P - 48019Building
Inspections
763-572-3604
763-502-4977 FAX
DATE I I� I;�^ I I
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
YOL'R E-MAIL
❑ OWNER C�]CONTRACTOR
Permit No
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.;
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ADDRESS: �O\�7► �'tihSCr� �,C'�c� 1Jt ci� F1r � ci 1� STA1`��NLIP�S�f 3�
PHONE: 14� ` S 0 t0 •�03
coMr,a�rrnME: _ CENTERPOINT ENERCY
corrTacTPExsorr: JOANN ZINKEN
sT.a� LzcErrsE # BUND #22013346 EXP DATE �8�20�2011
ADD�ss_9320 EVERGREEN BLVD SUITE' B" ciTY COON RAPIDS sTA�MN z�r55433
PHONE _ �] (G� • �i � 5 • S 7 � � FAX� � �� � S yd �
PERMIT TYPE �SI�rGLE Fa.NULY ❑ Tw0 Fa,iVIILY
TYPE OF WORK: � ��' �EPLACEI�IENT
DETAILED DF�SCR�PTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE B.�SED ON 510.00 PER FI�YTLT2E, ElCEPT WHERE NOTED. FIYTL'RES: (I1��ICATE TOTAL N-[J11BER OF EACH BELON)
PROVIDE HEAT LOSS C.�,I,C'S PER NL=+�rUAL 3 2006 ASHIZAE HANDBOOK
Equipment Installed MFG: MODEL: SIZEBN
IviFG:
MODEL:
�CT NIODEL:
_A/C $25.00 _FIREPLACE (GAS) $ I5.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00
BOILER $35.00 FtJIZNACE $3�.00
CHIhfNEY LINER $10.00 GAS DRYER $10.00
_DUCT WORK $10.00 GAS PIPING $10.00
Number of fixtures @$10.00 � x$10.00 =$' l 0. GC'�
Number of fixtvres @ $15.00 x $15_00 = $
Number of fixtures @ $25.00 z $25.00 = $
Number of fixtures @ $35.00 x $35_00 = $
State Surcharge = $ 5.00
(MINIMUM FEE $40.00) T ta1= $ � � • �
SIZEBTU
SIZEBTU
�G S RANGE/OVEN $10.00
W GAS GRILL $10.00
GAS LTNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $15.00
TION FOR A PERMIT-NOT VALID LTNTIL 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 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 of a or ich requir s rev' w and approval of plans.
SIGNATUREOFAPPLICANT PRINTNAME JOANN ZINKEN DATE I�
APPROVAL INSPECTORS SIG TURE DATE
' PLEASE NOTE:' SEPARATE A RE IRED FOR BUILDING; ELECTR CA A E HANICAL WORK
City of Fridley
B�iilding Inspections Department
�University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977