P - 35443Build�n�
Inspections
763-5"72-3d04
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BUIL�IN�
I�E�II�ENTIAL ��'�P�,��AT'I(]N
�'iTY C�F FRIDL�Y
� UWNER
Y(3Ult C�MAIL ApDkh'SS
Permit No.:
R�ceiv�d �y:
��t� x�c�a:
PRO�`I�RTY OWNEIt/ �aM�:_ _ _
T�NA[VT S.T�?1,.�p.--.•_ _ ....... ...............�.�—
i1DDRE5S'–• ....... �O_� .L._rITF� ST. Ip`I E C'17'Y_�� (_,�,�. STAT�IY�F�� =J Z
PHONE: I�lib3- S�7r_..�._�.i�-[.�_O. —` I-
SUBMITA COPY OF
YOUR STATE LICENSE
WTTH APYLICATIOIV
PRCIPERTY TYPE
TY�?k:
WC1�14:
NAMC:-.,.�.1��_..E�VI/� �
STAT� LICGNSE # ��
,wD�ESS:__�-1_�-1 $ .. ...�.1_�A.�' __�_C
PHUV � IO '�',J' I— rI Sb '� OSS� FAX
Q w1Nlii,fi FAMlLY/NEW CONSTRUCTION
(7 TWO TAMILY/NGW �•ONSTRUCTIQN
b ADDITTON ��'����' O C�RAUFJSHf31
❑ ElAS{':MFiN'i' I�INISFi r� �,00r•
C7 I)k?L'K O sIDING
__._.___. C7 SWlMMINt; Pt
EXR DATE
.._ ..... ... ... . . .......�.._...---
__ C]'CY �(N�o ��CS„STATi��,(p,S'SOI�
._. �x�,�
- -------
DESCRIt3E WORIG F3FI.N(i DQN.F: ,. .. . . .. ._�Z.�j_�.(Z-�EXII_:��L�C.�%lMll�Tl.� �IJ�
SIZE UF iMPROVEMENT LI,NG7'H WiDTH HEIGHT S. Ft,
'� �''y��� t] HOUSE ONLY
NUMBCR OP SQUAItGS ,,,_,� iJ H(7L1.Sf+ � Ci,A,KA.G�i �iASCMENT It�MC)DELIIdG SUH,M�',I :
GA�IAGES I� A'1"fAC:H�I) GAKAUE 1. 8xisting Cloa� Plan
PRUP(i.SB� SIZE; ❑ DGTAC'(�IGU ftARACI� 2. F�r��P�d fk�oi pi�n
FRnI�S6D 1•iC1(IF•IT: 3. List of strirtura! e�embers lo be c�r.�!
`�}ll?1LYSi
❑ Vinyl
�1 Alumimrrn
❑ Othet
RSa�t
❑ Tdm
Q Hasctrt
�1 ��X[.�'�'��N(; ()Y�:NINUS �Iyes pNo LOCATION OF WINDOWS
OA FOR NEW OPGNIN(i3-DE9CRiBL SiZls c7F
c7YF{NINCi C'HANC�NS 1R
TYPE QF W1NL1(}W TQ BFs tNSTAL,I,,�sf]
AGL F�FS A,R� BASEn �DN VALUA
TQTA,G ,1Q$
Permit ree
Pl�n Rbvit�w
Fit� Sarcharge
Surch�rge
Licznse Surcharge
9AC ChArge
Curl� Cut Escrow
EtosiUrl Gcmtrol
Park �ee
Sewer Main �t►flrge
Total Duo
PORtdEW CONSTRiJCTInN 1NGL1JI51NcY 17yc;.KS,
d�,�.1T,�S?.�V,�..� 1'.9�SiFiES SUSMIT:
1. "a1tG I�IdiI/SUiYCy SIIOVYII� f11C CXISt111g SitOCtllfbS
arul pr�pus�d projnc�
2, '1'wo ects a� construation plans
3. Enex�y Cniculukians
CION, INCLUDINC �'H� C0�3T U�' LABUR A►tYp 117A,T���A��.,S:
THE ]997 U.H.0 F�E SCHEUULL;)
�sa . °-° o�t:uPancY TYP�
r i��e��� rn�����
,� S�e 8�ck Pa�e for Fee Schedule
65A/o of I3uildin� permit i ee
�.001 times the totAl jab valuution
, I�,,, .OQOS x Pe�xnit Valuatioi� Minimum $.50
�7 �} � �5.00 (State Licensed Residential Contr�otprs)
___ .. __ .._ $155b per 5AC Unit (Plans to MV1/CC for clefienninatlon)
� �t+6�t=, �tx$2L=$
� $a50 Conservation Pl�ui Review
$� Fee Determin�d by �.ngineQring
� ��reement necessary ( ) Non Necesse�y ( )
