P - 451083uilding
nspections
� b3-572-3604
ATE t
iTE ADDRESS
HIS APPLICANT IS:
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BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL AD]
(,�a 3 h zn 9�a �1 S1`r
❑ OWNER �ONTRACTOR
'R�t ERTY OWNER/ I ��E:
TENANT �DRESS: S?'T li 4 S �1 f'a� S
PHONE: � � 3 � 7%' � 3�
— _ _ _ __ ----- --
Pella Windows & Doors
N'a�E:_ 15300- 25th Avenue N.- Suite 100
STATE LIC PlyrilOUirl, MN 55447
a�DxESS: �63/ 745-1400
pxoN� License# 20165884
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CONTRACTOR
SUBMIT A COPY OF
YC)UR STATE LICENSE
WITH APPLICATTON
PROPERTY TYP.�
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING PO�L
TY"PE OF WORK: � ��'
�'MAII'
�ESCR.TBE WORK BEING DONE:
IZE OF IMPROVEMENT
OOFING – --- – - - -
UMBER OF SQUARES
ARAGES
ZOPOSED SIZE:
?OPQSED HEIGHT:
:IIING
Viny[
Aluminum
Other
INDOWS
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CITY
�E
. ORIES
Permzt Na.:
Received By:
Q �a/���o�,cs_ ro�
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Jodt m Elc��r Jon� S
45��3ys •_tb��
CITY STATE_ZII'_
❑ DFAIN TILE
❑ OTHER
u tu�vt i ivi�
� REMODELING L� f S ��!A �1'}� � S�• �'!�'2 C�b n!!'l p 4
W �Il (��t,� f �-P (Q u
LENGTH
❑ HOUSE ONLY
❑ HOt7SE & GARAGE
Q ATTACHED GARAGE
❑ DETACHED GARAGE
HEIGHT
n�- nop���,�
A,4 e1!
� Sq. Pt.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List af siructural members to be used
FOR NEW CONSTRUCTTON INCLUDING DECKS,
❑Soffit ADDITIONS & PORCHES SUBMIT•
❑ Trim l. Site Plan/Survey showing the existing strucmres
❑ Fascia and proposed project.
2. Two sets of construction plans
3 Energy Calculations
� EXISTING OPENINGS RJYcs QNo LOCA�'ION OF WINDOWS '
2 FOR NEW OPENINGS-DESCRIBE SIZE OP � a�/1 r o o m
?ENING CHANGES & /
r'PE OF WINDOW TO BE 1NSTALLED D« NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(I1SING TI�E 1997 U.B.0 FEE SCHEDULE)
. TOTAL JOB VALUATION $_ ��7 g 7 OCCUPANCY TYPE
;rmit Fee $ L 3. / 5�• See Back Page for Fee Schedule
an Review $ 65% of Buitding Permit Fee
!_rcharge $ • 0 (.0005) times the total job valuation — Minimum $.50
r-e S�.n-charge $ /, � � .001 x Pez-mit Valuation (1/10%)
cense Surcharge $ '$ - �� $5.00 (State Licensed Residential Contractors)
�C Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
.u-b Cut Escrow $ ft+ 6 ft = ft x$20 =$
�osion Control $ $450 Conservation Plan Review
�rk Pee $ Fee Determined by Engineering
:wer Main Charge $ Agreement necessary () Non Necessary ()
�tal Due � "l n_ 9�i' Make checks aavable to: Citv of Fridlev AtfacF� Stinulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
:�ereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work wi�l be in
nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
3.n in the case of all work which requires re ie and approval of plans. rJ
sNATURE OF APPLICAN � -'� PRiNT NAME ( l i � ! � L � `� i ! � DATE T � � � � /