P - 48131Building MEC�II�NICI�I�
Inspections RESIDENTIAL AI'PLICATION
763-572-3604 CIT� OF FRIDLEY
763-502-4977 FAX EFFECTIVE 1-1-2011
DATE � d.�
SITE ADDRESS _
T'HIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
YOUR E-MAIL ADDRESS
S � S�r � U 0.v�
❑ OWNER �CON]
NAME: �' �
aDDxESS:�,,��"_�
PHONE: `1 V.'� � S 1 LI +
Permit No.:
Received By;
� . ;,-.�: ,r . ' � '�
CONTRACTOR coMrArrYrr.a�: CENTERPOINT ENERGY
SUBMIT A COPY OF corrrACT P�xsorr: JOANN ZI NKEN
YOUR STATE sTa.� r.icErrsE # BOND #22013346 EXP DATE O8� 2�� 2� 11
LICENSE WITH ,e,DDx�ss: 9320 EVERGREEN BLVD SUITE ° B crrY COON RAPIDS STATEMN z�55433
APPLICATION PHONE -1 i.3 '-i $ S ' � LI D �i _ FAX _ �T G 3-- % S �- �'�lG�
M_�� �u'_1y=�1�'fi�l
TYPE OF
DETAILED DESCRIPTION OF
FAMILY ❑ TWO FAMII.Y
i 3EPLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
C�
FEES ARE BA5ED ON 510.00 PER FI�YTIIRE, EXCEPT WHERE NOTED. FIXTLTRES: (I1��ICATE TOTAL NiJYIBER OF EACH BE�.ON�
PROVIDE FIEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZEBN
A/C $25.00
AIR TO AIR EXCHANGEER $15
_BOILER $3i.00
_CHIIviNEY LINER $10.00
DUCT WORK $10.00
Number offixtures �a $10.00 _
MFG:
MODEL:
MFG: MODEL:
_FIREPLACE (GAS) $15.00
_FIREPLACE (WOOD) $35.00
F ACE $35.00
AS DRYER $10.00
GAS PIPING $10.00
_ x $10.00 = $�C�,
lI
x $15.00 = $
'x $25.00 = $ ^
SIZEBTU
S1ZE/BTU
�GAS RANGE/OVEN $10.00
_NEW GAS GRII.L $10.00
_GAS LJNIT HTR 510.00
_POOL HEP.TER 535.00
VENTILATOR $15.00
Number of fixture§ @ $35:00 'x $35.00 = $
State Surcharge = $ 5.00
_ �� ._,�,,:; ^�.
MINIMUM FEE'$40.00 ota1= $ y �. � �
S-f3-ki�'7{PPiT�ATION FOR 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 wili 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 'cation for a permit and work is not to art without a permit; that the work will be in accordance with the
approved plan in the case o I w k which requir revie and a oval of plans.
.
SIGNATURE OF APPLICANT aJ�ANN ZINKEN DATE I iZ' %" I�
APPROVAL INSPECTORS NATURE �' DATE �% I Y //
PLEASE NOTE:'
� City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977