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AF - 36097City of Fridley, Minn. BUII.DING PERMIT Date: ��ar� ;��?��!t ��,, �w�� N� '7951 OWII@P: �^�,1� Fi Fs°�i � _�' A'��i�f�i��: �'q�+r��Bll�ld@T ��Te _ �8.'"€��` , - •- . �iil�$ . � �'' � . ,;r �g„ �i'� r� .�.. , c ^+� k e � ACl� �� , a � t, .r�..%, �:�;'� �'c� � ^�'' �"1.�{�' � �� m ` i . LOCATION OF BUILDING �� ', � No. �� gfreet � � _- t� l Part oP I.ot Lot Block Addition or Sub-Division �';"�+° a �,°�`" � � �:� •"�;`' ��'�' , ��', Coraer Lot Inadde Lot Setback Sideyard Sewer IIevation Foundat3oa IIevation DESCRIPTION OF BUILDING To be vsed as: �� ''��`� Fra�t Depth Height Sq. Ft Cu. Ft Front Depth I�eight Sq. Ft Cu. Ft Type of Construct3on F.�t. Cost �'�.'��' To be Completed In consideral3on of the issuanc:e to me of a�ermit to construct the building des�tbed at�ve I agree to do the proposed work in acceordance with the d�acriptalon above set forth and in compliance with afl provlsions of orritnances of the dty oP Frldiey. In co�aiderat[on oP the �yment of a fee of $�'�' , Permit 9a hereby granted to '° a ��', `_`°�: r'''� to conatruct the buiiding or addition as descrYbed above. Thispermi t is granted upon the �expresa c�ndition that the�e�on to whom ft is granted and his agents, einployees an� worl�nen, in all work done fn, around and upoa said building, or anyp� thereo� shall conforai fn all reapecta to the ordinaace�e of Fridley, Minnesota g locatton, constructiou, atteratian, maintenance, repafr and azoving of bufldings wi�� dty limits�an�ttiia permit may be revoked at aqq time upon violation of any of the P�viaiona of said ��. �, :;.a.= �, � J ��,� .� � `� • . _ _ . - +'r++�au+8 --.—Y�. .wr NOTIC� ' 'Ilds pqemh doa not �wr i6s eoasteuaH�, IeaaOdloe ter 'wte6i6. P��+�B. 6b hfaHe�, mru ee wat�r. B� �un ts n� Na 8uqdlo� Insp�etor tor qparat� pumHa Ior fina H�a. ,� � �, �: . /�' '-r � APPLZCATIOft FOR $UILDING PERM[T CITY �F FRIDLEY, MINNESOTA r 9 6 OWN'ER' S NA4ME BtrILDER . -• ADDRTsSS �DL`RESS � � � � � LOCATION OF BT�II,DING �_�,�.__ s � �, �-�,�.�C� :.Dte�^�j �' � � Stree� ��--�'�—_� part of Lot .____,�.,.,.,.. L� �L�K ADDITION OR SUBDIVISION �- --�,-�-� Y�-°' �°'��' � Coraer Lot`_Insid� LpT Setback Side-�ard ,1��` ��.a�� :�°�-� .�-� -�--=-.—.,...�_.�..�,_�. �E'WER .ELEVATION F(?ITNDATION ELEVAT201�.. � � � Applicant attach to t�iis form Two.CerCificates of Survey vf Lot and proposed buildin$ location drawn on these Certificates. DESCR�PTTON OF BUILDING To be used s; '�� Front Dept �, geight Sq. Ft. Cu. Ft. _____,__ - Frant DepCh Height � Sq. Ft. Cu. Ft. Tyge of Co�natrucfiio�a -- :'l�a� ,�o E�timated Co�C 1� �� 0� To be completed �1'h� undersigned hereby makes app2ication for a permit for the work harein specified, agreeiag to do all work 3n strict accordance c,ri.th the City of Fridley Ord.iaaaces and rulings of the Degartme�at of Buildings, and hereby deciares that al� ehe faets ana repres�tations stated in Chis application e true and correct. DA� STGNATURE . J 1;91'L�.rL,�, (Sthedule af Fee Costs can be found on the Reverse Side). �� . -' < ��, � BOiLDI�4 PER1alIT. FF,�__SC1�ED8�.E " SE� CTION 2. The Iaspector of Buildings shall� before issuiag aay �rmit for the erecCion of any building or atructure, or for any addition to any existing build- ing or etructure, or for any alterations or repairs to anq exieting building or structure, ugon application therefore, require the payment bq the applicant for such permit o£ tee� to tbe amount herein below set forth and ia the_maauer'harei.�... provided to-wit= 2.1. For auy auch permit fcr the erection of any fire �proaf buildiag, other than a garage, warehouse, factory or gtaia elevator, or for the erection of any fire-proof additiou, for aimilar occupancy,-to anq existing building, shall be aC the rate of $1.40 for each one thousand cubic feet, or fractioa thereof� in auch cubitai coritenCs. 