P - 42143Building MECI�ANICA�
Inspections ��S�DENTIAL APPLICAT�ON
763-572-3604 CITY O� FRIDLEY
76�-502-4977 FAX EFFECTIVE 1-1-3011
DATE � ` I '
SITE ADDRESS _
THIS APPLICANT IS.
PROPERTY
OWNER/
TENANT
-l1
� � �
❑ OWI3ER
NAME:�
EwDxESS: �S
YOUR E-MAIL ADDRESS
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r
Permit No.:
Received By: ��_
Date��: A PR 2 5 2 11
CONTRACTOR coNrnAx�rr�: CENTERPOINT ENERGY
sUStvIIT A coPY oF corrr.acT PExsoN: JOANN ZI NKEN
YOUR STATE sTA� Lic�rrsE # BOND #22013346 Ej� DATE �8�2��2�11
LICENSE WITH ,�Dx�ss: 9320 EVERGREEN BLVD SUITE ` B ciTY COON RAPIDS STATEMN z�r55433
APPLICATION pHONE 763-757-6202 F� 763-757-6701
PERMIT TYPE �SINGLE FAMILY ❑ TWO FA�VIILY ❑ TOWNHOCJSE
TYPE OF WORK: � �w �LEPLACEMENT ❑ ALTERATIOAI/REMODEL
DETAILED DESCRIPTION OF WORK
'r- C v r�td �� i cm,�r'
FEES ARE BASED ON SI0.00 PER FI�YTURE, EYCEPT WHERE NOTED. FIXTtiRES: (Ir�ICATE TOTAL NUA�IBER OF EACH BELO��
PROVIDE HEAT LOSS C.4I,C'S PER MA1ViJAI,, J 2006 ASHRAE HANDBOOK J
Equipment Installed MFG: ��„4, -� MODEL:��{��'Yi— �e�� SIZE/BN O�T011 16
MFG:
MFG:
�AIC $25.00
�AIR TO AIR EXCHANGEER � 15
BOII.ER $35.00
CHIIvINEY LINER $10.00
DUCT WORK $10.00
00 a
MODEL: SIZEBN
MODEL: SIZE/BTU
,FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00
�FIREPLACE (WOOD) $35.00 _NEW GAS GRILL 510.00
FURNACE $35.00 GAS LTNIT HTI2 $Ia.00
GAS DRYER 510.00 POOL HEATER $35.00
GAS YIPING $10.00 VENTILATOR $15.00
_$
Number of fixtures @ $15.00 x $15_00 = $
Number of fixtures @ $25.00 � x $25.00 = $ �. � �
Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = ' ` $ 5.00
MINIMUM FEE'540.00 Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby-apply for a buildin� permit and_ I acknowled�e that #he information above is .complete-and accurate; that the work-will be in - ---.
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicatio for permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of 1 w k whi re u' es rev' w and approval ofplans.
SIGNATURE OF APPLICANT PRINT NAME JOANN ZII�KEN � �a� /9'/��
�
EPARATE P RE RE UIR$D FOR BUILDING, ELECTRI AL
� � City of Fridley
uilding Inspections Department
6431 University Avenue NE, Fridley, MN �5432
763-572-3604 FAX: 763-502-4977