AF - 35645.
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PermYt No. IG �,3 G
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Latli or Cover the interior of tbis �nilding until
the followin� in�gecto�s h�,ve made the�r in�p�-
tion and signed . 4}� �.d.
InspBCtors commesits: �.�:2 � � C.�{�/TG �
��� /��� ����I s �/� �-o fii� C,� �
L���2 k 73/�? v r;�F � si.0 r .4 s!�i ��.,N�
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�7.'Y`b]F' FR�LEi' . '�'. -��, ��.a... �
560-3450
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Caty of Fridley, Mirm.
BUILDING PERMIT
Da�; ISeptember 16,,,_1970
pwaer; H. J. Stevens g�� L�t�dex Co .
Addreae 5228 Capitol St . A� 2909 Nic�lett Av�,..
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LOCATION OF BUILDING
No. 522$ � Stceet - Capitol St . Part of Lot
Lot 18 _- Block � Addition or Sub-Division Cax �, s ons S�mi t
Corner Lot ._.�____ Inside Lot Setback ._._._ Sideyard �
S�'� n��� -- :- Foundai3on IIevation
DESCRIPTION OF BUILDING
To be vsea as:
Repair Foundatio�nt � Depth Height Sq. Ft Cu, Ft
Front Depth � FTeight Sq. F'� Cu, Ft,
Type of Construc°�ton Frame �� �� 2 000 _ To be Completed -10,�15 /70
In consideratfon of the issuaace to me of a permit to constr�xet the bwilding descrlbed above, I agree f,a do
the proposed work in accordance with the description above set forth and ia comp ce with all proviatons of
prdinances oE the dty oE Frfdley.
�
In conafderai3on of the payment oP a fee of $�Q� , permit is hereby granted to Iaon r Co .
to construct the buflding or addition as described above. Thia permit ia granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�en, 3n all work
done in, around and ugon safd buflding, or any gart thereof, sYxall conform 3n all respecta to the ordinanceg of
FridleY, Minnesota regarding la:ation, construct►on, altera.tion, ma3ntenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time u�n violation of aay of the provisiona of said
ordinancea
`
, 's
�I1IIg InSpflCtOr
CLARENCE BELISLE
NOTIC�
TI�S psredt d�r not eover ths �oealrucHoe, ieshllattoa fe� xr►riae. P�+�e, 6n 6eatiee, sswar er water. B� wre w�
t6e Bnildhtg lespsetor Po� mperats parmha for �h� h�ms.
i1
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : � }� � ��,4°� �� /f �S BUILDER : _ � a' !\! /' .1: J� O�' �
ADDRE�a S : �_� � C�� TQ'� S I� ADDRES S : __`,L �' a °% lI � � C � ,� l �% � �'�_
NO:. ' STREET:
LOT: /� BLOCK: % ADDITION: C/� �,L S G%I/S ,SP//1� /��I � �
CORNEA LOT: � INSIDE LOT:,� SETBACK: SIDEYARD:
Applicant attach to this form ltao Certificates of Survey of Lot and proposed
building location drawn on theae Certificates.
HESCRIPTION OF BUILDING
To Be Used As:.
� � �° �7��' y c �� �. � i �� � :��v t,� Fxo11t : Depth : Height :
� �;
Square Feet: Cubic Feet:
Front: Depth• Height•
Square Feet; Cubic Feet:
e of Construction: _ ;������ � � . �
�'P �- _���'�j� stimated Cost. �, o o �
To Be Completed: � � -. / �- _ 7 �a `
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in �tiict accordance with the City of
Fridley Qrdinances and ruliags of the Department of Buildings, and hereby
declares that all the facts aad representations stated in thia application
are true and correct.
DATE : _ % - I c"/ - '7 G S IGNATIIRE : � �9 a .�!� -�fLi� �
(See Reverse Side For Additional Infoxmatioa.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing pexmits for the
erection of any building or structure, or for any addition to any ezcisting
building or structure, or for any alteration or repairs to any existing
building or structure, upoa application therefore, require the payment by the
applicant for such pe�it of fees to the amount herein belaw set forth and 3n
the manner herein provided to-wit:
UNIFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousan.d cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building penuits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average*
height�of the roof surface of the main gable of a pitched roof.
��i _
For rep�irs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
lesa than $5.00.
V�RIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the coastruction site.
A Certified Sutvey af the lot,.showing the location of the foundation, once it
has been coustructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Applicatioa for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building penait has beeu
issued; and said structure shall aot be used or occup�ed until a Certificate
of Occupancy has been issued. •
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BRANCH OFFICES:
FARGO, ND.
BISMARCK, ND.
SIOUX FALLS, Sp.
WATEHLOO, IOWA
ROCHESTER, MINN.
�=���..� � � ��
FORMERLY OPERATED AS A DEPARTMENT OF
TW/N C/lY TEST/NG AND EAIG/NEEIi/NG LABORATORV, /IVC.
662 CRO�IFYIkELL AVENUE — ST. PAUL, MINN. b5114 — 645-6446
�
�f� OFFICEHS:
� CHAHLES W. BRITZIUS-Pcesident
ROBERT F. WITTMpN-Executive Vtce-President
NORMAN E. HENNING-Vice-President
CLINTON R. EUE-Secretary
JOHN F. GISLASON-Treasurer
Septembe� 28, 1970
I.o�mde� Coaap�x�y
2909 l�i�ollet A�eaue
l�inneapo lis, i�in��sot� 554�8
At�en�ion: 1�< l�'be�t I�a�de�
llte< SAil Ia��re��t;t�a�io� m ����
S�ttl�e�a� - F�id1�3'm
l�.t�are���t� � �15�b8
�eat�.�nemo
W� la�v� ���d�ac�ed a�eail atsa�r�stig�,�Cio�a �,�d fo�d��i�n �aa�l�rsis for �h�
ref���n��d pro�ea�� o W� �.�e ���a��mitt�3,�� fiw� c�pie� saf �ta�° ��po�� o
�his wca�k w�� condu�C�cl tra ac�o�d�nc� wi�� yo�,r ��rb�l �.an�l�o�iz��io�a o�
S�ptember 23, 197U,
�i� �epc�rt p���emmts o�� f�adiaags �.aad x°�c�m�e�aci�,�io�� p�r�air�iaa� �o the
smil i�aeest3,g��i.o�a �i �mm�izae��iaa� $x��ly�i� f�r tl�� ��f���ffi��d p�e3���
l�ca��ci a� 5228 C�pi�t�l Sttr-�et No�the�s�>
���� s0i1 t�at ��i�a�� w��e� mad� on Sep�Cemb�� 24, 1970, �°�ae bo�i��
���e �ae�t d�w� �� �h� l���tie�xa� s�aown ��n tt�� ��t��Ya�d �k���h o �� �s�rf���
�lev�tio�s wea�� ��f���s�c�d �o th� ��p of �b,� hyc��an� 1�����c1 �� �i�� ���h=
w��t �oa�t�r �f �pit�l 5����ffi �aad �u�l�e� �lese�ra� ��k�r� �� 10�00° ��x�
as��am�d el����ian) .
