P - 36709Building
Inspections
763-572-3604
763-502-4977 FAX
DATE 1 \' G
SITE ADDRESS �
THIS APPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
❑ OWNER K7CONTRACTOR
PROPERTY I�IAME: .. I.a..f1 �
OWNER/ ,�D�ss: l�'� � �ar��ha p
TENANT pHONE: �I tD3 • a c�21 •��q �`
Permit No.
Received By:
Date��'�i:�
ATE��ZIP
i ' � �,�j1
CONTRACTOR coMPn.NYNa.ME: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTACT PeRSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # 80ND 2201334 EXP DATE Y
LICENSE WITH ,e,DDx�ss:9320 EVERGREEN BLVD NW SUITE B ci�nrC00N RAPIDS STATE MN ZTp55433
APPLICATION pHONE 763-%57-62�2 FAX 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�SINGLE FAMILY ❑ TWO FAMILY
0 NEW i�REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
� ALTERATION/REMODEL
FEES ARE BASED O1V SI0.00 PER FIXTURE, XCEPT WHERE NOTED. FIXTURES: (I DICATE TOTAL NUMBER OF EA BELOW)
Equipment lnstalled MFG: �'y.r�$ �` MODEL: s rn�,e�Q(QQ' ��{ SI TU ,�.��
MFG:
MODEL:
S1ZE/BTl1
MFG: MODEL: SIZE/B'I'U
_A/C 525.00 . _FIREPLACE (GAS) 515.00 GAS RANGE/OVEN 510.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00
BOILER 535.00 �FURNACE 535.00 �GAS UNIT HTR 510.00
_CHIMNEY LINER 510.00 _GAS DRYER 510.00 �PdOL HEATER 535.00
DUCT WORK 510.00 _GAS PIPING 510.00 ,VENTILATOR 515.00
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 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 whi h r uire review and approval of plans. �
SIGNATURE OF APPLICAN�'I'�1 �" �� �� �PRINTNAME ROGER HOFFHEIN DATE �N l�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977