P - 44923�uilding
�nspections
ib3-572-3604
)ATE � � 5 ( I
�ITE A.DDRESS %i� � �
'HIS APPLICANT IS:
?Rt7t ERTY OWNER/
TENANT
CONTRACTOR
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
. „
YOUR
❑ OWNER �ONTRACTOR
NAME: T Q
ADDRESS: i ti � li ! CL %' l�,. � D�V' CITY_
PHONE:! �' l� L z_�I_7 ' L 7 � y
Pella Windows & Doors —
N`�E:_ 15300- 25th A N S't 100 —
catl�'t�
Permit No.:
Received By:
Date Rec'
STAT�'�zrn ss y3�
venue .- ui e
STATE`LIC �(S T 3�l J` ' 4 0 r{,'1 ,
SUBMIT A COPY OF Plymoutll, MN 55447
Y,�TJR STATE LICENSE -ADDRESS: CITY STATE_ZIP
WITH APPLICATION %63/ %45-14�� •
P s�rG� License# 20165884 E
PROPERTY TYPr, '
❑ TWO FA � .ORIES
VIIT TYPE Q�DITION ❑ GA.RAGEISHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
ESCRIBE WORK BEING DONE
[ZE OF IMPROVEMENT
CE/REPAIlZ � RE
w� n['fot,� r�
T ��.rr_rru
t ,�,5 /�!l e�� �, ��1' �
HEIGHT' Sq: Ft.
�OFING ❑ HOUSE ONLY :
i1MBER OF SQUARES ❑ HOUSE & GAR.AGE BASEMENT REMODELING SUBMIT:
4RAGES O A'TTACHED GARAGB L Existing Floor Plan
:OPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan
;OPOSED HEIGHT: 3. List of structural members to be used
AING FOR NEW CONSTRUCTTON INCLUDING DECKS,
Vinyl ❑Soffit : ADDITIONS. & PORCHES SUB7vIIT:
Alucninum ❑ Trim 1. Site Plan/Survey showing the existing sfructures
Other � Fascia and proposed project
iNDOWS 2. Two sets of constructionplans
EXLSTING OPENINGS i�'i'es ONo LO ATION OF W � 3. Energy Calculations
; FOR NEW OP£NINGS-DESCRIBE SIZE OF � Q S�t /`�Q ��� 69"y'!� EL "�
'ENING CHANGES & �
PE OF WINDOW TO BE INSTALLED ��s NUMBER OF WINDOWS y
ALL FEES ARE BE4SED ON V:4LUATION, INCLUDING THE GOST OF LABOR ,AND MA
. TOTAL JOB VALUATION $ G T� E� �,7�U.B.0 FEE OCICUPANCY TYPE
rmit Fee $ 3, ? See Back Page for Fee Schedule
in Review $ 65% of Building Permit Fee ,
rcharge ` $ /. Y$ (.0005) times fhe total job valuation — Minimum $:50
•e Surcharge $: a. t 7 .001 x Permit Valuation (1/10%)
;ense Surcharge $ S; 0 � ' $5.00 (State Licensed Residential Contraetors) ' �
.0 Charge $ $1450 per SAC ITnit (Plans to MVJCC for determination)
rb Cut Escrow � ft+ 6 ft= ft x$20 =$
�sion Control $ $450 Conservation Plan Review
-k Fee $ Fee Determined by Engineering -
�✓er Main Charge $ Agreement necessary O Non Necessary O
tal Due $ Q j, 'j O Make checks payable to: City of Fridley Attach Sfipulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID L3NTIL PROCESSED
ereby apply for a building permit and I aclrnowledge that the information above is complete and_ accurate; that the work will be in
iformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
mit but only an application for a permit and work is not to start without a permit; that the work will be in� ac�or�fat�ce- with the approved
n in the case of all work which requires re ie and approval of plans. U�5 ��
NATURE OF APPLICAN'F4�S / PRTNT NAME / � • ' ! �"C ' ( ! n � DATE � �
I.