So31 ��anpliaa� w�� p�a�i4�n�d ir� a��ord�a��� t�3�h AS� D 15�6e67 0��ia�� �l��s
p�oceclu�rem a 2" 0. A. �plit b��e]. �s�mpl�r i� cl�i��� iva�� th,� aQil �y �
1�+0 1'b w�igh� falii�,� 30'8> AiEt�� ��a ini�ial ��� �f 68eg �h� ra�nb�� of b1ow�
��qui��ci �o drive �lae a�mpl�r �aa �ddi�:L�t�l 12" i� lcffio�a �� th� p��e��a�
�3.on resi�taxace o� Ai va].�a�< Z`Yi� A1 v�l� i� ��a ixadex of �he a��1��i�� ci�a��i��
gf �e�hesionless soils ��d the �on�i����c�r �f coh�sige �mils. 7�,ai� wa].1
�ube sa,mpl�s wc��e ota�t�.iatecl �ccordia� �o ,AS�io n i5$7�6� wh��� ix�cli�C�t1 i��►
appropriate s�mtao 1 caa �he 'borin� logs m �
As th� s�mp1�� w��e ai��ina�d ira �he fi�lds ��.ey w�r� �risa�ll� and m��s�.11y
classified la� th� ca�ewr �hi�f i� �c�v�dazace with AS�Ma D 24�8�69e tte�a�
�esea��tive p���iomms of �.il s�mgl�� wer� �Chen �����ned� �o th� lab����c��r
for �ss��h�r �x�amiaa�.�ioa� �nd for v���ifi�a�ion �f �he fi�ld classifi��.tiotae
AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES, ALL REPOHTS AHE SUBMITTED AS THE CONFIDENTIAL PROPER7Y OF THE CLIEIVT.
P�ge 2 - ��� S�ttleme�t - F�idleya
Minneao�a 0 �15868
�n addition, selected sample� were submi���d �o a pr�grr�a �f labc>r��o�y
t�sts. Lo�s of t�e bo�inga indiaati�g th� depth and idea�ificativ� of
the ve�ivris strata, �be � pglues �h� labora�o�r �eat datae wa�er l�vel
informa�ion and pe�ti�eat info�tion ��ga�ding �1� method of main�a��in�
�nd ad��ncing the drill hol�� a�e �t�ached> Ch�z�� illat��r�tiag the �oil
claseifica�io� p�o��dur�e �h� descriptive t�rmi�olo�• �ad ��►m�l� ��d oa
�t�� bo�in� lm�s are al�a at��.ct��d<
Th� borings w�re p�at do�ca �� e��1�,�� �t►� ��ail co�diti�an� �t tta� 1�c��i�n
of an esi��ing hoea�� i� whi�l� coasid�rable �et�I�m��t t�� oc�c���do Fr�m
a physical exami��ion �f �h� hou��, it app�a��� �h,a� �Is� �re��es� ���C�1�-
menk la�� o���rred is� th� �o��tlaw���� co�,�r af tta� h���a A la��� c���1c i�
�pp���nt ne�� th� south�re�t eo�ae.�r �aad � po�tion of th� �ou�h w�ll 1�.�
m�v�d oc�tward� app�os3ma�ely� lBBo Addi�ioatal c���tc� ����n� i�a �� c���t w��.l
�nd alo�ffi th� �ots�ta w�11e A�t �hc� �im� �hi� �ro�lc w�� daaa�, �,a �x��.v�ti�xa
i�d be�� m�d� to th� t�p of �he footia�� �1��� � po��i�n of �h� ���� r��ll
�a.d ans�st of the sottt�ia w�llo Axt e�n�ir�tio�n of �ia� IIe Se �o1o�i�a1 S�eyr
foar �h�.� r��ea ix�di�a��� th� ho�a�� i� ioc�t�d ira � 1��1 1�w ����. whi��a
�x�ended �i�ough �Ch� �ro �auic� l���ted �oa�tt���st of �h� ho�� ��nd � little
dis��a,�� �ao�tis of �h� hc�aa��<
�ri�ag 1 ws�s p�t do�n aa��� the so�a�hw��� eo��� wi���� Car� ��ttlem��� �pp����
�o ta� ���t�sto �.� soil g�ofil� co��i��s of �+e of fi11 ���ly�.aag 3'�8 �f
medi� de�es� ei1�o F�om 7�° �0 148, � l.sa�r�� of an�diamn �o �oft f�t �1�.�► ���
�n�ouat���do A�dium deaas� �o d�ns� s��d ��s �a�co�����ad f�om 14° �c� tia�
depth of �tae borings o�ring 2 lo�a��d 1�+' from th� �oe��h����t co�e� �1ommg
th� ao��h w�ll ehc�w�ci simil�r s+ail c�nditi�x��a ����p� ffil�� the fa� cl�.y w��
��m�wt�� ttaimmne� ��d � t'hi� l�q�ar �f ���� ��� ea�c�e�����d j��t �1�ca�� �h�
aande Boris�� 3 loca��d �� th� nor�h�ast co�ca�� m£ fih� h�ea�� �how�d fill
o���lyiag �il� tahich 3tt t�a�t i� �nde�lain b}► � l�qe� og m�di� ci�n�e �o
�e�► 1�s� �ando F�om 16° to �h� d�pth of th� l���imgg a lay�� mf m�di�a
t� sof� f�t cle��► w�s �aaco�n�er�de �h� ��aiis �r� �11�i�1 d�p��it�e
�o�xect ura��� �mm��r�d bori�ag �3 �ad �'�� l��r�l� a�cl tim�� of �����d��� �.r�
n�t�d o� th� lo�. W�t�� l��el r�c�oded ixa r�1��3�e1� ���eriou� �oila ��e
gen��e�11y �o�asid�red �eli�ble. Th� g�o�sxad w�t�r 1�v�1� c�an b� �sp�ct�d t�
flu�t�t� bo� s�a��11y �md �e��l�a
�� top �f �h� footiag ���� l�o�ia�� 1 is �� �l�v��i�x� 9�,0° >����fo��e i�
�ppea�s tha� �11 �h� footi�� ��e re�ti�ag �x� �ta� �i2�y ��il� cahi�h g+��s���ll�►
