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CITY OF EDINA
CITY OF EDINA
4801 50
th
Street West, Edina, MN 55424-1394
Building Inspections Department

(952) 826-0372 FAX (952) 826-0389 TDD (952) 826-0379
www.ci.edina.mn.us

PERMIT NUMBER


HERITAGE LANDMARK
CASE NUMBER

for office use only
Siding Permit Application
PRINT OR TYPE APPLICATION


Site Information
Address_____________________________________________________________ Suite/Unit number_________________
Lot________________ Block_________________ Subdivision_________________________________________________
Tenant/Building name__________________________________________________________________________________
Is a variance required?
Yes
No If yes, provide Planning Department case number____________________________


Work Description
Proposed starting date____________________________________ Completion date________________________________


1 New
2 Addition
3 Alteration
3 Remodel
4 Repair
4 Replace
Single Family Detached
3&4 Family Residential
Recreation/Amusement
Private School
Single Family Attached
5 & More Residential
Grade/Fill/Excavate Only
Church/Religious Bldg
Residential Garage/Addn
Office/Warehouse
Demolition Single Family
Hospital/Institutional Bldg
Residential Addition/Porch
Restaurant
Demolition 2 Family
Antenna/Tower/Dish/Etc.
Residential Deck/Shed
Office/Bank/Professional
Demolition 3&4 Family
Other Nonresidential Bldg
Reroof
Retail Store
Demolition 5&More Family
Pools
Interior Remodel
Hotel/Motel
Other Demolition
City Owned
Basement Finish
Parking Garage/Ramp
Industrial Building
Heritage Landmark District
2 Family Residential
Service Station/Repair Garage
Public School
Retaining Wall
Job Description_______________________________________________________________________________________
____________________________________________________________________________________________________
Construction
I-A
I-B
II-A
II-B
III-A
III-B
IV-HT
V-A
V-B Fire Sprinklered
Yes
No
Energy Code Compliance:
option (a)
option (b) - submit Energy Code Worksheet with this application

Valuation
Applicant is

Owner
Contractor
Designer



Contractor Information
Company name____________________________________________ MN Contractors License #_____________________
Address______________________________________ City____________________________ State_____ Zip_________
Contact person name____________________________________________
Phone____________________Cell______________________ EMail________________________Fax__________________

Designer Information
Company name____________________________________________
Architect
Engineer
Designer
Address______________________________________ City____________________________ State_____ Zip_________
Contact person name_____________________________________ MN License/Registration #________________________
Phone____________________Cell_______________________Email________________________Fax_________________

COMPLETE APPLICATION ON REVERSE SIDE
Owner Information
Name_______________________________________________________________________________________________
Address_____________________________________________________________________________________________
City____________________________________________________ State__________ Zip__________________________
Phone____________________Cell_______________________Email________________________Fax_________________


Applicant Signature
I hereby apply for a permit and attest to the following:
All information on this application is complete and accurate.
All work will comply with Edina City Code and Minnesota State Building Code.
I understand this is an application only, not a permit. Work will not start without an approved permit.
All work will be done according to plans approved by the City of Edina when approved plans are required.
Erosion and sediment control, when applicable, will be installed before starting work.


Existing grades and drainage will not be altered without approved grading/drainage plans and schedule.
Applicants signature_________________________________________________ Date_____________________________
Applicants printed or typed name________________________________________________________________________

Owner/Applicant Statement
-

To be completed only when the homeowner is the permit applicant
I understand the State of Minnesota requires residential contractors, residential remodelers and residential roofers be licensed to work in
the State unless they qualify for a specific exemption from the licensing requirements. By signing this statement, I certify that I am building
or improving this dwelling myself. I claim to be exempt from state licensing requirements because I am not in the business of building on
speculation or for resale. I certify I have not built or improved any other residential structures in the State within the past twenty-four
months. I also acknowledge that, because I do not have a state license, I forfeit any mechanics lien rights to which I may otherwise have
been entitled under MS 514.01.

I further acknowledge I may be hiring independent contractors to perform certain aspects of the improvements on this dwelling, and I
understand some of these contractors may be required to be licensed by the State. I understand unlicensed residential contracting,
residential remodeling and residential roofing activity is a misdemeanor under Minnesota law, and I forfeit my rights to reimbursement from
the Contractors Recovery Fund in the event any contractors I hire are unlicensed
.

Homeowners signature_____________________________________________________ Date_______________________

Homeowners typed or printed name_______________________________________________________________________

Contact the Minnesota Department of Commerce, Enforcement Division to determine if a contractor is licensed or exempt or to check on
contractor status. Metro 651-296-6319, Outstate: 1-800-657-3978 or www..state.mn.us and follow links to License Lookup


Approvals

for office use only

Building Inspections Dept
By_____________________ Date___________________
Engineering Dept
By_____________________ Date___________________
Planning Dept/Heritage Preservation Board
By__________/___________ Date_________/_________
Health Dept
By_____________________ Date___________________
Fire Dept
By_____________________ Date___________________
Assessing Dept
By_____________________ Date___________________


Fees

for office use only

Permit fee
Yes
No ___________
Plan review fee
Yes
No ___________
State surcharge
Yes
No ___________
Contractor license fee
Yes
No ___________
Investigation fee
Yes
No ___________
SAC fee
Yes
No _____# of units ___________
Sewer assessment
Yes
No ___________
Water assessment
Yes
No ___________
Sewer REC
Yes
No ____# of units ___________
Water REC
Yes
No ____# of units ___________
______________________ ___________
TOTAL _________________
G:\forms\appl-BLDSide-r6 G:\BuildingSafetyPoliciesInformation\Current\BS023B-ExtFinish-032708-r0.doc



Purpose: Provide information to contractors about City exterior finish permit requirements.

Scope: Applies to all structures to which exterior finish materials are being applied.
Exception: A separate permit is not required for exterior finish installation if the installation is
included with an existing building permit.

The following are items contractors and customers should be aware of regarding your residential exterior finish projects and the
building codes.

INSPECTIONS: Two inspections are required, the weather barrier, lathing (if applicable) and the final. Inspections will not be done unless
the Permit and Inspection Record are posted on the site. Failure to complete required inspections is a violation of the building code. A
violation of the building code is a misdemeanor.

ELECTRICAL PERMIT: Electrical permit is required. Final approval of the electrical permit is required prior to final inspection of the
exterior finish permit.

SHEATHING PAPER: Approved weather resistive sheathing paper (house wrap) shall be installed underneath the exterior finish and taped
or sealed to windows and doors jambs.

SIDING MATERIAL: All exterior finish material must be of weather resistant material and installed in accordance with the manufacturers
specs and the building code (be aware of code requirements for clearance to roofing, grade and solid surfaces).

FLASHING: Flashing must be installed over all exterior openings, continuously above all projecting wood trim and kick out flashing at wall
and roof intersection. Casing beads and weep screed required for stucco finishes. Corroded, existing flashing must be replaced.

CAULKING/SEALING: Caulk and/or seal all exterior penetrations and around windows and doors.

BACKING MATERIAL: All backing material must be approved for such use.