P - 36937V1
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATHpL�y�"(� / /
SITE ADDRESS �;
THIS APPLICANT IS:
PROPERTY NAME;
OWNER/ �D�
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
YOUR E-MAIL ADDRESS
❑ OWI�TER L�}CONTRACTOR
Permit No::
ate
CONTRACTOR co�ArrYx.�: CENTERPOINT ENERGY
SUBMIT A COPY OF coNra,cT P�zsorr: JOANN ZINKEN
YOUR STATE sTA� LlcErrsE # BOND #22013346 �{p Dp'� 08/20/2011
LICENSE WITH ,e,DDx�ss: 9320 EVERGREEN BLVD SUITE: B ciTY COON RAPIDS STATEMN z�55433
�PLicaTTOrr PHO� 763-757-6202 F� 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�'i�GLE FAMILY � TWO FAI�IILY
❑ NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK
O TOVJNHOUSE
Cf7►�TERATION/REMODEL
FEES ARE BASED ON 510.00 PER FIXTURE, E�CEPT WHERE NOTED. FIXTLZ2ES: (I1v�ICATE TOTAL NUNIBER OF EACIi BELOW)
PROV�E HEAT LOSS CALC'S PER MANUAL J 006 AS Iir+.NDBOOK � � p
Equipment Installed MFG: MODEL: �.�l��j SIZE/BTU _ lXJ� QQ�
-
MFG: -��� MODEL: ��-�- Q a SIZEBN ��
MFG: MODEL:
A/C $25.00 FIREPLACE (GAS) $15.00
_AIR TO AIlt EXCHANGEER $15 FIREPLACE (WOOD) $35.00
BOILER $35.00 FURNACE $35.00
CHIIvINEY LINER $10.00 GAS DRYER $10.00
DUCT WORK $10.00 GAS PIPING $10.00
Nnmher nf fixtnrec' n� 1(1 (ln " x P 1(1 l)n = P
ixtures @, $35.00 �
�rge = '
SIZEBN
GAS RANGFJOV�J 510.00
NEW GAS GRILL $10.00
GAS LR1IT HTR $10.00
POOL HFATER $35.00
VENTILATOR $15.00
THIS 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 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 f�diT ork which requires review and approval of plans.
SIGNATUREOFAPPLICA RINTNAME JO�INN ZINKEN DA� i
APPROVAL INSPECTORS SIG ATURE DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977