��e medir�m d��e or fairl� s�iEf o�� �h� k►�► �h� 1�����m�r te��� s th� i��
clay h�� a ve�► 'h.i�h m�ig��re aoa��a� a�d ma�t b� �oa��id�red t�i�kaly c�mpr��sibl�o
The t�st r�sul�� �lso sh�w tlta� �h� a�iff�� �l�y t�� a� maa�h l��a�� �oi���a��
c�nten� tth�a� �he �ofte� f�t clayo
I� is �.ppa�rent th�t �h� se�tl�m�n� ha� �esul��d ixa ��llan�e iaa �ols�e of
�h� fat cla�e �'laia wr�uld b� c�bas�:d by co�vlid�,�i� of th� f�� �b�.�r cl�� ��
�aa i�.�r��� 3.� %h� �t���s �r du� �o a low�ri�g of th� ffi�i����� co�a�exx� f�om
P��� 3 - ��� S�t�l��t � F�3dl��s
iiiamme�o�a m �15868
dspingo lYo topsoil taas f4erad b�lo`a �he fi�l �� 1a��i�ag 1 indi�a�ixa� ti�t th�
o�i�3,na1 ��de was p�obably clo�e to tl� pr�s�ffit ��ousaid s�fac�o Theref�re�
the weight of the soil �t�� w�s excava��d for th� t��em�n� when the hoa�s� was
origiasally t�uil� woeald ��nd to comp�a�s��e fo� tlae �ei�ht of the hot�s�, 7,°h�re
wr�uld be �mm �Lac�e�s� ix� ��r��� ig �h� ��il imm�cii�tC�ly b�lsaw �h� f��3.�
h�s���r, it is �sait� p���bl� tta�,t x�o ixae�ea�� i�a �����s was �s��mit��d to
the `and�rl�3,n� f�� c]..�q o Ii �hi� w��� �� a�h� c��� ir� �01�� of th�
fat clay woulci � da��: p�im�.aily t� a low�ri� mf th� ma�istrsre �o�at�xa�o �ai�
coaald t� �ea��cl bq a l�a��ist� of ��a� w�te� �abl� ��� $r� �n��ad�d p��i�cl �€
tim�o I� mayr � r����eY th�t a�o gro�d w���� wa� ��a���t���d i�a l��irng� 1�a�d
2. At bo�ing 3� 1ig�le w�,��� w�� ���mcara��r�d iaa �� s�aad �trov� �ix� f�t �l�y
aad �l�e f�t clay at this 1oc�.�i�� is ����r�ll� ve�y �of�e It wa� a����d �h��
ther� is a l�rge �tre� xae�� �i� ao��aw��� �o��r �f ��� lao�e��e I� i� qu�,t�
pos�ible �Hsat tl�� •ro�� ��a°�a�tu�� of the ���� i� �� � d�g�h s�uffi�i��� �� cl��w
�t��asi�� �sao�ats �f mo�,���� f�m �he f�t �la�►o �e��fo�e� it ia s��i��
poaaibl� t�t tt�� �r�� �.� � p�im�� ��� of th� cla�a�� ira moi�t��� �oaa�ent
of �he f�t �1a�o �tae �p�a� o€ ����g ��i� siz� of tl� t���� �ci �h� �v�� ������
tan�e of ��u��e would b� im}aor�aa� f�i��o�� in d����mia�ix�ffi if �he ���� t�� �d
im ixaflu�mm�� m�. �h� ci��� ix� moia��e ��mm��n� �f �h� f�t cl��re
Th� r���mea��adatio� for ������tiox� �f t�,� gr�blem a�� x�o� cvaaclu�i�e o�1�
�l�in�t� aol�ti�� woa�id be �o ��d��ia� �h� �a�ti�� hoas�� fo�d�,ti�aa �ta��ea�t�
�he us� �f pili:a�a �is ��a�ld 1�� ��a� costl� ��ad ic� p�oteabiyr u��C ���a�t�ci
wh��a �oaa�icl�ri�g �1�� ��1ue �f tta� la��ns�a �� t�ea�ia�� r�er� a�o� t�k�n d��p
en���h �ra �val�t� pili�ag 1ea�gth�, 1�ow��e�e �t�� pili� �e��ld ta��� to p�m��rate
�11 c1�p�si�C� �f s�f� £a� �l�y �nd b� d�i�ea� �ar r�deqa�.�� di�t��� i�a�o the
a�de�ly3.an� ��r�t� tm de��lop �d�q��e �upp���e
� s�cond sol�ffi%o�a w��ld la� �o �ebaa�ld th� ��11 �t3.lizia� �gs�eacfl f�o�ia���
plac�d �� �ta� �am� �l���tiomm �� �h� �xia�i� foo�ia�� o ��t i� s��i�e p��b�1�i.�
�iaa� s�� �drli�ioa�l set�l�m�a�t raill o��nr o�e� �a� �xte�d�ct p��i�d o£ �imj�
ci� to f��ther d�yri�xg o�� vf �t�e fat �a�y, If �ta� �¢aeat �t�c�� �f �1�� ��ee
pnn��r��e� dor� to tha fat c1�ye ��m�vix�� ��i� ���e m�.y ����1� h�lp in r�d��-
iaa� t'�� ��ca� of f�t�� ����l�m�a� o
A�hi�d s�lu�i� wo�ald b� �o �cl��pia� �h� w�ll �loaa� the we�t ��d a�a��h
por�io�a of �ta� h�u�� by ����ncli� pi��s �ad �a��d� �S�ams eio� t� �� a�c1��m
lyimmg ���d. A 1o�d3g�� of up to 4fl00 pa�anmmda per �q��� f�ot �e�uld b�
uti].ized �ffi �k�� ��nda �w�e�rs it sh�r�id b� n�ted �t�a� ft��ure s�t�l��t
may oecur 3mm the r�ix�irag po��io�� of �}�� h�use wh�r� th� £�t cl�� ux�d�a��
lie� thc hou�n ��c� ��ain cl�,ffer���i�l �et�l�a� could ��, p�obl�ma
at appe��s tlaat ��b�ilding �he c��11 r�tili�ia�� �p���d f�a�iaa�� �.� aa��l
dep�h wo�1d lie �h� m��t c��on�mi�a1 �oleati�a� ���li�irag tka�� �c�m� ��a��c����
m��,s�re� may hade �� � t,�lcemm ��sia� im tia� futaa�°� o If �ta� h�us� i�
�snppo��C�d vsn pilira�„ w� �ugg���t e$t�ndin$ bo�i�n�� 2�.a�ci 3�� �, ��ffic�.��.�
