P - 36961�uilding
Inspections
763-572-3604
763-502-4977 FAX
DATE � " oi I " I �
SITE ADDRESS Ln � Cp �
THIS APPLICANT IS:
PROPERTY Np�,�
OWNER/ �D�
TENANT
�IEC�IA�l�ICAL
RESIDEl�TIAL AP�I,ICATION
CIT�' OF FRIDLEY
EFFECTIVE 1-1-2011
❑ OWNER
YOUR E-MAIL ADDRESS
C�rl
�
Permit No.:'
Received By:
D�E'����
T$�IP��J ��
CONTRACTOR co�arrYrra,t�: CENTERPOINT ENERGY
SUBMIT A COPY OF corrTacT rExsoN: JOANN ZINKEN
YOUR STATE sT.a� r.icErrsE # BOND #22013346 E}{p pp'I'E 08/20/2011
LICENSE WITH ,�Dx�ss: 9320 EVERGREEN BLVD SUITE' B ci� COON RAPIDS STATEMN z�55433
APPLICATION pHONE 763-757-6202 F� 763-757-6701
PERMIT TYPE I�LSI�IGLE FAMILY ❑ TWO FAVIILY
TYPE OF WORK: I � ��'�' ��PLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERAT10NfREMODEL
-�ta,.r v� a�:C' � —
FEES ARE BASED ON 510.00 PER FIXTLRE, EYCEPT WHERE NOTED. FIRTLRES: (IIvDICaTE TOTAL NU�iBER OF EACH BELO�
PR04TDE HEAT LOSS CALC'S PER b'IAN J 2��RAE HANDBOOK �e(�.M � b� -��.�
Equipment Installed MFG: MODEL: SIZEBN �
MFG:
MODII.:
MFG: MODEL:
A/C $25.00 FIREPLACE (GAS) $I5.00
_AIR TO AIR EXCHANGEER $►5 FIREPLACE (WO�D) $35.00
_BOILER $3�.00 ✓FfJRNACE $35.00
_CHIhINEY LINER 510.00 GAS DRYER $10.00
DUCT WORK $10.00 GAS PIPING $10.00
__ . __ _ --- -- x$1Q.00=$
x$15.0a=$
x $25.OQ = $
'�'j �
@ $1'
SIZEBTU
SIZE/BT'U
_GAS RANGE/OVEN $10.00
NEW GAS GRILL 510.00
GAS UN1T HTR $10.00
POOL HEATER $35.00
~VEIVTTLATOR $15.00
Number of fixtures @ $35.00 �_ _ x $35.Q0 = $ � � ! ' '
State Surcharge = ` ' $ 5.00
MINIMUM FEE $40.00) Total = $ � � �
TEIIS 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 o e City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicaf for a pe it a wo k is ot to start without a permit; that the work will be in accordance with the
approved pian in the case of all k ch requ' ; v' d approval of plans.
SIGNATUREOFAPPLICANT PRTNTNAME JOANN ZINKEN / � DATE �� /�
PLEASE N
PERMITS
�/City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977