P - 45000Building
Inspections
763-572-3604
763-502-4977 FAX
DATE N O V •
SITE ADDRESS �
THIS APPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
Ck t
Permit No.:
Received By:
CITY OF FRIDLEY I Date Rec'd
C
��
YOUR E-MAIL ADDRESS
•'� _ -
❑ OWNER �]CONTR.ACTOR
PROPERTY tvAME: 1'
OWNER/ ADDRESS: 1
TENANT _.,-
STATE�ZIP 5" sy�r
CONTRACTOft coMPaNYNAME: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTACT pERSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 2 0133 EXP DATE
LICENSE WITH �Dx�ss:9320 EVERGREEN BLVD NW SUITE B ci�C00N RAPIDS STATE MN ZTP55433
APPLICATION pHONE 763-757-6202 FAX 763-757-6701
PERMIT TYPE
TYPE OF WORK:
n��
�SINGLE FAMILY ❑ TWO FAMILY
❑ NEW �REPLACEMENT
OF WORK
❑ TOWNHOUSE
0 ALTERATION/REMODEL
FEES ARE BASEb ON 510.00 PER FIXTURE, E CEPT HERE NOTED. F[XTURES: [ND C TE TOTAL NUMBER OF BELOW
Equipmentlnstalled MFG: MODEL: .�, S]ZE��
MFG�, � MODEL: t� �A P m-O� SIZFIBTU �
�A/C $25.00
AIR TO AIR EXCHANGEER S15
_BOILER 535.00
_CHIMNEY LINER S 10.00
DUCT WORK 510.00
MFG: MODEL:
. FIREPLACE (GAS) $15.00
FIREPLACE (WOOD) 535.00
�FURNACE 535.00
GAS DRYER 510.00
GAS PIPING 510.00
SIZE/BTU
GA3 RANGE/OVEN S10.OU
_NEW GA$ GRILL 510.00
_GAS UNIT HTR S 10,00
_POOL HEATER S35.00
VENTILATOR 515.00
THIS IS AN APPLICATION 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 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 all work which r uire review and approval of plans. �
�; �. � �
SIGNATURE OF APPLICAN � _PRINT NAME ROGER HOFFHEIN DATE I I a�_
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977