dep�� to de�C��:mia� �h� �nd�rlyiffi� soil co�aditi�ns o
Abaaut SU� of �ia� ��il ��1�� �aill b� l�eld �,� ttai� �ffice for �w� �oa���
�nd will thea b� di��.rd�d a�l��� �� ��� xaotified �o h�ld th�m f�� � 1�rr���
p�riod o£ �imee
P�g� 4� Hous� S��tl�m�mm� m Fridl��,
1Kiin��sota - �15868
The recoa�aend��io�� �sd/or ��gge�tions �o�t�in�d in th3s repo�t are our
opiaions based on da�a which �r� ����ed to be ��pr��entati�e af th� si�e
explored; b�t beca�se the ar�� of the bo�i��� in r�latiott to �he �ntire
area is veyq �mall, and fos othe� ��aso��a �� do �ot w���ant comditi��s
below �he d�pths of our bo�in��m �� t�� th� st�a�� 1���d frcam ��r bo�i��s
a�e �e�es��rily �ypic�l �f �� ���ir� �i��o
Ve�y tr�ly y�u��e
� '�' � � �: `" � �." ;
Wilfred Ae ��111' re �•
i�AWa �b
E���s
�
' " Sstl �z�cle+�atde� L�a�
JOB N0. 158F18 VERTICAL SCALE l9B �'4'� LOG OF TEST BORING N0. 1
PROJECT ��SE SET'�LE1�111T', FIZIDL�� MI1�1,iTESO'TA
DEPTH DESCRIPTION OF MATERIAL SAMPLE LABORATORY TESTS
FE'NE-f ,�SURFACE ELEVATION 9$.S° N WL NO. TYPE W D P:L: Q�
FILb, mixture of STLTii SAND, SILT and �T�� � 1 SS
SILT, black aand some brovan
8 2 SS .
4
sr.�T, i��� g��y �a ��o� ���i�as m�i��a
m�ditun dense, l��a�e� of fat clay �nd �ilt�r lp 3 SS
Ciay {r�)
7� FAT CI�iY ��a�d laroraf� mo��l�d t� 9° t}x�a r�
9�' �' ��'a 6 4 SS 49
medivnn �o sofC� a few l�mix�,tioaa of �ilt
���)
5 5 SS
�r 6 SS
i4 � 2� a� s� iis
SAIVDs fi�ae gr�inede light brawna moi��Cg m�dia�n
d��s� to d��se �S�) 12 8 SS
1� 9 SS
� i io ss
21 ��d of ��iaa�
WATER LEVEL MEASUR6NENTS sTAttT 9°Z�$°�O COMPLETE 9m�'4°7O
DATE TIME SAMPLED CASING CAVE-IN BAILED DEPTHS WATER a �e @ o
DEPTH DEPTH DEPTH LEVEL METHOD PsI�• O m 19 �20 15
9�24 12s 15 21° 21B to ATone
to
to
t0 CREW CH�EF ���b�t1d��'
� Se�ll �z�cle�at�a�c ��w�Cax�t
�oB No. 15868 VERTICAL SCALE 1f� °�e LOG OF TEST BORING NO. 2
PROJECT H�USL SETTLEI�IV°l.'_ 1�IDIaEY, MINNESO�A
p�TM DESCRIPTION OF MATERIAL SAMPLE LABORATORY TESTS
FE'NE.T ,�SURFACE ELEVATION 98•8, IV WL N0. TYPE W D � Q�
FILL' miuture of CiAY�Y SILT and SIL�Y CLAY, a
litC].e gravel and concre�en black and a li�tle 7 1 SS
brvwn
� 2 SS
� 13 3 SS
6
SIIeTSi �l�g, light g�ay a�d b�own mo��lede stiff, 4 SS
' l�nses of silt �CL)
1� 5 SS
10 FA`T Cl�AYa g�eay and some browr� mott e,��� er 9 6 SS �
stiff, a f�w lerasea of silt �CIi) .
12 FT Y sm�
s $��3� s
" 3 7 SS
�5 0 8 8 SS
I5�
SAND, fine gr�iaa�d9 lighg brota� �0 1igh� gr�y, 9 SS
moiste l�ose to m�di� ��ases � le�,�e �si black
silty clay a� �bout 17�' �SP) �3 1Q SS
2C�
Ead of �ring
WATER LEVEL MEASUREMENTS SrART �°�LF°�O COMPLETE 9°'2`+��
DATE TIME SAMPLED CASING CAVE-IN gAILED DEPTHS WATER
DEPTH DEPTH DEPTH LEVEL METHOD P� Ds O e m�.� B @ 2' '3O
9m24 2a 30 20' 20' to None
to
to
t0 CREW CH�EF �������e�
` S� ���r� Gr��
JOB NO. 15568 VERTICAL SCALE 1�� �'�'� LOG OF TEST BORING N0. 3
PROJECT H�LTSL SETTI+EMEI�, �$IDIoEY, MINNESaTA
DEPTH DESCRIPTION OF MATERIAL SAMPLE L480RATORY TESTS
FE'NE.f ,�'SURFACE ELEVATION 98 0 9' N WL NO. TYPE W D � Q�
FILL, mixture of SAN�, STLZR CIAY and SIL� SAI+�, 3 1 SS
browa and a 1ittle dark brown and black
2 2 SS
� 2 3 SS
7 I
SI�7C, browni�h gra� �nd b�own mot�l�d, w�atm � 1� SS
laose, some lenses of clay�y silt
��)
8 5 SS �
�
12 6 SS
SAND, £iae $rained, �rsyi�h larowng wet to 14°
th��a wat�rb�ax�ixag, medium d��s� �o �r��+ l�ose, � 7 SS
a few lea�ses of organic mat�rial and sil�y cl�y►
��pm�)
4 8 SS
16
FAT GLAy, �aym m�d�.um to aoft, some l�nses �.ad 9 SS
lemi��ions of silt gCH)
6 10 SS
Z 11 3S
� �.2 ss
13 SS
° 4 1�+ SS
27 Enc� of ��3ag �
�
WATER LEVEL MEASUREMENTS START 9m21#°7O COMPLETE 9°2G'°�O
SAMPLED CASING CAVE-IN WATER
DATE TIME DEPTH DEPTH DEPTH BAILED DEPTHS LEVEL METHOD P.De OB ° L 1 @ g' �'O
9-24 5:10 27' 14�' to 1�+°
to
to
t0 CREW CH�EF ���������'
SYMBOL
C.S.
