P - 39990Building 1`/IEC�IANICAI� PermitNo.:'�-�tl� I�b��
InspeCtlons IZESID�+ I�TIAL AI'I'LICA�'ION �e�ei�ed By:
76^-572-3604 CITY OF FRIDLEY Date Rec��r�,��
76�-502-4977 FAX EFFECTIVE 1-1-2011 �b
DATE �'`1 ' t` YOLR E-MAIL ADDRESS
SITE ADDRESS ��� � �S V d ��
THIS APPLICANT IS: ❑ OWNER I�CONTRA.CTOR
PROPERTY NAME: �+('G.�C i S �EY1v"1 C'�''k'
TO NANT ADDRESS: �3,0 ��� C�1�V '� � E CITY �r' i� �'�-�-1 STATE 'V►N ZIP�Z'
PHONE� `I ��j' �( g � - "t 3 av
CONTRACTOR co�Arr�NAME: __�ENTERPOINT ENERGY
SUBMIT A COPY OF corrTncT PExsorr: JOANN ZINKEN
YotrxsTa.TE sra�LicErrsE#BUND #22013346 �DA� 08/20/2011
LicErrsE wiTx ADDx�ss: 9320 EVERGREEN BLVD SUITE B ciTY COON RAPIDS STATEMN zrr55433
apPLrcATTOrr PxoNE 763-757-6202 FAx 763-757-670I
PERMIT TYPE
TYPE OF WORI�:
� SI�IGLb FAMILY ❑ TWO FAlvIILY
❑ NEW �Q REPLACEIvIENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DE CRIPTION OF WORK t.`.� 1 �L t. "'�l.�Y'YL0.�' � t f
.
�c,b��i � 011�"��
FEES ARE BASED ON 510.00 PER FLYTLRE, EYCEPT VVHERE NOTED. FIXTtiRES: (I1��ICATE TOTAL NUMBER OF EACH BELO��
PROVIDE HEAT LOSS C.ALC'S PER M�urUAL J 2006 ASHR?,E HANDBOOK
Equipment Installed MFG: ���`�� MODEL: ��l� SIZEBN �3� OOG
NiFG: �(y�,� MODEL: �I�PiY� O� SIZEBN ��c�►r� �4
MFG: MODEL:
� A/C $25.00 FIREPLACE (GAS} $ I5.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $3 �.00
_BOILER $3�.00 �FURNACE $3�.00
_CHIhINEY LINER �10.00 GAS DRYER $10.00
DUCT WORK $] 0.00 GAS PIPING $10.00
Number of fixtures @ $10.00 `x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 � x $25.00 = $ ��J�C`�5'
Number of fixtures @ $35.00 � x $35.00 = $ �$ • �
State Surcharge = ' $ 5.00
(MINIMUM FEE $40.00) ` Tota1= $ �� � ��
_ SIZEBTU
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
GAS LJNIT HTR $10.00
POOL HEATER $3�.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 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 pertnit 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 of a wor which requires revi and approval of plans.
SIGNATURE OF APPLICANT-- I��b�`�a[�-- . PRININAME JOANN ZINKEN DATE � IQ l I(
APPROVAL INSPECTORS SI(]➢QATURE "
< PLEASE NOTE: SEPARATE PERMITS ARE
DATE
NG; ELECTRICAL AND'MECHANICAL WORK
City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977