$ � •� Mxke Checks n�vahle to: Citv nf Fridlev Attaeh
'1'HIS IS ATti Af'f?LIC'AT3UN NOR A FERMIT•N�T VALID t1NTIL PR(��SSF�7
1 h�by a�ify i'or a buifding pen�nit �nd I acknowladge that the information abuve is cumplutc and accurate; that tiie work wil! be in
confiarm�ne� with th� ordipent,qy �i�d ceydes pf the City of Fridtey and with the Miiu�esot� Gonstruotion Cudc�s; Ghat [ understand this is not a
perrnit but only an application for � permit and wark is nnt tt� 5tt�rt i�yitlaout a pe��nit; that tlte work will be in Aceord�nce with ch�r �pprc�vod
pl�i in the case of�li work which reqaires review and approva� ofplans.
31GNATiJRL QP APPLICANT,, ,� f ;r��' g►�id.Q�.%-- PRINTNAN(G��,�, DATC IJ "Z� �'� �
flWlitly{1w. niw-..a� ..o..�y.v.....y ..... .... _, .,..� . , � �
Upon final paym�t, RR9•Way Weterp►oof&rg vvlU iasue a Uf8lime guara�ntee eovering the drafn tile instanaoon. r�e guarnr�wu wea �w� ..�..o�
condensation or dampnesa on walla or Itoo�s. Ths pump and exlt Orro aro covend by a ssparete 1 yea► manufYClunt's wananty.
NORTN WAiI _�FL POURED WALIS SUMP J�r!�__ PUMP �����
$pUTH WAII fT. TILED FLOORS BATTERY BACK-UP �"��
EAST WALL =-��FT. CARPET FLOORS H20 PROOF: EGRf�S1WW ^
WEST WALL FT. SHEEiROCKIPANELiNG VAPOR 6AP � DRAIN
TRUNK LINE FT. BLOCK WAILS $�:@��; RITE•WAY OMEOWNE
' TOTAL � O FIREPIACE: O GUARANTEED 0 NOT GUAAANTEED
Additions Rite•Wav Does Not Cover
�Homeowner to suppty 110 electrical outlet for pump
Panelinp andlor sheei rock waUs may have to be cut
oH at the bottom
� �" Nail heads may pop or comer seams may separate on 2x4
sheet rockee waits.
Painted walls may become nicked Or SUined
iite in exCavatlon erea w�ll Qa lost
oor may have to be beveled
I�CarDetlnp ta be removed/raplaced by homeown6r
i BaseboaNs ro be removedlreplaced Cy homeowner
�_Bathroom fixlures (toilet, shower, etc) b be removedlreplaced
by homeowner
Other items t be mov by hom�wner
t '
Tunneled areas NOT quaranteed '
Wiu6�'jwb
^'�TL7 C �
O�tr �'�� �
`��
— � ^ �.. �. J
1.�� t
Thb bfd b puM on viwN extemd In�p�cdon only �nd usum�s M� eono«IW wmpon�mr ot tM �truelun WMn to alandnd bulMinq pnOtla. !n
tM pa ol atnxfunl vr�at, R!N Wiy l� rrof rwponUb/s fw raulNnp Wm�p�s. �nd �+a�rwa tM rlyM to wlfhdrnr or nn�potlaf� fNls aOm�M•
EsamplN of vMana�: bloek uvld�s fIi1W MM dm�nt: rw tound�fion urW�r seruetun: floNlrq N�b floor; floor d�plh �xqpdonally Mln w tAkk:
ob�buotbns �mbsdMA In eonent� tloor weh u M�t duea. wstn MO NvrN pip�s. �Netrical eonduH. hot watK pip�s. M�o►elnp rods, hm�
Mposln ab neaslw wnd I�Ilhtlbn. ete.. whkA v�rould IM�A�n with tM Inttdl�tlon.