P.D.
C.O.
3'/a HSA
4 FA
6 FA
2%a C
4C
D.M.
J. W.
H. A.
NXC
BXC
AXC
SS
2T
3T
DRILLING & SAMPLING SYMBOLS
DEFINITION
Continuous Sampling
2-3/8" Pi pe Dri I I
Cleanout Tube
3'/a" I.D. Hollanr Stem Auger
4" Diameter Flight Auger
6" Diameter FlightAuger
2�/a � C8S1(lg
4" Casing
Drilling Mud
Jet Water
Hand Auger
Size NX Casing
Size BX Casing
Size AX Casing
2" O.D. Split Spoon Sample
2" Thin Wall Tube Sample
3" Thin Wall Tube Sample
GENERAL NOTES
LABORATORY TEST SYM�LS
SYMBOL DEFINITION
W Moisture content - percent of dry weight
D Dry density-pounds per cubic foot
LL, PL Liquid and plastic limits determined in
accordance with ASTM D 423 and D 424
Qu Unconfined compressive strength-pounds �r
square foot in eccordance with ASTMD2766-66
Pq
Ts
G
SL
pH
O
M.A.*
C*
Qc*
Additional insertions in Qu column
PeneVometer reading-tons/square foot
Torvane reading-tons/squarefoot
Specific gravity - ASTM D 854-58
Shrinkage limit - ASTM D 427-61
Hydrogen ion content-meter method
Organic content-combustion method
Grain size analysis �
One dimensional consolidation
Triaxial compression
�See attached data sheet and/or graph
WATER LEVEL
SYMBOL —�
Water levels shown on the boring logs are the levels measured in the borings at the time
and under the conditions indicated. In sand, the indicated levels can be considered
reliable ground water levels. In clay soil, it is not possible to determine the ground
water level within the normal scope of a test boring investigation, except where lenses
or laye►s of more pervious waterbearing soil are present and then a long period of time
rr�y be necessary to reach equilibrium. Therefore, the position of the water level symbol
for cohesive or mixed texture soils may not indicate the true level of the ground water
table. The available water level inforrr�tion is given at the bottom of the log shaet.
DESCRIPTIVE TERMINOLOGY
�avsin
TERM "N" VALUE
Very loose 0-4
Loose 5-8
Medium Dense 9-15
Dense 16-30
Very Dense Over 30
coNSisrovcv
TERM '°N" VALUE
Soft
Med i um
Rather Stiff
Stiff
Very Stiff
0-4
5-8
9-15
16-30
Over 30
Standard "N" Penetration: Blows per foot of a 140 pound hammer falling 30 inches on a 2 inch OD split spoon.
RELATI VE PROPORTIONS
TERM RANGE
Trace 0-b%
A Little 5-15%
Some 15-30%
W ith 30-50°/a
PARTICLE SIZES
Bou Iders
Grave I
Coarse
Fine
Sand
Coarse
Med ium
Fine
Silt and Clay
Note: Sieve sizes shown are U.S. Standard
Over 3"
3�.._3..
#4-3/a••
�i4-#10
#10-#40
#40-#200
Determined by plasticity
Characteristics
� CLASSIFICATION OF SOILS FOR EIVGINEERING PURPOSES
ASTM Designation: D 2987 — 66 T AND D 2988 — 66 T
1Unffied Soil Classification System)
Major divi�ons yy�ols Typi� ��� Laboratory clessification criteria
2
_� Well-graded gravels, gravel-sand -a 06 0 ��so%
� d;� G� mixtures, li�ttle or na fines c �u Dlo 9reater than 4; C� between 1 and 3
�10%�60
o � � � m
N C ` � 7
�
,i �N � � L df
N C
� m v� GP Poorly graded gravels, gravel- $ �� Not meeting all gradation requirements for GW
_ �o y :.� sand mixtures, littie or no fines •
m$v ` N �
N � � Z � �N
a� y tA �
� r.L � o G� d Silty gravels, gravel-sandsilt y ��� Atterberg limitsbelow"A"
°—' �+� w- E m��� ° N y � line or P.I. less than 4
o:U��+
o r o, « m� � Z� ��� o Above ••A•• line with P.I.
� m� '� �� � o a-R� - between 4 and 3 are bor-
= o o— m•� w N � ��°�. der/ine ca�s requiring use
� z ? � Q, � GC Glayey gravels, gravel-sand-clay '�, t ,,� Atterberg limits above "A" of dual symbols
c s � Q mixtures W m ;:_ line with P.I. greater than 7
4'a o � . . .
� y '8� SW Well-graded sands, gravelly m o ;;' C �bo reater than 6; C= r��,2 between 1 and 3
�� c '� �= sands, little or no fines �, ;:: u 9 c
o— c o � �io �io�6o
� '� nmi � c °' � ' : :
m � �� CW i �_((�
� ,� m Oj d cC0 W . .. ,
o �? c� � Poorly graded sanrls, gravellY c y= .. ...
