P - 84358Building
Inspections �,�
763-572-3604 �`�
763-502-4977 FAX
DATE 10� I� � I Z-
SITE ADDRESS �L�VI �
THIS APPLICANT IS:
;� MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECI"IVE 1-1-2012
w YOUR E-MAIL ADDRESS
O OWNER ❑CONTRACTOR
PROPERTY N�: ror
ONNER/ �.DD�tESS:�4't 5
TENANT pHONE: `I l0'3 •
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PermitNo.:�(�"a'�E 73U(0
Received By:�y��
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CONTRACTOR co�.a�rrr.aME: CENTERPOTNT FNFRGY
SUBMIT A COPY OF corrrACT PExsorr: JOANN ZI NKEN
YOUR STATE STATE LICENSE # 2201 3346 EXP DATE 08�2��2012
LICErrSE vv�Tx �D�ss: 9320 EVERGREEN BL NW SUITE B crrY COON RAPIDS STATE��ZIP55433
APPLICATION pHONE 763-785=5404 F.� 763-785-5400
PERNIIT TY'PE
TYPE OF WORK:
�SINGLE FAMILY � TWO FAMII.Y ❑ TOWNHOUSE
❑ NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �.hS�G,« i I�� �.oQ�G `�t.f` �AC C C�•Y� G� 0.� r
_��-j;�iane r
FEES ARE BASED ON 510.00 PER FLYTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NLTi�IBER OF EACH BELO�
PRO�'IDE HE.�T LOSS CALC'S PER Vf.��JA� J 2006 ASHR�,E HANDBOOK.
Equipment Installed MFG: �'�rtCr t e N^ MODEL: � i1�i� 7�0$ � SIZE/BTU $C � 0O0
MF'G: r� t1:{� MODEL: ��I �N17�q� SIZEBN 3�OA �L•5 SC!
MFG: MODEL: SiZEBN
�A/C $25.00 _FIREPLACE (GAS) �15.00 _GAS RANGE/OVEN S10.00
AIIt TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRII,L $10.00
BOILER $35.00 ,1FURNACE 535.00 _GAS UNIT HTR 510.00
CHIIvINEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures @ $10.00 x $10.00 = $ '
Number of fixtures @ $15:00 x $15.00 = $ '
Number of fixtures (a 525.00 � x $25.00 = $ .��'�" � �
NnmhPr nf fi�mirPC (n� �i5_n(1 { ' x P�5 nQ = � . ' '�9�i��i
CtatP Cnrr.harve =
I hereby apply for a building pez
conformance with the ordinances
not a permit but only an appli
approved plan in the case o�
SIGNATURE OF APPLICANT
APPROV.�L, INSPECTORS SI . i
' PLEASE NOTE:' SEP �
and
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o a
$ 5.00
%� : � �� � t'L � CYlI� �c�v'� ' J.�C'�C� u� -c? cj `�,f�f C� v.Y'c� �.
,ICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
wledge that the information above is complete and accurate; that the work will be in
e City of Fridley and with the Minnesota Construction Codes; that I understand this is
and work is not to start without a permit; that the work will be in accordance with the
res revi and approval of plans.
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PRiNTNAMF JOANN 7TNKEN ra�A� O�/��lL
b 1' J AKb tC� UlKbL t'VtC tSU11:U1NlT, �LbC,liCll:,
City of Fridley
uilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977