P - 41796Building
Inspections
763-572-3604
763-502-4977 FAX
DATE 6�`'—'
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-I-2011
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❑ OWNER �lCONTRACTOR
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Permit No.:�
Received By: �
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CONTRACTOR coivrnArrYrr.�: GENTERPOINT ENERGY
SUBMIT A COPY OF corrrACT PExsorr: JOANN ZI NKEN
YOUR STATE STATE LICENSE # BOND #2201334G EXP DATE �8�2��2�11
LICENSE WITH ,a,DDx�ss: 9320 EVERGREEN BLVD SUITE' B crrx COON RAPIDS srA�MN z�55433
APPLICATION PHO� 763-757-6202 F� 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�SINGLE FAMILY ❑ TWO FAi�ID..Y
❑ NEW �„REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
�
FEES ARE BASED ON SI0.00 PER FIXTURE, EYCEPT WHERE NOTED. FIk"TURES: (IN�ICATE TOTAL NUMBER OF EACH BELOV►�
PROVIDE HEAT LOSS CALC'S PER MANU 2006 A HANDBOOK +�
Equipment Installed MFG: MODEL:� C pN — 0 J SiZE/BTU Z S, 0 0�
. MFG: MODEL: SIZEBN
MFG: MODEL: SIZEBTU
_A/C $25.00 FIREPLACE (GAS) $15.00 �GAS RANGFIOVEN $]0.00
AIl2 TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00 NEW GAS GRII.L $10.00
BOILER $3�.00 �URNACE $35.00 _GAS LTN1T HTR 510.00
CHI1vINEY LINER $1�.Q0 GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $13.00
Number of fixtures' @ $10:00 'x $10.00 = $
ttures @ $25.00 'x $25.00 = $ '
. �..� ��"h
State Surcharge = I $ 5.00
(MINIMUM FEE $40.00) Tota1= $ �� ' �� '
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNPIL FROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an appiication for a 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 all rk 'ch req �es review d approval of plans.
SIGNATURE OF APPLICANT �� � , NAME A DATE ' r�, �
APPROVAL INSPECTORS SI ATURE DATE J ` �
`' PLEASE NOTE:
�{�J City of Fridley
, Building Inspections Departrnent
643 ] University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977