P - 84271Building
Inspections ew� �
763-572-3604
763-502-4977 FAX
DATE i �I (� �
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
O�V;�IERJ
TENANT
�n MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE t-1-2012
� YOUR E-MAIL ADDRESS
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❑ OWNER ONTRACTOR
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Permit No.: � O li-
Received By� ' �`J �
Dat��e�d:� �' � � � �
CONTR�CTOR con�ArrYrr�: CFNTERPOINT ENER(;Y
SUBMIT A COPY OF corrTACT rExsorr: JOANN ZI NKEN
YOUR STATE STATE LICENSE # 2201 3346 EXP DATE �8�2��2012
LiCElvsEVV�� ,�Dx�ss: 9�2[� EVERGREEN BL NW SUITE B crrY COON RAPIDS STATE�ZIP55433
APPLICATION pHONE 763-785-5404 Fa,x 763-785-5400
PERMIT TY PE SINGLE FAMILY ❑ TWO FAMII.Y ❑ TOWNHOUSE
TYPE OF WORK: � �W �,��CEMENT ❑ ALTERATION/REMODEL
DETAILE D SCRIPTION OF WORK �v�S��--�� � CZ�CJ�S.�� ° �-'�'R0.� i°_ Q-V� Q-t r
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FEES ARE BASED ON 510.00 PER FLYTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUVIBER OF EACH BELO�
PROVIDE HE.aT LOSS CALC'S PER MANU J 2� 006 ASHRAE H�iNDBOOK. n
Equipment Installed MFG: r Y' ��-' Y- MODEL: '� 9 1 P S 1-� ( U � g��g� ��t � ��
MFG: ��'-'r`c�2� MODEL: o�`[ l��V(j�t3io SIZEBTU �ulG �UCX�
�A/C $25.00
AIIt TO AIR EXCHANGEER $ I S
_BOILER $35.00
CFII1viNEY LINER $10.00
DUCT WORK i 10.00
1T0'P� ��=.
MFG: MODEL:
_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 = $
i.00 = $����
SIZEBN
GAS RANGE/OVEN $10.00
NEW GAS GR1I.L $10.00
GAS UNTT HTR $10.00
POOL HEATER $35.00
VENI'ILATOR $15.00
� �#�-�S t4Pi-��'PtiP_'KflfJf�iFOR A PERMIT-NOT VALID UNTIL 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 ap tio or 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 al wor�c,�ch requ' s review,�nd approval of plans. J /_/
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SIGNATURE OF APPLICANT
APPROV.�I,
' PLEA�
DA
ITS ARE'RE UIRED FOR BUILDING, ELEC �
� City of Fridley
.J Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FA.X: 763-502-4977
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