P - 44851Building BUILDING Permit Na
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY vate ��"�: '� � f� �
na� 04/20/2011 Yo[rx�-�..4nn�ss estherd�windowworldmn. com
stTE.aDV�ss 1541 S Bavarian Pass
THIS APPLICANT IS: ❑ OWNER OCONTRACTOR
PROPERTY OWNER! NAME: Robert Gj ertson
TENANT �b�ss: same as site crr�r sTn� z[r
PHONE:
CONTRACTOR ��;pr 8uilt Americ
SUBMTT A COPY OF STATE LICENSE # BC - 2 0 3 56 84? � DA� 0 3 i 2
YOORSTATELICENSE ADDItE�S: 2211 t AV� E �TTy ATOi'th S10 STATE z� 551.�9
wITH APPLICA'i'ION rxorrs 6 51- 7 7 0- 9315 Fr� 6 51- 77 0- 04 95 �
PRUPERTY 1'YPE ❑ SINGLE FAMILYlNEW CQNSTRUCI'ION SIZE
O TVJO FAMILY/NEW CONSTRUCTION 3TORIES
PERMIT TYPE ❑�bITION 0 GARAGElSHED ❑ WIlJDOW5
❑ BASEMENT FIMSH ❑ ROOF O DRAIN TII.E
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIl►�IING POOL
TYPE oF woRK: ❑ rr�w ❑ twnrriox
❑ MAINTENANCF✓REPAIR ❑ REMODELING
DESCRIBEWORKBEINGDONE: Replacing 1 windows, existing apenings
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT . Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF 5QUARES ❑ HOUSE & GARAGE BASEMEt1T REM011E�.INCs SUBMIT:
1. F,acisting Floor Pian
GARAGES Q AT1'ACHED GARAGE 2. Proposeci floor pian
PROPOSED SiZE: ❑ D&TACHED GARAGE
PROPOSED HEIGHT: 3. List of structurat members to be used
�F� FOR NEW GONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDITtONS. & gORCHES Si j�j�;
❑ Aluminum ❑ Trim t. SiGe Plen/Survey sFwwing tqe estistis�g structiue,a
❑ Ehher O Fascia and ProPo� ProJ� , :
WINDOWS
- 2. Two sets of construction pians
IN EXIS1'ING OPENINGS �Yes ONo LOCATiON OF WiND()WS 3. Energy' Ca1G'lau°ffi
OR FOR NEW OPENINCrS-DESGRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIIdDOW TO BE INSTALLED Trap i zo � �gEg OF WINDOWS 1
ALL FEES ARE BASED ON VALUATION, IN+CLUDING THE COST OF LABOR AND MATERtALS:
Pemut Fee
Plaa Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Pee
Sewer Main Charge
Tatal Due
(USING THE 1997 U.B.0 FEE SCHEDULE)
VALUATION $ 1044 OCCUPANC'
$ {�/L�_ See Back Page for Fee Schedule
$ b5% of Building Pennit Fee
$ L a �.001 times the total job valuation
$ i ,0005 x Pernut Valuation Minimum 5.50
� 0 $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Revievv
$ Fee Detennined by Engineering
S Agreement necessary () Non Necessary ()
TFIIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROGESSED
I hereby agply for a building permit and I acknowledge that the informarion above is compiete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Conshvction Codes; that'I understand this is not a
permit but anly an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATURH OF APPLICANT ��'��/ P� N� E s the r Dah1 DA.t.E Q 4/ 2 0/' 11