P - 46481Building
inspections
763-572-3604
763-502-4977 IiAX
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S1TE ADDRGSS
TH1S APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
1'OUR STATr LICENSC
AND CERTIPICATG OP
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
cFi-�ccrivF i-i-?oi i
YOUR E-MAIL ADDRESS _
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❑ OWNf R T]CONTRACTOR
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ADDRCSS: �i 8� /-I G C�l S O A S�' N� CITI' �^i/ �[� STnTP. '+� Z.IPssy� 7
riioNr�: 76 3r 4� y• �l 8?9
N�M� Pella Windows & Doors _
s.rATi� i 15300 25th Ave N. Ste 100 GAD CERT NlI�4[3GR _
ADDRB� Plymouth, MN 55447 CITY _STATE 71P
�HONr-_ Lic # 20165884 Ph. 763/745-1400 �_,�
$ SRJGLE PAM[LYMBW CONSTRUCTION SIZG
❑ TWO PAMILY/NEW C:ONSTRUCTION STORIGS
� ADUI"iION ❑ GARAGf-/Sl-IGD WINDOWS
O [�ASEM6NT FINISII ❑ ROOP ❑ DRAfN "fIL�
❑ llGCK ❑ SIDING � OTHCR
❑ SWIMMING POOL
❑ NLW HOMG CONSTRUCTION ❑ �DDITION
L��AINT[iNANCGREI'AlR ❑ RGMODCLING
DESCRIBE WORK F3C-ING DONE:
C17.F nF fMPROVEMCNT
ROOFING
NUM131=R OI� SQl1AR(.S _-
GARA(;ES
F'ROPOSGD SIZL:
------ _ —
PRC)P(')SI:D HL?ICil�l"I':
SIDING
� VinVl
❑ Aluminum
❑ Other ___
V17NDOVVS
IN GXISTING OPBNINGS t�'es ❑No
OR FOR NEW OPENINGS-0L-'SCRIQE SI"LE OF
OPENING CIiANGLS &
rYPE OF V✓INDOW 'r0 �3E INSTALLLD D7a
LGNGTH WIDTH I iGIGHT
❑ HOUSf:ONLY
o i tous►� � cnitnc;r:
❑ A'I°I'ACI IED C�ARAGIi
❑ DL.TACI IGD G/1RA(iE
❑Soflit
❑ Trim
❑ f=ascia
OCAT'ION OF WINDOWS
�k.�ch��, L.v,�q 0,n,�g 8.d�e•rnc
� NUMQER OF WINDOWS I�
• nq �
�
RnSl=M1'N"I' RI:MOI)GI.ING SURMI'I':
_ __-- -- -- -- __ -- _. ___ ...
I. I xistin� I�loor Plrin
2 I'ro�iosed (loor plan
3. I_ist of slruc!urol members �n bc used
I�(>R NI:W CONS'I'RUC'I�ION INCL.l1DING I)IiC'KS,
ADDI'I'IONS & PORCIif�S SU[3MIl�:
i. Sile Plan/Survey showing lhe existing struclures
and proposed pr�ject.
2. Two sets of construclion plans
_l. Gnergy Calculations
FOR WINDOVUS — f'ROVIDC U-VAI.,IIE AND
MANUFACTURG STICKGR ON WINDOW.
ALL FEES ARE I3ASEll ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THI; 1997 U.B.0 FEE SCHEDUL�)
('OTAL JOB VALUATION $ 7 O� 3 OCCUI'ANCY TYP[:
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Trosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
�
$
$
$
$
$
$
$
See Bacl< Page for Fee Schedule
65% of Building Permit Fee
.001'times the total job valuation
.0005 x Pern�it Valuation Minimum $S.UO
$5.00 (State Licensed Residential Co�tractors)
$2230 per SAC Unit (Plans to MWCC for determination)
ft+6ft= _ftx$25=$
$450 Conservation Plan Review
Fee Detennined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checl:s navable to: Citv of Fridlev Attach Stipulations
TNIS IS AN API'LICAT(ON FOR A P6RMIT-NOT VAUD UNTIL PROCESSCD
I hereby apply for a building permit and i acicnowledge that the information above is complete and accurate; chai the work will bc in
conformance with the ordinances a codes of t] City of Fridley and ���ith the Minnesota Construction Codes; that 1 understand this is not a
permit but only an application for a pe �i a� work is not to start ���ithoui a pennit on site; that the ���ork w�ill Ue in accordance with the
approved plan in the case of all «� ic � ires view and approval of plan j
SIGNATURE OF AI'PLiCnN"T' PiZINT' NAME�� S C/1 ��) � DA"I'G_ �� ����
AI'PROVAL INSPECTOR SI ATURE -�
PLEASF, NOTE: S�PAR,
FOR PLUMBING, ELLCTRTCAL AND MECHANICAL WORK