P - 40824Building
Inspections
763-572-3604
763-502-4977 FAX
��\' � �
RESID�NTI�I, APPLICATION
CITY OF FRIDLEY
EFFECTTVE 1-1-2011
Permit No.:
Received By:
D �Yi�� 9 �. �
DATE I� \�\ �� l YOL�R E-MAIL ADDRESS I
SITE ADDRESS � �nd� � � �� 1V C
THIS APPLICANT IS: ❑ OWNER �SCONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
NAME: (� l ��� i C�'�1'1
.aDDx�ss: `ll.oCS`� �-`'-" `�- �i� ci-rY �-r ,d 1-e�� sTaT�1 Yj 1Nz���
PHONE: —I.�03 ` � � a ' i � C� �
co�A�rr.a�:_ �ENTERPOINT ENERGY
corrT.acTPExsoN: JOANN ZINKEN
srn� LicErrsE� BUND #22013346 EXP DATE �8�2��2�11
aDDxESS:9320 EVERGREEN BLVD SUITE'B ciTY COON RAPIDS sTaTEMN z�55433
PHONE ���'" ��� � S��%U �{ FAX G�� - 7�S -S�% O C�
�SINGLE FAIvIILY ❑ TWO FAiv1ILY
❑ NEW �PLACEMENT
« �
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILE ESCRIPTION OF WORK �S�c,�.�.` I 1'�EK�I�Cr �`�itX.u�� �- 1��(1 C�,� C3l..t`l� Qt r
C�c)�(1,�►�\Orl � �:
FEES ARE BASED ON 510.00 PER FL�TLTtE, EYCEPT WHERE NOTED. FIXTtiRES: (In�ICATE TOTAL NUVIBER OF EACH BELO��
PRO�IDE HEAT LOSS CALC'S PER D7ANL� J 2006{�SHR�E fLaNDBOOK
Equipment Installed MFG: �\LWd MODEL: � 2� � SIZFj�/�N ���G
IvfFG�� NIODEL ��'P`'Y1 '� c� � SIZEB ��►rl I
MFG: MODEL:
�A/C $25.00 _FIREPLACE (GAS) $15.00
_AIR TO AIR EYCHANGEER $15 _FIREPLACE (WOOD) $3�.00
_BOILER $3�.00 �FURNACE $3�.00
CHIIvINEY LINER $10.00 GAS DRYER $10.00
DUCT WORK $10.00 GAS PIPING $10.00
Number of fixtures' @ $10.00 x $10.0a = $
Number of fix:urea @ $15.00 x $15.00 ° $
Number of fixtures: @ $25.00 � x $25.00 = $�� �
Number of fixtures @ $35.00 � x $35.
State Surcharge =
(MINIMUM FEE $40.00y'. Tota1= $ �
00=$ 3�J ��
5.00
. ��
SIZEBTU
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
GAS LTNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowiedge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes o ity of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but oniy an app 'cation a pe it and ork is not to start without a permit; that the work will be in accordance with the
approved plan in the case 11 wo w'ch r quires r ie and approval of plans.
SIGNATURE OF APPLICANT �PRINT NAME JOANN NKE DATE � l
APPROVAL INSPECTORS 3�GNATURE
" PLEASE NOTE: SEPARATE )
� �' DATE
E ITS RE UI FOR BUILDING, ELEC C.
City of Fridley
lding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
MECHANICAL WORK