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P - 43889Building 11�i]�C�IANICI�IJ Inspections R�SIDEN�'IAI� APPLICAT'ION 763-572-3604 �ITy OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2011 DATE �C��� � �� SITE ADDRESS _y�� [� I THIS APPLICANT IS: PROPERTY NA OWNER/ � TENANT YOUR E-MAIL ADDRESS S' �-• ��r►�►� �,� ��U� ❑ OWNER �CONTRACTOR s�a� ci�_ C-rid1 Permit No.: IZeceived �y; t►t�'_ •.. .. :.� � I� r � • A� r�Z�ss a � CONTRACTOR col,,rnAx�rN,v�: �ENTERPOINT ENERGY SUBNIIT A COPY OF corrrAC-r P�xsorr: JOANN ZI NKEN YOUR STATE sTA� LicErrsE # BOND #22013346 �{p Dp'� 08/20/2011 LICENSE WITH �Dx�ss: 9320 EVERGREEN BLVD SUITE' B crrx COON RAPIDS STATEMN z�55433 APPLICATTON .. _ _ - - - - - - - _ __ _p �/ PHONE _ � ��' %� � �iFu�— F� — R%�.3 "° %O S ' S`•f C�d PERMIT TYPE TYPE OF WORK: �SINGLE FAMILY ❑ TWO FAMII.Y ❑ NEW �REPLACEMENT ❑ TOWNHOUSE ❑ ALTERATION/REMODEL DETAILED DESCRI T ON OF WORK '�y�S�c�l;� /�'i�,o�G�� 2��--� �{-t.,��- i'lC�.� �' CAX� __�� Y' �OU'1.�� �tOV1, -E'�(`- FEES ARE BASED ON 510.00 PER FI�YTL'RE, EYCEPT WHERE NOTED. FIh°I'tiRES: (IlV�ICATE TOTAL NU�IBER OF EACH BELO�� PROVIDE HEAT LOSS CALC'S PER MANU.�J 2006 ASHRAE Hr1NDBOOK Equipment Installed MFG:� `�_ MODEL: �D� -d� SIZE/BTU �00 � L��- vl r� � MFG: �� MODEL: U �CP��' �`'� SIZEBTU �'I'OY� � MFG: MODEL: SIZEBN �A/C $2�.00 FIREPLACE (GAS) $1�.00 GAS RANGFJOVEN $10.00 AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 _BOII.ER $3�.00 �FURNACE $35.00 GAS LJNIT HTTt $10.00 CHIIvfNEY LINER SI0.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Number of fixtures'@ $10.00 x $10'.00 = $ Number of fixtures @ $25.00 � x $25.00 = $ o� �� Nurnber of fixtures @$35.00 � x$35.00 =$ �?�J f� State Surcharge = ' ' $ 5.00 (MINIMUM FEE $40.00) Totai = $ �� � � 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 app tion for a permit and work 's not to start witJ�out a permit; that the work will be in accordance with the approved plan in the case�CVf a1 wo�hich requi�r�evier�and ap�val �/plans. , . SIGNATURE OF AL INSPECTORS/�TGNATURE /� � l/ f�i/.f�'�)� DA PLEASE NOTE:' S'EPARATE PERMITS ' RE UIRED FOR BUILDING; ELE AL City of Fridley , Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 I