= � a � SP sands, little or no fines q� o� :•. Not meeting alI gradation requirements for SW
�° �$o �mo .. •
�
� coz ��°c$ • .
s t�'~c •• me�,�� .
i r a �i o d c� m� m Atterberg limits 6elow "A"
o �� c E SM Silty sands, sand-silt mixtures 8 a� a c.i � line or P.I. Iess than 4 Limits lottin in hatched
� s— "' co.., � c��`' �. P 9�
�' /0 � m i8 � �i °� e,�, �, zone with P.I. between 4
oy 3� w � c c� �� c� and 7 are border/ine case.s
? y v�m o �E '� � � o requiring use of dual sym-
e a Clayey sands, sand-clay mix- m � y� o+. qtterberg limits above "A" bols.
iR aa S� tures Q Q y—� �1D line with P.I. greater than 7
Inorganic silts and very fine �'
sands, rock flour, silty or clay-
� �L ey fine �nds or clayey silts �
W with slight plasticity
>r For cl�ificetion of fine�grained
f0 '� Inorganic clays of low to me-
'm � i� soils and fine fraction of coarse-
m -o m �L dium plasticity, 9ravelly clays, 50 grained soils.
'y y E sendy clays, silty clays, tean Atterberg Limits plotting in
$ __ clays hatched area are borderline classi- CH
y° � fications requirir►g u� of dual
o �
c ;J Organlc silis and organic silty � ��Is.
s ` �� cla of low lastici m Equation of A-line:
�, Y' P t1' .D PI=0.73 ( LL - 201
!� L C
m'�
m� inorga�ic silts, mic�ceous or �� e
� y � MH diatomaceous fine sandy or � ��c
�.�, r silty soils, elastic silts a ,Q. OH a MH
� ..
LL � � � ZO
�d
w .o L Inorganic clays of high plas- CL
.° W�' �H ticity, fat clays
z � � 10
� in � 7 ---
-� '� q-_... _�M �Q MLa dOL
` J py Organic clays of inedium to 1
� — high plasticity, organic silts �
0 10 20 30 40 50 60 70 80 90 100
Liquid Limit
�
,_ 'c = � Peat and other highly organic Ri�ticity Chart
_ � y SOIIS
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sua�ecr PER
City of Fridley ° 12129 �
, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I EC .
r
� ; y _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �� j��
1 ' �
�� � /"�h � CITY HALL FRIDLEY 5S43P NUMBER REV. DATE PAGE Of APPROVED BY
•°'� � ,�� 612-560-3450
_ 910-F15 5/18/73 � /
JOB ADDRESS 5228 Capitol .Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],$ 7 Carlsvn's �u�it Ma:nor South Addition SHEET
2 PROPERTYOWNER MAILADDRESS _ ZIP PHONE
I3. Stevens 5228 Capitol Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
David Christensen � 1040 128th Avenue
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION C$ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS t
iC��-�C.� .Q�/laQ.-�� � �
� SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF GONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTAUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�].
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,300.00 .7S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC OR TH PE FO ANC F CONSTRUCTION. � 9, OO
PLAN CHECKFEE TOTALFEE
� � ��� 9.75
S NATUREOFCONTRACTORORaUTHORIZEDAGENT tDA7N WHEN PROPERLY ATED THIS IS YOUR PERMIT
�_.C.(�L��Z_.(%/i!� � — ��
Si� NATUREOFOWNERIIPOWNERBUIL�ERI lDATEI BLDG.INSP pA7E ���
,
A�PLICATION FOR RESIDEIVTIAL, ALTERATION,
OR AUDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : ?� .0 � . �l � U C `�► -S BUILD� :�(� i � � ! S °-e 'Z.S � 7�
annxESS :�'2 ,2� �-���L Ill � a���ss :_/'c� � o /� ��'�u�
No:. �',Z.� 8� s��s ��b ; 7'a l�' �'
LOT t BLOCK : .�DDI�ION m L�`r..� sf� `2. S' !.( 7vi � r��S G.
CORNER LOT: INSIDE LOT: SE'��AGKa SIDEYARD:
Applicant attach to this forffi �,ao Certific�.tes of Su�vey of Lot a.nd proposed
building locatian drawn on these Certifica�ese
�ESCRIPTION OF BUILDING
To Be Used As;
�'-1�2 S'_� c✓,P ��_,___.v S�'ront : Depth a Height ;
Squaxe Feet° Cubie Feets
Froat • _��ptp� ; Height :
Square Feet; Cubic Feet:
1�ipe of Constxuction; �,� L(,i �_ Estimated Cost;,� �� ��
To �e Crnapleted : _ �j �_ y `� � / � � �
The undezsign�d hereby makea applicati�n for a peranit for t:he work herein
speeified� a�reeing to do all work in stf�ict accordance with the City of
Fzidley prdiaaucee and rulings of the �p�,��ent of Buildings, and hereby
declares tl�at all th� facts and repre�ent�tiomm� stated in �kais application
are trues aad cozrect.
.
DATE : � � S IGNAT[TRE ^
(See Revezse Side �or Additional Inform�tion.) .
�� U � '
, ?� ,s�� �����
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e
� � �S�
r
BUIT�L��NG PERIv��T r6;E uCI�EDU�,�
SECTION 2. The Inspector of Building� st��sll� b�fore issuing pegmits fo� the
exection of any building or structuYe, or for any adciition co any exi�ting
building or stxucture, o� for any alteratio� or repairs to any existing
building ox structuxe, capon application th.erefo�eg require the payment by the
applicant �or such pex7m�t o+ E�es to �he �.r�ount her�-Ln below sef� for�h and gn
the tqanner herefn provided to-�ait :
� UNIFORM BUILDIIVG CODE m Type 1, 2&/� -$% 015 fce� �a��a oxte �housand cubic
feet, or fraction the�eof, in sucl� cubical e�,n�ents, Type 3& 5-$1.85 for
each one thousand cubi� feeta
.
ADDI'TIONAL I�IFORI�iATION
�or the purpo�e of camputing fees for building pe�tnits, the cubical con�ents
of an� building or addition, i� dete�mined by multiplying the ground area
covered from a point six (6) inches below �he floor line of the basement
o� tl�e cellar to the �ver�.ge heights of the upper surface or to the average
heigtr�t o� the roaf surface of the main gable of a pitched roof.
For repaira or alterations to an exi�ting s��actuxe, the fee shall be at Che
rate af $3.00 pex each five hundred dollaxs ($500.00) or fraction thexeof in
the cost o� al�. propoaed woxk.
Txi x�v caee sh,all the fee chagged for �y pe�i� as set foxth in Section 2 be
less than $5.00, �
VBRIFICATION OF FOUNDATION
NOTE: Pexmits fox eonstru�tion will be is�ued a minimum of 24 hours fram th�
time �f applicatios�, �� �il�v fox proper �ev�ew of �1x� p�opo�ed structu�e and
oi t.Y�e coastxuctiora si�.eo
A Certif3.ad Survey of the lot, showizg �he location of tlie �oundation, once it
has b�een constructed, wi11 be require� bP���e proceeding with the €xaming.
