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Inspection�
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I�ESIDENTI�AL APPL[CATI�ON
CITY OF rRIDL�Y
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���Mr; Pella Winciows & Doors
S.i.A�-�, � 15300 25th Ave N. Ste 100
��������,, Plyinouth, MN 55447
i,ii�Nr Lic # 20165884 Ph. 763/745-1400
Q SINGLI= 1=AMILY/NGW CONSTRUCTION
❑ "I'1�J0 PAMILI'/NGW CONS7RUCTlON
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TYPE OF WORK: o Nrw iioMr coNS��r�ucrioN ❑ ADDITION
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DESCRI[3E WORK I361NG DON1=:
SIZE OF IMPROVGML:NT'
ROOFING
NUM13fiR ( )P 5(1llAltliti
GAitAGIS
�'ROPOS(:D SI7.1:�.
I'ltOI'OSI?I) Illil(ill'I'
�IDIN(:
❑ Vinyl
❑ Aluminuni
❑ Otl�er
❑ I IQI.ISI= ONLY
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❑ A'T"I'nCFli;l� GAKAGI�
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WIDTFi FIL'-IGIiT tiQ P"I'
10'INDON'S
IN GXIS"TING OPL'NINOS�j'cs ❑No LUCA"I �(�N C�P WpINDOWS
OR FOR NEW OPGN1NGti-DL'SC{t1f3G SILL 01= __ K/ f'[ !I � n _
OPFNIIJG CIIANGGS & Sl� dN„S �`
fl'I F OF N%INI)OW '1'O 13f' INS I ALI_PU NUMf3F_R OF WINDOWS__ __ ___
I;n.SI:Mi�N"I� RI?.MOI�GI.ING 51113M1'I':
_ _. ._ ---. _ ___... _ _. _ .
I I�xititin�, I loor I'lan
2 I'n��uised Ilucu ��Inn
3- I.is� (il Slruc!urd mrnihcrs lo bc uscd
I�l)I: NI?.W C(7NS'I�I:UC'I'ION W('I.l�l)ING I)li(�'h.5
AI)Dll'IONS & P(:)ILCI II�S SUIlMI_'f;
I. Site �'lan/Survey tihowing th� csistin!: slruclurrs
smd proposed nr�ject.
2 f���o scts ol conslructiun pltins
3. I�nergy Caicult�lions
I�OR WINDOW�S — I'ROVIDLi U-VAI,UL /1N1)
MANUPACTUF'.G S"1'IC'KLR ON WINDOW.
ALL �GGS AR� 13ASrD ON VALUAT'ION, INCLUDING THG COST OF LAI30R AND MATGRIALS:
(USING THG 1997 U.B.0 FEr SCi��DULG)
COTAL JOB VALUATION x �'S � I OCCUPANCY '['l'I'G
— --�-- - — _.
-- -- —
Permit Fee _$ _ �//,� /__ See 13ac1: Page for Fee Schedulc
Plan Re:view $ --� 65% of [3uilding Pcrmit Pee I
Fire Surch��rge $ �� 001 �times the total job valuation I
Surcharge R �.,�- S'. 0005 x Permit Valuation Minim�m� $5.00
License Surchary�e � � p C� $5.00 (State Licensed Residential Contractors)
SAC Charge 9� $2230 per SAC Unit (Plans to M WCC for determination)
Curb C�rt Cscrow $ _ ft -i- 6 ft = ___ ft x$25= $_____
Grosion Control $ $450 Conservation Plan Revie�v
Park F'ee $ Fee Determined by C'n��ineering
Se�n�er Main Charge $ Agreemei�t necessary O Non Necess��iry O
Total Due �� '. 0%- Malce ehecl:s payable lo: Cify of rridley __Atlach Sti�ul�itions _
Tl-IIS IS AN MPUCATION POR A I'GRMIT-NOT VALID UN'i'IL I'ROC6SSLD
I hcreby apply for a buiidin� pennit and I acl:no��ledge that the information above is compleie and accurate; lhat the �vorlc ���ill be. in
conformance ���ith the ordinances and codes oi'the City of Fridley and ���itii the Minnesota C:onstruction Codes; that 1 underst�ind Ihis is not a
��ennit but only an a��plic�lion ior a pern�if and work is noi start ���iihot.n a permi[ on sitc; that the ���orl: �n�ill be in accordancc with the
I ap�roved plan in the case of all «�or�l. I�i • e�ir s review d approvai of plat�s�,.- f
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�r�r�ROV�i_ iNSri-.c�orz �� �r��r.r:� _
PLEASI; NOTG: SEPARA ' �'l� . , 'D FOR PLUMBING, LLLCTRICAL AND MF_. I [ I21t