P - 36706Building M���-IAN�CI�I.�
Inspections RESIDEl`�Ti�AL AI'PLICATION
�
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-1-20i1
DArE _ c _ (
SITE ADDRE55 _��
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
YOUR E-MAIL AI
i� t ree k 7
❑ OWNER �CONTRACTOR
. � _ t ► .
5
Permit No.:
Recei���y:
Date Rec'dJ
�
a.DD�ss: �.°l �i;ae Geek,Te. NE ci� Fr�'J 1e.�.� STAlrI••Nz� S°,i�i3:
PHONE: � �03� S� L ' � ��
co�ArrYN.�: CENTERPOINT ENER6Y
corrrACTrExsoN: JOANN ZINKEN
sTa� LicErrsE # BOND #22013346 EXp DATE �8�2��2011
�DxESS: 9320 EVERGREEN BLVD SUITE' B' cin COON RAPIDS srArrFMMN z�55433
PHONE 763-757-6202 F,� 763-757-6701
1�SINGLE FANIILY ❑ TWO FAMILY
❑ NEW �REPLACEMENT
� TOWNHOUSE
❑ AL,TERATION/REMODEL
DET�A�IL�E� SCRIPTION OF WORK '" c�. 1 t�.
i'�Y�[� ► 1 �Y'1 e1r
FEES ARE BASED OiV 510.00 PER FLYTL'RE, E�CEPT WHERE NOTED. FDiTtiRES: (IIVDICATE TOT?.L NU�IBER OF EACH BELO��
PROVZDE HEAT LOSS CALC'S PER M?urU J 2006 ASHRAE HANDBOOK
EquipmentInstalled MFG:� rl"iEv" MODEL: �$�%'vQ�b�±"��"� S1ZE/BTU�OOC��n,i
MFG: �r i tl MODII.: �'i �• CI e�i � SIZEJBTU �. �t'1I I V S�
I A/C $25.00
AIR TO AIR EXCHANGEER $ I S
BOILER $35.00
CHIhINEY LINER $10.00
DUCT WORK $10.00
Number of fixtures Q $lO.OQ _
Number of fix:ures Q $15.00
MfG: IvIODEL:
_FIREPLACE (GAS) $15.00
FIREPLACE (WOOD) $35.00
�FURNACE $35.00
_GAS DRYER $10.00
GAS PIPING $10.00
x $10.00 = $
x $15.00 = $
SIZFJBTU
_GAS RANGEiOVE?V 510.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
POOL HF.ATER $35.00
+VEN`fILATOR $15.00
11
Number of fixtures @$25.00 t x$25.00 =$ w��• �
Number of fixtures (cr� $35.00 1, x $35.00 = $ ��' �
State Surcharge = ' $ 5.00
MiNIMUM FEE $40.00 Totai = $ �o"� t ��'
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
_ I hereby appiy for•a building permit and I acknowledge that-the informationabove is-complete and--accurate; thatxhe-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 nd work is not to start without a permit; that the work will be in accordance with the
approved plan in the case o wor 'ch re ir s rev' w and approval of plans.
SIGNATURE OF APPLICANT ` PRINT NAME aJOANN ZI NKEN=� ,� DATE�Q I�
.� �'`3"/i�
PLEASE NOTE:'
City of Fridley
, uilding Inspections Department
6431 UniversiTy Avenue NE, Fridley, MN 55432
�63-572-3604 FAX: 763-502-4977