P - 44975Building
Inspections
763-572-3604
763-�02-4977 FA�
DA'i�
s�r� aor�R�ss G i 2
TH1S APPLICANT 1S:
PROPERTY OWNER/
T'ENANT
From: 6514847427 Page: 3/3 Date: 3/1/2011 2:32:57 PM
B ILi)ING
RESIDENT L APPLICATIflN
CITY tJF FI2IDLEY
FFECT]VE I-1-z011
YOUR E- A! L ADDRESS � W �!- w�'� 1-` t� � S
r, ✓' +' s -� � r' .
O OWT3ER L9CONTRAGT R
ADDRESS;
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SUBhfIT A COPY OF • gTATE LICENSE � .r�� S
YOUR STATE L[CENSB 1 —�----
.4ND CEIiT]FICATE OF , ADDRESS: �'i �J � t� "`j
INSURANCE � pHONE C� t Z � � � � ' .�.f $
PROPERTY TYPE [� SINGLE FAh4ILYMEVI' CON5TR
O TWO FAMILY/PEW COI�STRUC
PERniIT TYPE
Cl BASEMEZVT FT�3iSH ❑
0 DECK ❑
TYPE UF WORK: ❑ NEW HQME CONSTRUCTION
DESCRI$E WORK BEING DONE RGp1�LK � �,,�at'
SIZE OP IMPROVEMENT [.ENGTH
RQOFING O HOUSE OP
%fUMBfiR OF SQUARES D HOUSE &.
GARAGFS O ATTACHE',
PROPOSED 51Z�: 0 DETACHE
PROPOSED HE[GHT:
ID
p vinyl Osoffi�
0 Aluminum ❑ Trim
O OtGer O rascia
wnvnows
TN EXISTI?VG OPENINGS �ts ONo LOCAT}ON OF Wlt�
OR FOR NEW OPENINGS-DESCRIBE S1ZE pF
OPENING CHANG�S & r
TYP� OF WINDOW TO BE II�STALLED �i n�f 1 S. N�UMBI
V�
7 6 �i
D CERT
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� Fa�x G S� - Y$ �( -'7 Y Z?
T[ON S]Z£
)V STOFZIES
r1RAGE/SHED 'INDpWS
fJOF ❑ DRATN TILE
[DING ❑ OTFiER
i'�RMMIh'G POOL
❑ ADDIT'IpN
O REMODEL[1�G
�a� S
Permit Nc��; "" T
n
Received
Da��a �R 2��
�
� Ci i"�1 • : . �..V 1^1
STA
Y
GARAGE
GARAGE
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I. Existing Floor Alan
2. P�opased floor plan
3. List of structural me
?OR NEW CO�[STRUCTION
I. Site Plan/Survey sht
and proposed projec
2. Two scts of construc
3. Energy Calculations
FOR WINDOWS-PROVIDE
�rtAVUFACfURE STICKER C
ALL FEES ARE BASED ON VALUATION, INC UDING THE COST 4F LABOR AND MATERIAI�S:
SING THE 1997 .B.0 FEE SCNEDULE)
COTALJOB VALUATION � 7. �''' OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
SurcE�azge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park �ee
5ewar Main Charge
Total Due
$ See Back i�age for Fee Schedule
$ 65% of Building Permit Fee
$ .00 i times the total job valuatian
$ .0045 x Permit Valuation 144inimurn $5.00
$ $S.UO (State Licensed Resider�tial Contractors)
� $2230 per SAC l�nit (Plans to MWCC for determination)
� ft+6ft= ftxS24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement nec�essary.( � Non Necessary O
$ . � Malce checks aavabie #o: Citv of Fridkv Attac]
TE �ZIP S"S'ti �`�/
ers !o be used
�LUDING DECKS,
�
ng the existirtg structures
n pians
VALUE AND
16�iNDOW .
THIS 7S AN APPL[CAilO FOR A PERMTE'-NOi VALID UTlTIL PROCBSSED
t hereby apply for a building permit an 1 acknowledge at the information above is complete and accurate; ti�a tl�e work will be in
conf�rmance with the ordinances and codes f Ci � of ridley and with the Minnesota Canstrucrion Codes; that 1 derstand ihis is not a
permit but onty an application for a permit w rs n t to start without a permit an site; that the wark will be i accordance with the
approved plan in the case of ork ich r ir s review d approval of pl
SIGNATUR,B OP APPLiCANT RINT NAME �f ✓C t�I+�t/.JtIY�.- DA �
APPROVAL tNSPECTtJR SIGNA RE