TM pwmr(�) �eknowl�dpq Uut Wn w� InFOrm�d ot my/our �Iqht to e�nql fhb apnsmsnt as nqulrM by �aw �nd d+at Nw Mw bNn hxnisMO
wltA �n �xkt �ppy of MI� conMet. You,1M buy�r, m�y uneN thl� purchaN at my tlms prlor to mldnlgM ot 1M p�IN buslnNS d�y NUr tM Nb of
purohu�. pwnq �yree� fh�t in w�nt ol eanuN�tlon b�yond thn� buslnay dq� of 1hN eontnet d�b, owner �hUl p�y on d�msrM. MnntyM� (25%)
qrqnt of IM eaNrut �la u Iri' adpuMed dsmapn fo► tM M�ach.
f`-A�i?P_AC70R PpE.L1EN NOTICE
p) •A PENSON OR COMtVANY SUPP�YINQ IABOR OR MATERIALS FOR TNIS IMPNOVEMENT TO YOUR PROPBRTY MAY FILE A UEN AGAINBT YOUR
PROt+ERTY IF TAAT iERSON OA COM�FANY IS NOT PMD ROR THE CONTRIBUTIONB.
(b� UNOER MIWNE80TA LAW, YOU NAVE TME RIOHT TO PAY PER80N8 WNO SUPPUED LABOR OR MATER►ALS FOR THIS IMVROVEMENT
OIRECTLY ANO DEDUCT THIS AAAOUNT FROM OUR CONTRACT PRICE, ON WITHHOLD TME AMOUNT OUE THEM FROM US UNTiI 120 DAYS AFTER
COMPLETION OF TNH IMPROVENIEHT UWIESS WE 6IVE YOU A LIEN WAIVER SIGNED BV pBRSON3 WNO SUPPLIED ANY U180R OR MATERIAL
FOR THE fMPA0VEI1fLNT AMD WHO GAYE YOU TIME�Y NOTICE."
�t �itf�Olit hereby to furrish mAte(isl an�labor Com�plete, in accordance with the above specifications tor ihe sum o1:
—�—� �p
Any aura�iala dwlNion hom abow Nxcl�k+Uw+� brvdvin0 anro costs
wip be aasculee oNy upon v�ten orden. eqnetf bY oaPaa�e alficerpf
adea ageM, arid wAI tiecane en �us tl�arsp over arwl above the eeNme�a
AN pb dates eonYupsM upon strlkes, aaidsnh a de1M'a DeYo^C OD�
eamd. Ownsr b arry flrs, tomado. a� oJhe� neuaasry Mwrance.
iron depotllt uW sseewve sanGwA Mff4tra�bn due a cr�ketl weps irot
f70v9190 GI yUi/OIIIM.
Rla.way ww na e. n,pontible �a a» wnenes w a aamags eausea
. . ....�• �x��.. �..•t.�w.��J� .�wwM.�w'.Ni�ir.irw�� v`'111 M
TWD Dollars ($) —63`-� r�tr7�4�
^ Dpilaf8 (S) `""'—�
K � z � Sub-Total (S) �
ZN-�t
%) Down Payment (E)�.
Baiance (3) �
PAYMENT TO BE UPON JOB COMPLETtOIY.
�IWNBEiJRGENT TO PAX F��MIIkN 4PON J.06