEDULE}
TOTAL JOB VALUATION S 3 9 9 9. Q 0 nrrria.
Plarr Review
Fire Surchar�e
Surdiarge
License Surchatge
SAC C�Sarge
Curb L�ut Escrow-
Erosinn Gontirol
Pazk Fee
Sewer Main Chazge
Tota! Dae
FOR NEW CONSTRI;GT[ON INCLUD[NG DEGKS,
ADDITCONS &PQRCFiES ct�g��z�
1. Site P1anlSurvey showing die existit� strucwres
az►d Propo�;d projaet.
2. Two sets ofconstrudion plans
3. Encrgy Calcaladoas
FOR W}M70W3— PROVIDE U-VALUEttND
IvfAN�1FAGTUR6 STlCKER pN WINDOW.
See Back Page for Fee Schedule
65°fo of Building Pertnit Fee � Q 2- g 9�� F a�
.001 times the total job valuation
.00US x Perm9t Valuation 1+vlinimum $5.00
$S.UU (State Licensed Residential �ontractors)
$2I�0 per SAC Ur�it (f'ians W 1�4WCC for determinatian)
ft+6ft= ftx$24=$
$450 Conservation Plan Revievv
Fee Determined by Engineer
Agreement neces Nan Necessaryr ( )
Make checks able to: Citv oiFridlev Attaeh .r,tinM��t
THIS IS AN APPLIGAT[ON FO�[T-NOT VALID UNTlL PR4CE5SED
I E�ereby apply for a building permit and I knowledge e uifonmation aboE�e is complete and accurate; tl�at the work will be in
conformance with the ordinances and co es the Gity 'dley and with the IVlinnesota Construction Codes; that I uederstar�d this 9s not a
permit but only an application for a it d is n 'thout a permit on site; that the wark wi11 be in ac�;ordance with the
approved pian in the casc of all w� eh ' an proval oPplap�odd WE: S t hal
SIGNATURE OF APPLiCAN7' PRW'C T[AME P DAT�_ $— x 2— 1- d
APPROVAL 1NSPECT�R SifNa ,
ELECTRFCAL