P - 42274Building ��a9°�
Inspections
763-572-3604
763-502-4977 FAX
DATE Ul. , �
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SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
ao�d
NAME:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
.03 r�
❑ OWNER
YOUR E-MAIL ADDRES3
1Vt
�7CONTRACTOR
PHONE: �Ilo 3� S-L l' eZ.O Co
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Permit No.
Received By:
D����UG �� 2
TATErviN ZIP � SK3�
CONTRACTOR coMPANYNa,ME: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTACT PExsoN: JOANN ZINKEN _
YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE
LICENSE WITH ADDx�ss:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN Z�P55433
APPLICATION pHONE 763-757-6202 ____ FAX 763-757-6701
PERMIT TYPE
TYPE OF WORK:
DETAILED pESCRI
�SINGLE FAMILY � TWO FAMILY
❑ NEW � REPLACEMENT
OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
�
�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH E OW)
Equipment Installed MFG: �i,1.+t.�.�_ MODEL: �� �=U �p SIZE/BTU ���� dY�
_ ` MFG: �J�_ MODEL: �� P PY103 C� SIZE/BTU OZ � �'�Xl ,
�A/C $25.00
AIR TO AIR EXCHANGEER $15
BOILER $35.00
CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG: MODEL:
. FIREPLACE (GAS) $15.00
FIREPLACE (WOOD) $35.00
�FURNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZE/BTU
GAS RANGElQVEN 510.00
NEW GAS GRILL �10.00
GAS UNIT HTR $10.00
POOL HEATER $35.D0
VENTILATOR E15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pennit 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 application 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��all work which rec�uire review and approval of plans.
SIGNATURE OF APPL[CANT �_�`" � � `�PRINT NAME ROGER HOFFHEIN DATE FS' I�" ( D
._ .. _ .., _
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977