P - 42830�uilding
[nspections
763-572-3604
7C3-502-4977 FAX
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�1TE ADDRESS G � �
( H1S AI'PLICAN'i' 1S:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OI�
1'OUR S'I�ATG LICENSL
�ND CEPTIPICATG OF
INSURANCE
PROPERTY TYPE
PERMIT TYP�
TYPE OF WORK
BUILDING P�ri��it No��� �� ��'
RESIDENTIAL APPLICATION IZ���»��j 13y:�j�_____
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CITY OF FRIDLEY
Lr-r-��crivF i-�-zoi�
llate Rcc'd: � r
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RE-MAII,ADDRESS_ �� C(/'s a� �c�r�' 1 on�rs. �0 �" �_
. /(/',�
❑ OWNLR �CONTRACTOR
NAML: �J U /� �7 �- �! r -�
�n»R�ss: / ��S T 3 �'� t�Yt /U� ciTti� F�l1'�/�
ri-ioNC: G S r� G. 3 3•�� �1_� /
N�MC Petla Windows & Doors L n c(-
s rATr i 15300 25th Ave N. Ste 100 GAD CGRT NIIM[3GR
��n��, Plymouth, N1N 55447 c���v_
r�E-��Nr Lic # 20165884 Ph. 763/745-1400 �,� _
'9 SMGLG PAMILY/NGW CONSTRUC"T'ION SIZG _
❑ TWO FAMILI'/NEW CONSTRUCTION STORILS
❑ ADUI"i'ION ❑ GARAGG/Sl-IGD � WINDOWS
O BASLMCNT iINISl1 O ROO� � DRAIN "fILL
❑ DrCK ❑ SIUING ❑ OT11CR
❑ SWIMMING POGL
❑ NEW HOM� CONS'1RUCTION ❑ ADDITION
'qMAINTI�NANCG/REPAIR O RGMODCLING
DESCRIBE WORK BGiNG DONE: ��vl
ct7F nF fMPRf1VFM�N"r
ROOFING
NUMI3L,R CN� SQUARFS _- __
GARAGGS
PROPOSGD SI71:: _
PRpPOSf:D I�L;I(il I"f: .__._._-- -----
SIDING
❑ Vinyl
❑ Aluminum
� Other `__
V1'INDON'S
IN GXISTING OPEN�NGS �'es ❑No
OR FOR NEW OPENINGS-DESCR113E Sl'LE 01=
OPENING CI lANG6S &
T'vPF nF VdlNl�nW "I'O BE INSTALI.GD
❑ i�ousr: oN�.v
❑ i ious� �c� ���nttn�;i:
❑ A'1"I�ACFIED CiARAGG
❑ DE'fACI II:I) GAR/�(iF
❑Softit
❑ Trim
❑ f-asc�T
sTnT�r� %Izi�SSy3 �
S�/3��5' •G �'!�
STAT� 'Lll'
!�'�,�_�'Fl� k'/ s -�'�� ! �J �!I Q �
WIDTH I-IEIGHT SQ I�T
LOCATION OF WINDOWS
L�_ �, n� I'O��+r� i 6c�,ii/`o �M
NUM[3ER OF WINDOWS
13nSI:Mf;N"f RI;MOI�f'I.ING SU13M_fl'_;
I. I:xisting floor Pl��n
2. I'ro�iosed (loor plan
3. List of s�ruclur.il members to be used
POR NI�W CONS"IRUC'I ION WCL.UDING Ui:('KS,
AI,�DITIONS. & P RCI ILS SUL3M1"1�:
I. Sile Plan/Survey showing the existing structures
and proposed pr�ject.
2. Two sets of construction pians
3. Lnergy Calcula[ions
FOR WINDOWS — PROVIDB U-VALUE AND
MANUFACfURG STICKCR ON WINDOW.
ALL FEES ARE I3ASED ON VALUATION, INCLUDING TH� COST OF LAI30R AND MATERIALS:
(USINC3 THE 1997 U.B.0 FEE SCHEDULG)
'nTAL JOB VALUATION $ 3. 3/ S OCCUPANCY TYPG
Pern�it Fee
Plan Revie�a
T=ire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Tutal Due
$
$
$
$
$
$
$
$
$
$
$
r�
See Bacic Page for Fee Schedule
65% of Building Permit Fee
.001'times the total job valuation
.0005 x Pennit Valuation Minimum $5.00
$5.00 (State Licensed Residei�tial Contractors)
$2230 per SAC Unit (Plans to MWCC for detei-mination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Detennined by Gnjineering
Agreement necessary ( ) Non Necessary ( )
Make checl.s payable to: City of Fridley Attach Stipulations
THIS [S AN APPLICATION F4R A PERMIT-NOT VALID UNTIL PROCESSCD
I hereby apply for a building permit and 1 acknowledge that the inforn�ation above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and �vith the Minnesota Conscruction Codes; that 1 understand this is not a
permit but only an application for a pennit and work is ot to sta�2 without a pennit on site; that the �rork will be in accordance with the
approved plan in the case of ail wor �c ires rev' w and a roval of pl�a.n�^ I
SIGNATURE OF APPUCANT � NT NAMF ! / � SL � � II � DATG ! O � • �
APPROVAL INSPECT'OR SIG TURE �
r� Fa�r.NnTF• SF.PARAT� PER.M S ARE'R�QUfRED FORPLUMB]NG, �L�CTRICAL AND MECI1 ICAL O K