P - 48129Building �D
Inspections � w �
763-572-3604
763-502-4977 FAX
DATE � Lo ��
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
1VIECI�ANICAL
RESIDENTIAL APPLICA'I'ION
CITY OF FRIDLEY
EFFECT'IVE 1-1-2011
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❑ OWNER ISCONTRAC"
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Permit No.
Received By:
Date ec'd:
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CONTRACTOR coMrArrYrr.�: CENTERPOINT ENERGY
SUBMIT A COPY OF corrra.cT P�zsorr: JOANN ZI NKEN
YOUR STATE sTn� LicErrsE # BOND #22013346 � DA� 08/20/2011
LICENSE WITH ,�D�ss: 9320 EVERGREEN BLVD SUITE' B crrY COON RAPIDS STATEMN z�55433
APPLICATION PxoNE 763-757-6202 F� 763-757-6701
PERMIT TYPE � sII�tGLE Fa1vIILY ❑ Tw0 FAIvIIr.Y ❑ TowNHOUSE
TYPE OF WORK: � ��' � �PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DE�SCRIPTION OF WORK s.v,s}�.� � K•e.�la�e.e �c�rrtc�.� r C.Zlrl d Q.i f'
--- n ��i .� i �rt e �' •
FEES ARE B.�SED ON 510.00 PER FI�YTIIRE, EYCEPT WHERE NOTED. FIJ�TL?RES: (Ir�ICATE TOTAL NUb1BER OF EACI-I BELOW)
PROV�E HEAT LOSS CALC'S PER NL�rti J 2006 ASHRAE HANDBOOK ,�
Equipment Installed MFG: MODEL: 5sm, Ue ��Q� SIZE/BTU _ ���'� ��
MFG: �n.v r�`ei1� MODEL: �(t 1� P 14� OZ-�% SIZE/BN �:L�on �%
NffG: MODEL: SIZEBTU
,lA/C $25.00 _FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $ IS �FIREPLACE (WOOD) �35.00 _NEW GAS GRII.L 510.00
BOII.ER $35.00 �FURNACE $3�.00 _GAS UNIT HTR $10.00
CHIhINEY LINER $10.00 GAS DRYER �10.00 POOL HEAI'ER $35.00
DUCT WORK $I0.00 GAS PIPING $10.00 VEtv'TILATOR $i5.00
Number o f `fixtures' @ $10.00 x $10.00 = $
Number of fixtvres'@ $15.00 x
Number of fixtures, @ $25.00 � x
Number of fixtures @ $35.00 � x
State Surcharge = '
>15.00 = $
i25.00 = $���
>35.00 = $ �� ►�
' $ 5 00
MINIMUM FEE'$40.00 Total = $ � . ��
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNfIL PROCESSED
I heraby-apply for a buildin� permit and I acknowledge that Yhe information-above-is complete. and accurate; that the workwillbe 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 applicatio a per 't and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of wor' wh' h ires review nd approval of plans.
SIGNATURE OF APPLICANT ~ NAME JOANN ZINKEN�LDATE 3� �0���
PLEASE NOTE: :S�PARATE P
�:'IIT L'!`Tb°rIFAT�''
City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977