P - 36962Building
Inspections
763-572-3604
763-502-4977 FAX
DATE N pV �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
��,( �3q3CITY OF FRIDLEY
EFFECTIVE 2-] 9-09
� O YOUR E-MAIL
❑ OWNER KICONTRACTOR
Permit No.
Received By:
CONTRACTOR coMPaNYNa,MB: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTACT PERSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 01334 EXP DATE
LICENSE WITH ADnx�ss:9320 EVERGREEN BLVD NW SUITE B ciTVC00N RAPIDS sTATE MN ZIp55433
APPLICATION pHONE 763-757-6202 FAX 763-757-6701
PERMIT TYPE ��NGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: I� NEW �REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
O ALTERATION/REMODEL
FEES ARE BASED ON 510.00 PER FIXTUR�CEPT ERE NOTED. FIXTURES: I�QT,AL NUMBER OF EACH BE W)
Equipment ]nstalied MFG: � MODEL: djo SIZEIBTU ��0
MFG: MODEL:
MFG: MODEL:
A/C 525.00 . FIREPLACE (GAS) S 15.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00
BOILER 535.00 �CJRNACE 535.00
CHIMNEY LINER S 10.00 GAS DRYER S 10.00
DUCT WORK 510.00 GAS PIPING 510.00
S1ZE/BTtJ
SIZE/BTU
GAS RANGE/OVEN 510.00
NEW GAS GRILL 510.00
GAS UNIT HTR S 10.00
POOL HEATER 535.00
VENTILATOR S15.00
THIS IS AN APPL1CATlON 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 which r uire review and approval of plans. �
w�y� ¢..fl,e � � � �
SIGNATURE OF APPLICAN �"1- PRINTNAME ROGER HOFFHEIN DATE D
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-497?