P - 48166Building MECHANICAL Permit No.:' u ��x1 �
Inspections RESIDENTIAL APPLICATION Received By•
763-s�2-3604 CITY OF FRIDLEY D��'�'� �'� �` �� e�
76�-5�2-4977 FAX EFFECTIVE 1-1-2011
DATE ��31 �� � YOUR E-MAIL ADDRESS
S� �D�SS �1 S a b\,� 5� lU�
TI-II3 APPLICANT IS: ❑ OWNER I�CONTRACTOR
PROPERTY NpME: ..e� �� (p,�
OWNER/ twDxESS: —t 5 a$ �{o`� S`� C�t CITY r ��` s-rA��z�55U 3�
TENANT
PHONE: '-1(��j ` �I g U " � �
CONTRACTOR co�a.rrrrr�: GENTERPOINT ENERCY
SUBIvIIT A COPY OF corrTACr PExsorr: JOANN ZI NKEN
YOUR STATE sT.a� LicErrsE a BOND #22013346 EXp DATE 08/20/2011
LICINSE WITH ,s,DDx�ss: 9320 EVERGREEN BLVD SUITE' B' crrY COON RAPIDS STATEMN z�55433
APPLICATION PHONE_'11o3-'1g5'SLIUy FAX_ —I,lc�3'"'is5`�'S�iCX% -
PERMIT TYPE ��GLE FAMILY � TWO FAIvIII.Y ❑ TOWNi30USE
TYPE OF WORK: � �W ��PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �6�c�.�`-\' �p�C �. �wr�c "�--
FEES ARE BASED ON 510.00 PER FIXTL'RE, EYCEPT WHERE NOTED. FIkTL'RES: (I1��ICATE TOTAL NUNIBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MAi�iU T 20A�.`ir� AS �HRAE HANDBOOK C� �. Du �j �D � �p (7 OCX�
EquipmentInstalied MFG: L' �'E'- MODEL: � S BN 1
MFG: MODEL: SIZEBTCT
MFG: MODEL: SIZF./BTU
_A/C $35.00 FIREPLACE (GAS) $15.00 _GAS RANGElOVEN $10.00
AIR TO AIIt EXCHANGEER $15 . FjREPLACE (WOOD) $35.00 NEW GAS GRII.L $10.00
�BOILER $35.00 ✓�URNACE $35.00 _GAS LTNIT HTA $10.00
CHIIvINEY LINER S 10.00 GAS DRYER $10.00 POOL HEP.TER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $T5.00
Number of fixtures @ $10.00 ' ' x $10.00 = $ `
Number of fix:ures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 � x $35.00 = $ �� ` �
State Surchazge =' $ 5.00
; �--� ..�
MINIMUM FEE 540.00 Tota.i $ � � `��
.___�_.._
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby appty for a buiiding 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 applicati a perm' nd work is not to start without a permit; that the work will be in-accordance with the
approved plan in the case of or h� re ' es review and approvai of plans.
SIGNATURE OF APPLICANT • � NAME A DATE ���
APPROVAL INSPECTORS S ATURE DATE �� �
PLEASE NOTE: SE P ARE RE UIRE FOR BUILDING, ELE T'RI AL AND MECHANICAL WORK
City of Fridley
, uilding Inspections Department
431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977