P - 45114�
�--,�� �
1'
Building
Inspections
763-572-3604
763-�02-4977 FAX
DATE ��_ /T
SITE ADDRESS �
THIS APPLICANT IS
M]ECHANICA�
RESIDENTIAL APPLICAT'ION
CITY OF FRIDLEY
EFFECTTVE 1-1-2011
❑ OWNER
PROPERTY �AME: �.�n � I
OWNER/ ADD�ss
TENANT /
PHONE:Io/� �—�� r—
E-MAIL
Permit No.:
Received By:
.
:►•e • ,
il'4�( �!�'t�l�:i
TA
CONTRACTOR co�reAN�r;.aME:_ __CENTERPOINT ENERGY
sv�MIT a coPY oF coNT.acT rExsoN: JOANN ZI NKEN
YOUR STAT'E STATE LICENSE m BdND �22013346 EXP DATE 08�2��2�Z1
LICENSE u1Tx ADD�ss: 9320 EVERGREEN BLVD SUITE B cI-rY COON RAPIDS sraTEMN zr�55433
�nPLic?,�oN PxoNE 763-757-6202 F� 763-757-6701
PERI�IIT TYPE �NGLE FP.NIILY ❑ TWO FA�IILY
TYPE OF WORI:: � ��' �PLAC�MENT
DETAILED DESCRIPTION OF WORK
❑ TOW'.�THOUSE
❑ ALTERATION/iZEMODEL
FEES ARE B�SED ON S10.00 PER FIXTL�RE, EYCEPT Vv'HERE NOTED. FIXTtiRES: (Il�`DICATE TOTAL NiMBER OF EaCH BELOR�
PRO�'IDE HE.-�T LOSS CALC'S PER AL�tiUAI. J 2006 ASHR�E H�IVDBOOK.
Equipment Installed IvIFG: MODEL: SIZEBTU
MFG: �� NIODEL: SIZEBN �jDT
MFG: hIODEL: SIZEiBTU
A/C �35.00 ,FIP.EPLACE (GAS) $I5.00 GAS RANGFJOVEN $1G.00
_AIR TO AtR EYCHANGEER $IS _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 �FURNACE $35.00 GAS UNIT HTR $10.00
CHIl�lNEY LINER �10.00 GAS DRYER $10.00 POOL HEATER $3�.00
DUCT WORK S 10.00 �GAS PIPING $10.00 VENTILATOR $1>.00
Number of fixtures � $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15_00 = $
Number of fixtures @ $25.00 x $25.Od = $
Number of fixtures @ $35.00 � x $35.00 = $�.�,�
State Surcharge = ' ' $ 5.00
(MINIMUM FEE $40.00) . Total = $ � � (� '
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowled�e 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 veith 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 all work which re ' es review d approval of plans.
SIGNATURE OF AP PRINT NAME J A N DATE
.�,PPROVAL INSPECTORS NATURE DATE %
' PLEASE NOTE: SEPARATE PE IT A UI D FOR UILDING, ELEC AL MECHANICAL WORK
City of Fridley
Bu l.�ing Inspections Department
6431 U versity Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977