CERTIFTCATE �F OC�;i�1��IVCY
Appli.c�.ti.on fox a Certifica�e of Occup�aacy s�i�ll �e an,ade tea� (10) da.ys prior
ta tha use ox vccupancy of any structuxe for whic� a b�ailding permit has been
i.asued; azld said atxucture shall xaot be u�eci o� oc�upied until a Certificate
of Occupancy ha� been issued.
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City of Fridley � 2 9 8 0 2
�
AT TNE TOP OF THE TWINS � U I L D 1 N� P E R M I
; � RECEIPT NO.
� `v _.�__ COMMUNITY DEVELOPM�NT DIV. �' �
r � � PROTECTIVE INSPECTION SEC
i___.�; �'�' �'� CITY MALL FRIOLEY SS132 NU�IBEA NEV DAT@ vAGE Of APPROVED 8r
t 6�2—s�t-34b0 910-F15 6/30/99 / /
JOB ADDRESS 5228 Ca itol Street
t LEGAL ��T NO. BLOCK TRACT Oii ADDITION SEE ATTACHED
DESCR. 18 �] CdP'�SO11S SUR1CIll't - SOUt{1 SHEET
2 PROPEFTY OWNER MAIL ADpR�$$ 21P PHONE
Harold Stevens. 7 _
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO
Midwest Roofmn 18979 Glad t
4 ARCHITECT OR DESIGNEq MAIL ADDRESS ZIP PMONE LICENSE NO
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOHK .
O NEW O ADDITION O ALTERATION j� REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reside house and garage
9 CHANOEpfUSEFROM TO
STIPULATIONS �
Call for building wrap inspection before covering.
TYPE OF CON$T pCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SC. fT CU FT
AUTHOR12ED IS NOT COMMENCED V�!ITHIN 60 OAYS, OR IF CONSTRUCTION
OR WOFK IS SUSPENDED OR ABANOONED fOH A PERIpD OF 120 OAYS A7
ANV TIME AF7ER WORK IS COMMENCED. NO. DWLG. UNITS OiFSTREET PARKiNG
I HEREBY CERTIfV THAT I HAVE READ ANO �XAMIN�O THIS APPLICA710N STA�LS GARAGES
AND KNOW TME SAME TO BE TFUE AND CORRECT. ALL PROVISIQNS OF LAW$ 'ypLUATION SURTAX
AND ORDINANCES GOVEFNING 7MIS TYPE OF WpqK WILL QE COMP�IED
WITH WHETMER SPECIFIED HEFEIN OR NOT. THE GRANTING OF A PERMIT $6840 3.4Z
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pERMIT FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULA7ING CON-
STR CTION R THE PERfORMANCE OF CONSTRUCTION $139. 25 Fi r SC C. SG�
� ��— / �� PLAN CNECK FEE TO l FEE
� C C
S�GNATUpE OF CON7i7ACTOA OA AUTM0�7�ZED OGENT ID ?���- Li cens J. 54 e:7�
EN PROP VALID T 7H15 �S R P MI
i �
�
S�GN4TUAE OF OWNEA��F pyVNEA BURDEA� IDAf@� BL G�NS ' r��tE
x�w � � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.,DING PERNIIT APPLICATION
Construction Address: s°? �� ���f �� � f� ��`f��`� y
Legal Description: �o? � 8 � �%� z ` S7f ��� �O
Owner Name & Address: �W'a� Sf -e��� Tel. # �7� — 8� a�
Contractor: � � 4 ��Y.1 � �ofl �� � �, NIN LICENSE #
Address: /� � �2�f ��� t ���� Tel. # �f / �-- Y ��5�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
��<Q�_ ��:
Y�
Height
Height
Hgt/Ground
Construction Type: �/ `�/ � � Estimated Cost: $
,
Driveway Curb C�t Width Needed: Ft. + 6 Ft = Ft x$
Sq. Ft.
Sq. Ft.
Sq. Ft.
� �y� =�
_$
DATE: � ' 3a'"� % APPLICANT: ���. � �"�1��S�Y'1 Tel. # J � � l ,��`�
Permit Fee
Fire Surcharge
Sta.te Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� 1 �� �
$ .� • `
� 3. ��-
$
$ S�- OC�
$
$
$
$
� f��/� /
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] 1�Tot Necessary [ ]
.� - ".,
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erecrion of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50, 001 to $100, 000
$100,001 to $500,000
$500,001 to $1,0(�,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,QQ0 plus $10.10 for each additional$1,0(�
or fracrion thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5�,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,OQfl,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Cbrb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25,
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicat�on to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the locarion of the foundation once it has it has been �o���ted will
be required before proceeding with the framing.
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CITY OF FRIDLEY
6431 UNIVERSITY AVENiTE NE
FRIDLEY, MN 55432
572-36U4 l+'AX:
ADDRESS : 5228 CAPITOL ST NE
PIN : 263024220085
LEGAL DESC : CARLSONS SU1VaVIIT MAN SO ADD
: LOT 18 BLOCK 7
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CON5TRUCTION TYPE : ADDITION/ALTERATION
571-11i3"/
PERMIT N .�.(�2004-00442 v'�. 1
� �
DATE ISSUED: 04/06/2004
VALUATION : $ 300.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A
INSTALL A WATER SOFTENER
# ELEC WATER HEATERS
# NEW FIXTURES (EXIST OPENII�TGS)
# GAS DRYERS
# OF NEW FIXT'URES
APPLICANT
SHII,OAH WATER CO
7319 166 AVE NW
RAMSEY, MN 55303-
(763)753-9244
OWNER
STEVENS HAROLD J& IRENE D
5228 CAPITOL ST NE
FRIDLEY, MN 55421
0 VALUE OF FIXTURE/APPLIANCE
0 # GAS WATER HEATERS
0 # GAS RANGES
0 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
An �c�t� � Date
: � � i �: � � �` � �=--"
_ ,�..�<►�� -
PLBG PERNIIT MINIMUM FEE
PLBG FIXTURES (NEW OPENII�IGS)
PLBG FIXTURES (EXIST OPENII�TGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIlt/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 9781
SEPARATE PERMITS REQUIltED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0
1
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.00
0.00
0.50
35.50
Building
Inspections
763-572-3604
763-502-4977 FAX
BUII�DING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E�rrvE i-i-os
DATE YOUR E-MAIL ADDRESS
srrE .�vnxESS 5`� 1�il �F R44�1- 'N Q
THIS APPLICANT IS: 0 OVVNER L�CONTRACfOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SiJBMIT A COPY OF
YOUR STATE LICENSE
PHONE L!� � A.'
