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
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