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`� I Buildin
g
Inspections
763-572-3604
763-502-4977 FAX
DATE o��./�
SITE ADDRESS �
THIS APPLICANT IS
PROPERTY
OWNERI
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECT'IV� 1-I-2011
-�--�- YOUR E-M.AIL ADDRESS
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U
ADDRESS
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Permit No.
Date Rec'd:
CONTRACTOR co�al.�rrrnr�: GENTERPOINT ENERCY
SUBMIT A COPY OF corrracT PExsorr: JOANN ZINKEN
YourtsTA� sTa,�LicErrs�#BOND #22013346 �DA� 08/20/2011
LICENSE WITH �Dx�ss: 9320 EVERGREEN BLVD SUITE' B crrY COON RAPIDS sTA�MN z�n55433
APPLICATION pHONE 763-757-6202 F� 763-757-6701
PERMIT TYPE
TYPE OF WORI{:
�SINGLE FAMILY lJ 7W0 FAiVIII.Y
❑ rr�w ❑ xErr.ACEN�rrT
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DETAILED DESCRIPTION OF WORK /
❑ TOWNHOUSE
�$ALTERATION/REMODEL
FEES ARE BASED ON SI0.00 PER FIXTtiRE, E\CEPT WHERE NOTED. FIXTL'RES: (IIV'DICATE TOTAL NiMBER OF EACH BELOW)
PROVIDE IiEAT LOSS CALC'S PER b�rUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZE/BN
MFG: �I��.� MODEL: SIZEBN ��QO�
MfG: MODEL: SIZEBTU
_,A/C $ZS.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
_AIR TO AIl2 EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 �FURNACE $35.00 GAS LJ?�IIT HTR $10.00
CHIbINEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 �GAS PIPING $10.00 VENTILATOR $15.00
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r
tures'@ $15.(
>r nxtures � as�.uu
�harge = '
(MINIMUM FEE `S40.Q0)' Tota1= $ ��� � '
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 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 rk wh' h requires r iew and approval of pians.
i
SIGNATURE OF APPLICA NAME J C' DATE
APPROVAL INSPECTORS SIGN �'/. DATE /
" PT FA'CF 1�T(1TF•' CFAd 6TF P AF FlITTTRFT� Fl�R RTTTT T1TT�T(: fiPF TR AT; A1�TTl MF'(`NA1�Ti!`d'T'_-W(1RK
�--�' City of Fridley
, Building Inspections Department
6431 University Avenue NE, Fridley, MN SS432
763-572-3604 FAX: 763-502-4977
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