P - 62726Building BUILDING Permit No.. �C� �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date
763-502-4977 FAX �� ��
EFFECTIVE 1-1-2012
DATE � / � � YOUR E-MAIL ADDRESS �US �['L�I � � �� l� 7 �ii �"7� � L:t'7J'"'t
SITE ADDRESS � S �(� �� f � � KQ / v i� r'^ r / /� 1 {��1 . /1� l�J �'"S'� 'L �
THIS APPLICANT IS: ($'.OWNER ❑CONTRACTOR
PROPERTY OWNER/ NAME: 1�
TENANT ADDRESS: � .C? f'� CITY f" r'1 1 Q L1 STATE M A�ZIP S"S y Z1
PHONE: 7b'� —�'l � �Z,,,�" �% Z,�"
CONTRACTOR NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE STATE LICENSE # LEAD CERT NUMBER EXP:
AND CERTIFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE PHONE FAX
PROPERTY TYPE ,� SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITTON ❑ GARAGE/SHED �,}�VINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK O SIDING �OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDIT'ION
❑ MAINTENANCE/REPAIR J5j'REMODELING
DESCRIBEWORKBEINGDONE: R2Jl�U(" " ��CdtN y 'w��.YLi^ir� C�ldtl,r' I ��`F'XI m.� ��'�/� '
��.a��t+�a- tiJ l n
SIZE OF IMPROVEMENT r LENGTH WIDTH 7� ���/' �� HEIGHT —� /! r' S FT �U
ROOFING ❑ HOUSE ONLY $pSEMENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE & GARAGE l. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARy1GE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA �DITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim REMOVED? ❑ YES 0 NO 1. Site Plan/Survey showing the existing structures
and proposed project.
❑ Other ❑ Fascia 2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �1'es ❑No LOCAT[ON OF WINDOWS FOR WINDOWS – PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES & y�
TYPE OF WINDOW TO BE INSTALLED /'�A l p 1..e�r NUMBER OF WINDOWS
ALL rr,r.� Atcr, tsA�LL VP1 VALUAl1Vlv, 11VC:LUll11Vl� 1riL� (;V,l VN' LAKVK ANll MA"l�L�'KlALS:
TOTAL JOB VALUATION $�,'�(�S�N�G THE 1997 U.B.0 FEE SCHOCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
S ��= L-j See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �'(, �.001 times the total job valuation
$ `� .0005 x Permit Valuation Minimum or .50
$ $5.00 (State Licensed Residential Contractors)
$ $2365 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ ,�b Make checks uavable to: Citv of Fridlev Attacl
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT'IL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of�a�ll woF k}� ic�h requires review and approval of plans.
SIGNATURE OF APPLICANT `°�. U-t/� PRINT NAME M t�,t. �S � DATE �l� ! C�
APPROVAL INSPECTOR SIGNATURE
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,�,nd�rSert� .��
Frenchwood Gliding Door
AND-N•6-Q0470-OQOQ1
Virryl•Clad Wood Fra�e, Dual•Pane Low•E �artSun
TeMpered with Argon
Product Type; Sliding Patio Doors with Fra�e
ENERGY PERFORMANCE RATINGS
U•Factor Solar Heat Gain Coefficient
Q.30�1.70 Q.18
�U,S,(I•P) I�tricJSl
ADDITIONAL PERF4RMANCE RATINGS
Yisible Transmittance
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Mar,utacTUrer stipalat�s tna[ tnese ratings conform tQ aqplicab3� NFA; prcoitluns for Orterelning vnolo F�a.A:Ci
DB�10ffidfiCB. IiFAG ft21n96 A�G dBtBfMiRYd tor a}1%td bFt Of f�Y1�0�Me�td1 OM1dlllOfiS d�d 9 5(>101f1E Pfo�UQ2 5126.
uFAG dees na? !reeommend any proa�et and Coes not Yarrant tne sultatri,lty ot any praiupt tor any sppeit.c use
ConR¢lt �aenufatturera literatun f�� atne� �roduc? p¢rforaanCe lnic-rmation.
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WINDOW AND UOQft
� � MA�NUFACTURERS r
ASSOpATION
129-H-929
Andersen Corporation: 400 Series Frenchwood Glidinp t
^ P,laoufacturer s;ipulates conformance to the appiicabie standar�s,
STANDARD 2 Panei Ratin
Ai1PlY4fVJ0�PAjC91 101)iS2fA44D•09 C18SS LC-Pr,40 96.3" x H2.4"
�a+ar�J.an
�1�ICSA t01;IS21�40-05 `n��"QO 9s.3^ x e2.n�
DP+4Q .40
FL 1095
Glazing: 3.9mm FT outerl3.9mm FT inner
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L���t� matari�s.
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Re���irements �DMa HallmarK rer?ificati�?n Pr6grea
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