P - 44195Building a
Inspections C���
763-572-3604
763-502-4977 FAX
DATE�k
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
3 MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
vcrv'r p. . •
❑ OWNER
YOUR E-MAIL ADDRESS
%errace. N�
�]CONTR.ACTOR
Permit No.:
Received B;
Date ���:
NAME: � � �,�.,e. t � .e r
ADDRESS: g�S � ��V�erV►�.a� Te N�C1TY F�1-i �-u� STATEMNZIP 'S�y�%
PHONE: -1�+3' i�4 " �'�$2 T-
coMPa.NYNAME: CENTERPOINT ENERGY
coNTa,cT PERSON: JOANN ZINKEN
STATE LICENSE # BOND 2201334 ExP �ATE ,
a.DDxESS:9320 EVERGREEN BLVD NW SUITE B crTYC00N RAPIDS sTATE MN Z�P55433
PHONE 763-757-6202 Fa,x 763-757-6701
�, SINGLE FAMILY ❑ TWO FAMILY
❑ NEW �i REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
� ALTERATION/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE„FrXCEPT WHERE NOTED. FIXTURES: �lNDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: C,-A.rr t�e �r' MODEL: J81'V1UC Gt� Q SIZEBTII io0�00�
MFG: r.✓' + Z°� MODEL: /7I�i�$.2� SIZEBTU o� r7
MFG: MODEL:
� A/C $25.00 FIREPLACE (GAS) $15.00
AIR TO AIR EXCHANGEER $ I S �FIREPLACE (WOOD) $35.00
_BOILER 535.00 1 FURNACE $35.00
CHIMNEY LINER $10.00 GAS DRYER $10.00
DUCT WORK 510.00 GAS PIPING 510.00
SIZFJBTU
GAS RANGE/OVEN S 10.00
_NEW GAS GRILL 510.00
GAS UNIT HTR S 10.00
POOL HEATER $35.00
�VENTILATOR S 15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTlL 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 wor�k which require review an�d approval of plans.
SIGNATURE OF APPLICAN � � � PRINT NAME ROGER HOFFHEIN DATE _�- � O�f'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
r