P - 45096F3uilding
Inspections
763-5'7�-36U4
DA
From: unknown
Page: 2/4 Date: 5/5/2011 3:23:27 PM
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RESIDENTIA.� A�PLI�ATIO►1W� R���;v�a B �
CIT� O�, FR►rDLEY �G��l� ���
Fp=� EFFEC'l'lVG l•1•2Q11
'YOC�i F,-MAIL P�DDRESS m r� �r,,.�� r e c� c�d�' C�r�,F r'ti[� �['.,�r+�
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SiIE ADDRE58 ��
'TF[[S APPLICAtJT TS;
PROPEItTY QWNER/
TENAN"f
COAi'iRAC'�QR
SU�MIT A COPY OF
YpUR S 1ATE LJCFNSE
,tirr� c�x�r�rrcar�, or
iNSURAINCE
PROPERTY T'XPE
F�I7.'NfIT TYPE
❑ OWNCR �ON!'RACTQR
CITY�� :s'��P.1 _ STAT'E 1�,_'LIY� 1
STATG LiC�NSF. �i�" ,S]l e 3 M � � 1 _ LEAD C�,fiT N1UMBi'sR,,,,_� � I � �i ��CQ —2 �%I � �KSLc��
,annxES5: tD *��1 _ .�nnlrri t {�{,�.� I�„�_c�� sTATS�.r�P��„
,�SINGLE FAMi.LY/NEw CONS'�RUGTibAI
D 'I'wp FAMILY/NEW CUNS'1"RUCTION
❑ BAS�MEiV'T FiNISI� �R.00F
❑ DECIC ❑ Sll)iN�
TYPE UF WORK: � � NEW HQM.E CONSTRUCTTOIV —' � AD�i'T10N
,P�MAINTENAxCFJREPA1It ❑ �Man�.m�
DESC1�YBi VJORK BEING DCiN�: � r �'lbr.-. e�1i �. r� �-o� .�. b 1 D S�b tN
3L'�E �F lMPRQVEMEN�' LL•'l�iG7'F� Wff}7'H
Rf/OFING .�HOUSp OMLY
NTJMRER OF SQUAR�S _�_ Q i-IOUSE & GARA�aE
GARAGEB
PROPUSED 517.E:
pRQPpSED H�IGH'C'
Sit �,
❑ Vinyl
� Aluminum
❑ Other
CI .an'a�f3�D GARAG�?
❑ DETACE9L'L1 CrARAC'rF
CISotFt
❑ Trim
❑ Pescia
WIND W�
iN EJfIS71NG OP�IINGS QkGS C1No LOC�tTtQN OF WlNDOWS
pg, F(}R NEW OPENIA(CS-DESC�t[B�' S�E� OF
QPEiYirIG CHANG�,S &
TYPE OF WiNL10W Tb BE, llVSTALLED tdlJl�giER Ok �
ALI.�
'OTAL JUB VALC
Pecmit Fee
P1an l�eview
Fire Surcharge
Surcha�r�;e
License Surchar�e
�AC Chargc
Curb Cut Escrow
Erosion Gotttrof
Park Fee
Sewer Main Char�e
ARE BASED ON VAY.Y7A�.'f'�QN, ]
(USy]V�G� 1
r. mt..nr m I t
���
�t �
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�
[71jR,AlN 'CiL�
O 07'HER
�,�.j�+tENT REMOi�ELiNG S_U8M1�
I. TaciBting Flppr Plen
:3. Proposed floor pian
3. List of 5lt'uctLt►81 mcmbc�s to bc used
FOR fi1FsW C:ONS'1"KUCTJON IIVCLUATPiG DEC►cS,
A. D[71�.'LONS. & PORC:HF.S $USM1T:
I. Sita RIanJSurvey ahowins the e�ting structur�s
umf prvposad projoct.
3. 'I'w0 sels of Conslrucfron p1anR
3. �ncr�ry Cu1CU18Ciofls
r•oR w�nviaows - rROV►r��, u-vai.c� nxa
rv�.�rrur•�c� sTrGxFe aN wtt�ruow.
fG TN� GQST OF LABOrR A.►1`+TD MA'I'�RIALS:
FEE SC�DT.TLE)
See :IBsck Page for k ae S�hedule
65%� of �uilding Permit Fee
.OQi times the ta�xl job valuataon
.0045 x Fermit V�luation Minirn�unc� SS-00
�S_t1+0 (State Lic�nsed Residentisk ContractQrs�
$22 �Q per SAC UniC (Plans ta IyLW�C for determir,stion)
ft+bft= ftx$25=$
$45C� CbnservaCion �lar� Review
Fct �eCermined by Engineering
Agr�,�me�at necessary ( j Non Neooas�ry ()
Mak:c chccks aevable to: Cilr� of Fridlev Attac
TFllS JS A1J APPLICATI�N FO[t APERMIT•NOT Vpi,II) (JNTiL PKUClSSY:iI
T hereby apply for a building permit and I aclmawledge that t;lae +nformation above is compl�te and accurat�; that the wark will be in
confarmance with the orciinanees and �odes of t6e City of Fridlew and with the Minnesota Constn,c�ion �ades; that i w►derst�nd this is nat a
permi# but only an applieati far a pe it and work is not to start withou# a p�rmit on site; that rhe wark will be in orc}ance with the
approved plan in the case o work ic uires review and a�pproval of pl s•
SIG13ATt1REOr APPLICA.N'[' F12iNTNAME � Yl DATF, � �
APPRdVAi INSPECTOR SzGNATU _ _ _ _ -' _
PERMi�"S A� R�OU1R�;,D FaR Fr.irnlB]CNG. lE1LEC�+CA,l� ,�r�m