P - 42209Building 1VIEC�I�.NI�AI..
Inspections �SII)ENTIAI, APP�ICATION
763-572-36�?4 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-I-2011
DATE �'t � � ` � � YO(U�R E-MAIL ADDRESS
SITEADDRESS�r��`�L` r� S�' "a��
THIS APPLICANT IS: ❑ OWNER L�ICONTRACTOR
PROPERTY NAME: � �'1 'C
Permit No
Received By:
��� � �
� NAN� ���ss: lo C�S� 3g=�-� �-� 1�� ci-r�r F r�� 1-�-t srAr� 1�� SS 3:
PHONE: �I���J `� �5 � U �C��
CONTR�,CTOR co�ArrYrr�: CENTERPOINT ENERCY
SUBMIT A COPY OF coNrACT PExsoN: JOANN ZI NKEN
YOUR STATE sTA� LicEr�TsE # BUND #22013346 E�{p DA'I'g �8�2��2011
LICENSE WITH ,e,DDx�ss: 9320 EVERGREEN BLVD SUITE' B crrY COON RAPIDS srArsMN z�55433
APPLICATTON pHONE 763-757-6202 FAx 763-757-6701
PERMIT TYPE ��GLE FAMTLY ❑ TWO FANIILY
TYPE OF WORK: � ��'�' ��PLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
� ALTERATION/REMODEL
Id►'1E'1�
FEES ARE BASED ON 510.00 PER FLYTIIRE, EYCEPT V1'HERE NOTED. FIXTL'RES: (In�ICATE TOTAL NUVIBER OF EACH BELOti�
PROVTDE HEAT LOSS C.ALC'S PER M�u�iUAj�, J 2006 ASHRAE HANDBOOK r' '^
Equipment Installed MFG: ��,Y'� 1 L-° j�' MODEL: :�-f ry�� �� SIZFJBTU 6Z�Y1 `� S5�
MFG:
MODEL:
MFG: MODEL:
�A/C $?�.00 _FIREPLACE (GAS) $1�.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00
BOILER $35.00 FURNACE $35.00
CHIhINEY LINER $10.00 GAS DRYER $]0.00
DUCT WORK $10.00 GAS PIPING $10.00
Number of fixtures' @ $10.00 x $10.00 = $
Number of fi.Ytures @ $15.00 x $I5.00 = $
Number of fixtures @ $25.00 L x $25.00 = $ �� - �
Number of fixtures @ $35.00 x $35.00 = $
SIZEBTU
SIZEBTU
GAS RANGE/OVEN SI0.00
�NEW GAS GRiLL $10.00
GAS LTNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
State Surcharge = ` $ 5.00
MINiMUM FEE $40.00 Tota1= $ `�� � ��
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
_I hereby -apply for a buildin� permit and -I acknowled�e that the information above is complete-and accurate; that the wock wi1L be -in-
conformance with the ordinances and c of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a pe it and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of wo which re 'r rev' w and approval of plans.
.
SIGNAT'UREOFAPPLICANT �r%/1�I __ _PRINTNAME �QAN�_-�II�KEN_—�D� 7 �� �
APPROVAL
' PLEA1
TE
DA
"' City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
WORK