P - 40100�uilding l��C�I�l\II�AI� permit Ivo.:�' U . �
Inspect�ons �+ SI��N�TIAI� A�'PLICAiIOPl`T �e�ei�ea By: G� '
�6�-s72-�604 CITY OF FRIDLEY Dat�t�:
763-502-4977 FAX
EFFECTTVE 1-1-2011
DATE �" � a��� OUR(� E�-VL4IL ADDRESS
SITEADDRESS ��tipS b��� • \V��
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NAME: � 0.,e r�� h0 �
OWNER/ ADDRESS:wirC�aS �b,C- �- �t+ CITY � � STA'T�il�vZIPSSy�
TENANT pHONE: � (� ( a•''�j�0' y�3�
CONTRACTOR co�rnArr�NAME:_ CENTERPOINT ENERGY
sc�MIT a coPY oF corrT.acT PExsorr: JOANN ZI NKEN
YOUR STATE sTa� LicErrsE# BOND #22013346 EXP DATE �8�20�2�11
LicErtsE w1`rx ADD�ss: 9320 EVERGREEN BLVD SUITE B ciTY COON RAPIDS sTarEMN z�r55433
.�PLicaTTOrr PxoNE 763-757-6202 FAx 763-757-6701
PERNIIT TYPE �snvGLE Fr�LY ❑ Two Fv��,Y ❑ TOwM-tousE
TYPE OF WORK: � �v'' ��PLACEIviENT ❑ ALTERATIONlREMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON 510.00 PER FLYTL'RE, ElCEPT WiiERE NOTED. FIXTLZtES: (Ii��ICaTE TOTAL NUVIBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER NIANUAL J 2006 ASHI2AE HANDBOOK.
Equipment Installed MFG: MODEL: SIZEBTU
MFG: MODEL: SIZElBTU
MFG; MODEL: SIZEBTU
_A/C $25.00 _FIREPLACE (GAS) $1�.00 _GAS RANGFJOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $3�.00 ��F �ACE $3�.00 _GAS UNIT HTR $10.00
CHINfI�EY LINER �10.00 `TiAS DRYER $]O.00�cp�aosr,� en �' POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures' @ $10.00 �_ x $10.00 = $ 'l O �
Number offixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = ' $ 5.00
MINIMUM FEE $40.00) Total = $ � � • �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a buildin� 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 permit but only an appli tion 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 11 or hich requires view d approval of plans.
SIGNATURE OF APPLICANT NAME JOANN ZIN FN Dn� �L/��
APPROVAL INSPECTORS SI ATURE DATE �/ G
PLEASE NOTE:' SEPARATE P I ARE RE IRED FORBUILDING, ELEGTR CA D MECHANICAL WORK
City of Fridley
uilding Insnections Deoartment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977