P - 45691Building �p/j�' ��i��i(:l�j_, Permit No,. � ' ` t�
Inspections R�S���i j�'���L ��P��CA'I'I�� l�eceived Byo
763-572-3604 �jTY oF FRIDLEY R r°�� �
763-502-4977 FAX ��� �u
EFFECTIVE 1-1-2011
DATE [� O�LiC% �,, YOL E-MAIL ADDRESS
SITE ADDRESS t�� l I le, '�" �(". �
THIS APPLICANT IS: ❑ OWNER L7CONTRACTOR
PROPERTY NAME: Q1' I� �
OWNER/ �D�SS �� i , ' � CITY �^i^�1 �f..t.,/ STATE 1�ZIP$
TENANT pHONE: ✓I �.0� ' .cj� l • "~I (.oq (�e,
Co1vTRACTOR coNrna�rr�:_ �ENTERPOINT ENERGY
susM�T A coPY oF corrr.acT PExsorr: JOANN ZINKEN
YOUR STATE sTa� LicErrsE a BUND #22013346 EXP DATE O$�ZO�ZO11
LlcErrsE wlTx ADD�ss: 9320 EVERGREEN BLVD SUITE' B ciTY COON RAPIDS STATEMN z�55433
APPLICATION .�- ,.� -., ...
PHONE � Lr,,,s _ .�,'� � ,.; ; .� ,�'� f,. r FAX ' r� ;:. .. ` , Sr ' _ . t� : � '-y r'a
PERMIT TYPE �SINGLE FAI�IILY ❑ TWO F?.i�IILY ❑ TOWNHOUSE
TYPE OF WOR�:: ��W � REPLACEMENT ❑ ALTERATION/REMODEL
DETAILE D SCRIPTION OF WORK C.�.,�. l�.r'►'1, +C.t
_���� t 4Y��E i�
FEES aRE BASED ON 510.00 PER FLYTtiRE, ElCEPT WI-IERE NOTED. FLXTLZtES: (I1��DTCATE TOTAL NUiYIBER OF EACH BELO�i�
PROVIDE HEAT LOSS CALC'S PER bL�urU J 2006 ASHRAE HANDBOOK /_
Equipment Installed MFG: � MODEL: 5 Ii�UCirD� SIZEBTU tQ�� �d �
1vIFG: ��✓- MODEL: a�r N�7o�7 SIZEBTU s2 ��1 �%SL�G
MFG: IvIODEL: SIZEBTU
� A/C $25.00 �FIREPLACE (GAS) $I5.00 _GAS RANGE/OVEN $10.00
_AIR TO AIR EYCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 1FURI�iACE $3�.00 GAS LTNIT HTR $10.00
CHIhINEY LINER 510.00 GAS DRYER $10.00 POOL HEATER $35.00
�DUCT WORK $]0.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures @ $10,00 `x $10.00 = $
Number of fistures @ $15.00 x $I5.00 = $
Number of fixtures @ $25.�0 � x $25.00 = $�5�0'a
Number of fixtures @ $35.OQ � x $35.00 = $ �'s • �
State Surcharge = ' $ 5.00
MINIMCTM FEE $40.00 .Total = $ �� � �a
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and T 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 percnit; that the work will be in accordance with the
approved plan in the case o 1 w ich r ires re ew and approval of plans. ,
SIGNATUREOFAPPLICANT PRINTNAME JOANN INKE DATE �D Z� r�
APPROVAL INSPEC'I"ORS NATURE DATE � 6�
-PLEASE NOTE:' S PARATE PE RE RE UIRED FOR BUILDING, ELECTRI AL D MECHANICAL WORK
City of Fridley
ssuiiaing lnspections �uepartment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977