STATE LICIIVSE #
Permit N
Received By:.
� ,������: � ��
� 1R C����A STATE��P �S�I ��
' ��I� STATE�ZIP��.�u
FAX ,��r�,(�
EXP DATE � "� I • �.}`I
PROPERTY TYPE �❑ SINGLE FAMII,Y/NEW CO]VSTRUCI'ION SIZE
Q TWO FAMII,YlNEW CONSTRUCTION STORIES
pERNIIT TypE 0 ADDTITON ❑ GARAGE/SHID ❑ WINDOWS
❑ BASEMENT FINISH C�.ROOF ❑ DRAIN TILE
0 DECK ❑ SIDING ❑ OTfiIIt
TYPE OF WORK: ❑ NEW HOME CONSTRUCITON � ADDITION
�-MAINTENpNCE/REpAIlt ❑ REMODIIdNG
DFSCRIBE WORR BEING
�
Ff
gpp�G ❑ HOUSE ONLY g��T ggMODELING SUBMIT:
', NUMBER OF SQUARES � L9'HOUSE & GARAGE 1. E�risting Floar Plan
GARAGES ❑ ATTACFIED GARAGE 2. Proposed floor plan
PROPOSED S�: ❑ DETACfIED GARAGE 3. List of strncpaal membsrs to be u�d
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING ADDTiTONS. & PORCHES SUBMIT:
❑ Vinyl ❑$O�t 1. Site Plan/Sucvey showing the existing structures
❑ Aluminum ❑ Trim and sed ed.
❑ Other ❑ Fascia ProPo P%1
2. Two sets of conshuction plans
WIlVDOR'S 3. Energy Calculations
IN EXIST7NG OPENINGS OYes O1Vo L�ATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SiZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLID NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING TTHE COST OF LABOR AND MATERYALS:
SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ � ���� T�E
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
$ See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �. 5 .001 times the total job valuation
$ � � �� .0005 x Permit Valuation Minimum $.50
$ �_� $5.00 (State Licensed Reside�al Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ f}+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Detetmined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ `��•� Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PIItMIT NOT VALID UNTIL PROCE5SED
I hereby apply for a building permit and I aclmowledge tl�at the information aimve is complete and acc�nate; that the work will be in conformance with the ordinances and code
of tlie City of Fridley and with the Minnesata Conshnction Codes; that I undecstand this is neY a permit but only an applicatian for a permit and work is not to start without
permit on site; that the work will be in accordance with the �ved plan in the case of all wotk wlrich ' � neview and approval of plaas.
SIGNATURE OF� _PRINT NAME DATE51�
APPROVED BY DA ' "�� �
PLEASE NOTE: ARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WU1tK
�uiiain�
�nspe�tions
763-�7?-36C)4
76 �-502-=��77 F��
SI'f� ADDRESS
THIS r1PPLICANT iS:
i'�t�PERT`I
O'9VNEIt/
TENA.I�TT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
cEx�zc�� oF
INSIJItANC�
PERNIIT TYP'+
TYPE OF WORK:
❑ OWNER
������
�.���i��'�..� .�������r�z�'���T
��� ��' �����
�,�ECTrv� i-� �s
YOUR E-MAIL 1:DDRESS
Permiz No.•. I �
Rece ved By:
Daze��''�: �'� �
ADDRESS: ��Y1 � CITY STATE ZIP
PHONE: � %� � ��o�►
�
STATELICL-TISE� �IV�B° �+9�!! ��`,g��l � .+ E:CPDATE . • I�
STATEBOND# ���0 ��! � 9 � r� E.�CPDATE � �`."���"
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ADDRESS: �P9l�IP T���.§��CITY STATE ZIP
PHON� ����LZ���9 F�rT1��T-�+���t13G -- — -- - --
❑ SINGLE FAMII.Y
❑ NEW
DETAILID DESCRIPTION OF WORK
� TWO FAMILY � TOWNHOUSE
�REPLACEMENT
PER MS 16B.665 the permit fee is a minimum of �15.00 or 5% of the total cost np to 5500.OQ, whichever is greater, for the
improvement„ installation or replacement of a residential fixture, excluding the iuciures. (This should reflect oniy the cosi of labor )
Labor cost under $300 =$15.00. La%or cost between $300 to �500 = cost of labor x.OS = plus SO surciiarge
OR
FOR PROJECTS Wf�RE LABOREXCEEDS $500, FEES ARE BASED ON $] 0.00 PER FIXTIJRE, EXCEPT WE�RE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF' EACH BELOVt�. MINIMUM FEE S i5S0.
BATH SINIULAV ' FLOORDRAINS SFIOWER ,_WATERPIPING
BATHTUB GAS PIPING (NEED QTY LIG� SVJIMMING POOL ,_ WATER SOFINER ($3�
CLOTI-�S WASFiEiZ KTTCI�N SINK WATERCLOSET ,_BACKFI.OW PREV. ($15)
DygHWp.g� LAUNDRYTRAY ' �WATERHEATER($3� FOTCIItRIGATION
— WATER METER _ OTHER
Pertnit Fee
TOTAL DUE
(MINIMtJNt $15.501
$ Number of fixtures (a� $10.00 x $10.00 = $
.50 Number of fixtures tr � 15.00 x$15.00 =$
$ OR Numbez of fixtures @$35.OQ x$35.00 =$�
State Surcharge = $ •Si
� (MINIMLJM �15.50) Total = $ �
THIS IS AN APPLICATION FORA PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work wiil be in
con%rmance with the ordinances and codes ofthe City of Fridley and tivith the Nlinnesota Construction Codes; that I understand this is
ilot a permit but only an application for a permit and work is not to start without a permit on site: that the' `vorl: �vill be in accordance
�viih the approved pla�i in the case of �11 �.vorlc �v ich requires revietiv and approval of pians.
.r� o _ � • . . . /,l —� ., p � e
SIGi1ATUP.L OF
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