P - 42365Building
Inspections ��`
763-572-3604 C�
763-502-4977 FAX
�� MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-]9-09 __
Permit No.'
Received By: C!��
Da�t�Q� U L. 3 0 2
DATE �u.\ � a� C�-O (� YOUR E-iv1A1L ADDRESS
SITE ADDRESS � DO C.D� S�' N� -
THIS APPLICANT IS: ❑ OWNER �1CONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYFE OF WORK:
DETAILED
NAME: �'Y'v Z � r� r w�-- •
ADDRESS: �..O�OO LO� '�J� 1`�'� CITY �1r� `-e-�( __STATE��ZIP SSy3i.
PHONE: b�a-0�3�' ��0�
coMPA�vYNAME: CENTERPOINT ENERGY
coNTacT pERSON: JOANN ZINKEN
STATE LICENSE # BOND 22013346 EXP DATE
ADDxESS:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN zir55433
PHONE ��3-757-62�9 FAx 763-757-6701
�[NGLE FAMILY ❑ TWO FAMILY
❑ NEW ��PLACEMENT
OF WORK �v�sl- �-��
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE BASED ON $]0.00 PER FIXTURE, RCE�RE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment ]nstalled MFG: �E MODEL: s�' � V� ��00 -!� SIZEBTU C�,_LL'2� ��
MFG: ��� MODEL: �"l I� P A�S a-i.� SIZE/BTU sZ`"{'fl�'l I(p S
MFG: MODEL: SIZE/BTU
l A/C $25.00 FIREPLACE (GAS) $I5.00 _GAS RANGE/OVEN $]0.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 �FURNACE $35.00 _GAS L1NIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15 00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
�
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wil] 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 re,c�uire review and approva] of plans.
�� `�~' ' � PRINTNAME ROGER HOFFHEIN DATE -� -aq - ►o
SIGNATURE OF APPLICANT � ��Q-
City of Fridley
Building Inspections Department /
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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