P - 47154I3uilding
Inspections
763-572-3�U4
763-502-4977 1��1X
li U 1Lilil�l (i
I�E�IDENTIAL APPLICATION
CITY OF TRIDLEY
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( HIti Af'PLICAN"� IS ❑ O\�JN1=R bCONTRAC"I�OR
PROPERTY OWNFR/
TrNANT
CONTRACTOR
s�.>>3Mi�r n co�v or
YOl_IR S'1�ATG L1CF-,NS13
,�Nn ccr.�-�i=ic��rr: c>i�
INSURANC6
I'ROPi:RTY 7'YPE
PERMIT TYPF,
N n M r : _.__JL91�.—_�Z_
nr�i.>a�ss 5 l S/ St.
i>i ioN�.:---� � 3� 'S 7 S/ • b 5 7 L_
N„Mr: Pella Windows & Doors
�.i.A•i,i: i 15300 25th Ave N. Ste 100
���i�1z1,, Plyinouth, MN 55447
i,�_i�Nr Lic # 20165884 Ph. 763/745-1400
TS�INGLI= FAMII:Y/N�W CONSTRUCTION
❑ "I'�4�0 �AMILI'/N6W CONS'I'RUCTION
❑ nDDI"I'ION
O [3ASGM6�N�1� PINISi��
❑ Df:CK
LJ (iAKl�GL:/SI II.:U
o ��oor
❑ SIDING
O SWIMMING PUOI�
c�TV__�l_' !_l'�(�---- �"���� ��'��
rn r� cr aT n� � i n�►t ea.---------- ----
CI�'Y ---5� n f L
I Aa
SIZI�
S'T'ORI[_S -------.
WINDOWS
❑ DRAIN `fILL
0 o��fica
TYPE Or WOI2K: I❑ NI:W IiOML CONSTRUCTION ❑ nDDITICIN
�9.[��AINTf�NnNC6/REPAIR ❑ R6MOD6LING
DL-'SCRII3F_. \�JORK I3L1NG DONI::
S1ZE OP I���ROVGMI3N'l�
aoor�n�c
NUMIifiR OF tiQl InRIi:S
GAf2AGf�S
f'ROPOS6D SI'/I::
I'Kl)POSI D III:I(�II'I`.
_ –_
ti(I)ING
❑ Vinyi
❑ Ahiminuni
❑ Other
❑ HOUS� ON1.1'
o i i��usi�_ ��. � �nizn� �r
❑ A"T TACi ll f) GARnGI::
❑ f�Fi"f/�CI IL'D GAR/�GE
❑Soflit
❑ 1'rim
❑ Pasci;i
W1DTI-I
�17NDON�S
IN f_XIS"T'ING OI'GNINGSi91'cs ❑No I.00/�'ION O� 1��INDOWti
OR FOR N�W OPGNINGS-D6SCR1�3G SILE OP _�St O�Pb�/�'�� ���%��
� )PEIJING CI IANGGS G; .�y /�
Tl'Pf; (�F V�%INDOIN 7'C> BE INSfAI.I..,GU LA3J JM�t A�1pUMf3ER OF \NINllOWS__ v_____
���n.� f�
I IPIG IT � ti(;) I�.I.
SSY?/
7.1 I'
Rn.51:M1?N"I' RI;MOI�I:I.ING 51113M1'f,
_ ._ . __ _ __ __ ---_. _ _ _ __
I I.xititing I lour I'I,in
2 I'rn�xised Ilo��r �il�in
3 LLtiI cif struc!urnl mcnihcrs lo bc nscd
PUR NI',W �'ONS'I'RUC'I ION IN('i.l�l)IN(� I)Ifc'I:S
Af)DI_I'IONS ��C I'OItCI11�S tiUl_1M1_I;
I. Sile �'lan/Survey tihowing Ihe exilling struclurrs
and pro�osed �rnjecl.
Z f�-vo scts ol conslnic�iun pl�ins
3. linergy Calcula(ions
1 OR WINUOWS – PROVID[: U-V�I.UG ANI)
MnNUPAC"fURL S"fICKLR ON WINDOW.
ALL �GGS ARG 13ASrD ON VALUA'f'ION, INCLUDING T}�G COS'T OF LABOR AND MATGRIALS:
��$IN�G THr 1997 U.B.0 FE� SCII�DULG)
COTAL J0�3 VALUATION 9� �� �O OCCUPANCY TYP[:
Permit Fee _$ _����; _---- See 13ac1: Page for Tee Schediile ----- --
!'lan Review � .-,--� 65% of Building Permit Fee
Fire Surcharge $ l� � .001'times the total job valuation '
Surcharge 9�---�-�-3 0005 x Pennit Valuation Minimum $5.00
License Surcharg� 4� ,��d v _$5.00 (State Licensed f�esidential Contractors) �
SAC Charge 9� $2230 per SAC Unit (Plans to MWCC for dcterrnina�ion)
Curb Cut Gscrow $ _ ft -�- 6 ft = ___ ft x$25— $_ ___
Erosion Control $ $450 Conservation Plan Review
Park F'ee $ Fee Determined by Gn��ineerin`.;
Sew�er Main Charge $ ngr-eement necessary O Non Necessary O
Totai Due $��{ Q Malce checl:s payable fo: Cily of rridley __ A[tach Sti�ulations __
TI-IIS IS AN MI'LICATION POR A P6R�4I"f-NOT VALID UN'T'IL PROCf-:SSLD
f herebl' dpply for a building permit and I acl:no��led�e that the information above is compleic and accurale; lh�il lhe �vork ���ill b�. in
conformance ���ith the ordinances and codes of the City of Fridley anel ���ith the Minnesota Construction Codes; that 1�.�nderstand this is not a �
pennit but only an a��plication for a ��ennit an worl: is not to tart ���ithout a permit on sitc; chat the ���ori: w�ill be in accorelancc �vith the
ap�roved plan in the case of �II ���or' aP1"� � re i-es • approval of pla
SIGNATUf:Li Of AI'PLIC/�N' _ . I'RIN"�AME��--�`_�_�.�._ _._I)/�1�L_..--��� ..._���-1 —
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APPROVAL INSPI:C'1 OR SI A I UI:l3 �
P1.,rASI: NOTE: SF_•,PARATI: PLR. ARr R�QUIRLD FOR PLUMBING, ELLCTR]CAL AND MF_.CI A L I<