P - 60316APR-02-2012 02:07
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Ir�spectio�s
763-5'i�-3604
763-502,4977 F,AX
31'T8 ADDRES3 �
T�iYB APPT,ICANT IS�
PRQFER�'Y O�
�'�N'ANT
CONTRACTQR
SUHMIT A COpi' OF
YOUR STATE LICEN9E
AN'T) CERTIFICATB O�
INSURANCE
�'itOPERTY TYP'�
PM STANDARD WATER CONTROL 763 537 18$2
!3 �1 !l..�,INC",r Perntit No.:�
R�+ SII��NTIAI.� APPLIC,ATION �tece�vea ay:
CITY UF �"�ID►LEY I Dat��+�:�
YOil�t E-MATL Af1TaRESS
C O'V�NF�Tt '�CONTRACTOR
�wn�ss; crrY STATF zrp
PT�dN'8;�l��".*1�I1' ��,� �
STATE LICEIri$E #
� sn�ra� �nMr�srns�w caNS�ucrio�r
0 TWO FA.MTT.'St'1NEW CONSTAUCTCOhI'
(� k�A3EMENT FIIIISH C) FLUUF
� DF.,�(, O SIDiN4
� S'OV'Q�SM
TYPE OF WQRi{: p NEVi7 �Q'!v[B CONSTItUCTION ❑ ApATT10N
o �,rnr'r�+ta'c�a►� �' �tonEt.nsa
DESCR�P. 'WORx s�INQ DO]�?: r � � �
S1ZE O� YII�RUVEMENT Y.Y'NG'i'id W�ATH
itbOFING CI Ii0LF3E DM.,'Y
Ni.1MaF'R QF SQUAIt'ES ❑ HbU3E Bt i3ARACrF
��
P'ROl'USSD SI�k?;
AROPOSfiD 1�.+IC}H'f:
0 A'r'T'ACHFI} (}ARA(�E
D 1]ETACHEp OARAC3E
CERT
�DRATN TIL,$
❑ Q�
P.01
rP'[�ZYP�-
�IS,E�MB...*►'►`-�Un�.ixS�,SVS�rcT:
l, �ci9ting Ftppr Plan
2, Prpposed Anor plan
3. L,ls[ Of rnlrehv9l mcmbCts 10 bE t�sal
�� FC)R NF'UV CQNSTRUC7'fON' CNCLUDINti DEC�CS,
� Viqyl pSof'tlt SYriII�[�SpFFIT/6'A5C.'IA A1�IZ9NS. � PORS71Fs S[7��rr.
4 Aluminum C] Trim IiENC0VED7 d YEB D NO 1 Sito PiadSurve�y showeag thc cxistmg �tnu.turos
O pthcr O F�scla 8n4 I�FQ�d proJect.
2. 1"wn scts at'cot►+�ructlon pl�ns
WINffOWS 3, Etkrgy C�ICulations
�i E7t[STII�ICr OPEN'TNG$ CIYcs pNo LOCA7'1(�N OF WlND(.)'W'S FQR WATDD'VrJS -• PRpVJpF IJ•VAT.T.1'� ANn
Qit FOR N�W OPEMNGS-�P.SGRIBE 5IZE C)F AJtANtJF+ACTURE 3TIC1C%1t ON 4JINDC)W.
QP�"NINQ GHAN4ES �
T'YPL OF yV1NppW TO $�S 1NSTq1,LED ��R OF WINDO'OVS
ALL �'EE5 AAE BAS�b ON' VAL�TATION, INCL'CrI?YN'G THE COST O�' Y.AHQR AND 1VIATERIALS;
S�V'G TY�E 1997 U.B.0 F�E SCHEDULE)
"OTAL JOB VALU'AT[ON S�s� Q/ [�%D _ OCCUPANCY' T''fCP�
Plan Rer�iew
�ire Surcharge
Surcha�rge
Lioense Surcharge
SAC Charge
Curb Cut Escrow
Erosion Ccnttol
Psrk Foe
Sewer Main Chatge
S I 1���,,,,,,� Sae B�ck Pag� far.Fee Schedule
$ T' 65% of Building Potmit �ee
S .001 times the total job valuation
__S___ __ _. _... '1 .0003 x permit V'aluatibn Minimum or .30
S �' 55.00 (State Licensed R�s'tdentisl ContraCtore}
S �2365 per 5AC Unit (plans to MWCC for determination)
$ ft+6ft= ft��23=$
� $450 �onservation plan Rcview �
$ Peo betermined by Engineering
� Agreement neo�ssary ( } Non Naccesary ( )
� 17,� , I D Make ch�c�s nAy�►ble to: Citv of Frldlev Attacl
'i'FiTS tS AN APPLICATION �OR A pP.RMIT-N ALI�7 If.iN'1'II. PROCFaSSED
Y h�bY apPly for a building permit and I aekno � d that the i n�bove is Complete snd accw�ate: thet the wotle will be in
ca�armanca with the ordinanr�s sn co of of F' d with the Minncsota Const�uction C.�des; thnt I understand this is not a
parmit but only an applicati . a permi v r�"�° start withdut 't' �on site; that the work will be in accordance with the
approWed plan i� the c ell plans,
sYCNn�; aF ��.rc rr�,�r'r%�%Gl��SD� �ar� ��a� �
AFAArI'ltei n.it�a�l�Tno _ e t : � r�
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