P - 48057Bu�lding
Inspections
763-572-3604
763-502-4977 FAX
DATE � I0�3I �� � �
SITE ADDRESS �5
THIS APPLICANT IS:
MLC�IANICAL
RESIDENT�AL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1
YOUR E-MAIL ADDRESS
� e�r so ►� l� �., I
❑ OWNER L'SCONTRACTOR
PROPERTY NAr,,�: �t�Ob�ar�` ��C1..1�Y�.V1
OWNER/ �D�ss:_ �j�S a► �f'ai�Y�. V.��1
TENANT pxONE: ��.o�J' S1 � 3 S��o �—
Permit No.:
���e� �Yi
�.� � � �
a e ec'd:
ATE�I�IP���I
CONTRACTOR co�4rr�N.a��: CENTERPOINT ENERGY
suB�T A copY oF corrracT PERSON: JOANN ZI NKEN
YOUR STATE sTa� LicErrsE � BUND #22013346 EXP DAT'E �8�2��2011
LlcErrsE wiTx ADD�ss: 9320 EVERGREEN BLVD SUITE' B ciTY COON RAPIDS sTA�MN zir55433
aPPLicaTTOrr PxoNE 763-757-6202 FAx 763-757-6701
PERVIIT TYPE �S1ivGLE F.a1vIILY ❑ Two FAMILY
TYPE OF WORI�: � ��' Y�.��'LACEMtENT
DETAILED DESCRIPTION OF WORK
❑ TOWNF�IOUSE
❑ ALTERATION/REMODEL
�.
FEES �RE BASED ON 510.00 PER FLYTtiRE, EYCEPT Vl'HERE tiOTED. FLYTLT2ES: (In�ICATE TOTAL NiTNIBER OF E�,CH BELO`i')
PRO�TDE HEAT LOSS C.�1I.C'S PER bL4NU 2006 ASHRAE HAIVDBOOK ,`
Equipment Installed IviFG: �j,l,a,��� IvIODEL: � N�, SIZEBTU ���0
A/C $2�.00
AIR TO AIR EXCHANGEER $15
BOII.ER $35.00
CHIhINEY LINER $10.00
DUCT WORK $ ] 0.00
MFG:
MODEL:
MFG: MODEL:
_FIREPLACE (GAS) $1�.00
_FI$�PL.4CE (WOOD) $35.00
4"€URNACE $3�.00
GAS DRYER $ ] 0.00
GAS PIPING $10.00
Number of fixtures' @ $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures a� $35.OQ � x$35.00 =$ 3i �•�
State Surcharge = " $ 5.00
(MINIMUNI FEE $40.00) Total ° $ �l �• �v
SIZcBN
SIZEBTU
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL �10.00
G.4S U�TIT HTR $10.00
POOL HEATER $3�.00
VEiv�I'ILATOR $ I 5.00
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 rk is not to start without a permit; that the work will be in accordance with the
approved pian in the case of a�,�ij vorJ�hich r�es ev w and approval of plans.
SIGNATURE OF APPLICANT
APPROVAL INSPECTORS SI ATLTRE
' PLEASE NOTE: SE ARATE 7
FOR BUILD
City of Fridley
guilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
DATE S�/4��'I
AND MECHANICAL WORK
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