2.2. For aay euch permit for tbe erectior� of any fire-groof garage, warehause, f�ctacy or grain eleeator, or for the erecCivn of any fire-proof addition, for a3milar occupancy, to anq exisCing building shall be at the rate of $1.25 fo�,each one thousaad cubic fest, classified as "fireproof" by Settion 502 of Che Minaeapolis Building Cod�. IiOUSES . . . _ _ , , 2,_ 3. For anq such permiC.for the erection of any noa-fireproof building, other than a garage, warehouse, factorq or grain elevator, or aay aon•fireproof addition, for similar occupancy, to anq �xisting building - permit $1.00 for each one thousand cubic feet. GARAGES _.� 2 4. For any such permit for the erection of any non-fireproof garage, warehouse, factory or grain elevator, ar for the erection of auy non•fireproof addition, for similar occupancy, to any exieting building or for �each such buildia� or addition - ninetq cents ($0.90j fvr each ane thousand cubic feet or frsction�thereof, in the cubical contents thereof with the miaimum of $4.00. For Cbe purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout bq mulCipiyiug the graund area covered from a po3nt six (6) inchea below the floor line of the basement or cellar to Che average height of the ugper aurface or to the average heigbt of th� roof aurface of the main gable of a pitched.roof. 2 5_, For repairs or alCerationa to an ex3sting structure, th� fee ahall be at the rate af $3.00 per each Fiva Hundred Do11�rs ($SQO.QO� or fractioa . thereof in the c�st of all proposed work. � b,r Tn no case shall the fee char�ed for say permit as aet forth in Section 2 be lass than $4.00. '�±, � :�, '�� . ��, °` � � �� ,�. , r,,,� � - ::� �,� �� -�! � �� S ,�`O� � i �o O► n � ..� � �' � , � "C ;� : �� o�o�� -�h� � O o�� . � �� . � �� o �� rnm � � �h A� �� Ort �'i + �N �N �� aa�� - � � � �� fA f'f � F'• N c� `i �� r N � �. atOO N N � i � � 4 �w � � �� . ��o a- rn�� . � �n �� x � � �, . �g�� p' � ti o fi�� 0 �� :K W. � A � . Q� �-~Q�� i � ��°_� rt�� '�� n a \ � � ro ��t0 � N W � � F-' � . � � i J O �� i �� o� � � �� 5.�-�� W� � ~ � �� ,�°,��,�. A3 �a� � � �. ro �� .�� fD WO�� N� ��''`��r�a- ��° � �� a� � � r �u fi� �� ' � � �� ft � c� N � �o � N . m i �P � ��'��X N''C�2nt�Dfv � � � � � � � ��. �� N � ` �t �'� �d �� , . � �� . �. � � � �fiR��. ��"� -�� Nr•� ��`�� mroa � ~ c� �- ��o�►� ��,�� fr�g• (A •� M N fi N- '�~ � �� N� � �. � � � � � �� °,�°�� r�, ��nrr . � t0 � • ct w �� rt r 0 � � � � � .� � bF,d C ��,�� . � � �. � � � � �� . r�, a � �r�mo� (p Q fh - tfDt' �' � � �r ��1• ,� � P�' tD N (1� � �~ �� n �• �,�� ..-� �� ro fD � m � �.� �� a�� . �� o�� I-h � u. o�� w r � �� (� � O O� H . �' � .� � � � rr l0 N w � r m� i N ��P � � �' N � � � o� � � �� N�7' � x �i o�� a �n �: �� '� � �� m �• �� rr ro �� a �� w fi � r'S � � ��, � � -�� w � c��"' i N� � � ao � N H+ fi � n � ft' r �, � N W . � N � � � � � r � � � � 5,4(1GREI`iE PRIf`ITII`IG • 42�-e22o � � � ^�...-_� �' � �'. � � �` �' FORM 1 INITIAL COMPLAINT REPORT oEP-r. F�dle� �, No. 1 9651 _ TIME REC lO2S M TIME DISP M ON SCENE M CLEARED M DATE 4-14-76 RADIO IN PERSON BY PHONE�MAIL COMPLAINANT Richard Palmer ADDRE55 1329 Gardena ��, LOCATION MnorP T ak RQ8('}l PHONE NO. =t./ �y-2.8.3 � y � OFFiCER ASSIGNED Environment�l Officer � -rYPE- Nuisance--Animal Complaint �I COMPLAINT Yesterday the compl, went to above location with his family and couldn't - . _ ._ . . _ _._ . _ find a snot to �ut,his blanket because of excessive dog dro��ings He would like this taken care of immediatelv. FINDINGS AND DIS- ._._ .___-.� . ._ _ POSITION ,..�` . ' COPY TO ENITIRONMENTAL OFFICER.: - �— _ � _- -_ _. - �-- _- -.____,_ _ T a�g� REPORTED TO ORIGINAL Y��6 , �f ��,Q o0 �-,1� � -�e. ��, �e �—� c�z �� -;� �-�.�-�- �a��„� �,�.,� � � � �.�-�,�., .,�,,�, °�,�..e a.-.-�.w . �,�, SUBJECT • City of Fridley � 135'74 ` AT THE TOP OF THE TWINS g U I L D i N G P E R M I T � EIPT. � � . COMMUNITY DEVELOPMENT DIV. ��!'] r � L � PROTECTIVE INSPECTION SEC. �I (��`•- � � 1 � � � /�"1 � CITY HALL FRIDLEY � 55432 NUMBER REV. DATE PAGE OF APPROVED BY �----� � �'� 612-560-3450 910-F15 6 8 � � JOB ADDRESS x 5874 Central Avenue N.E. 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTYOWNER MAILADORESS ZIP PHONE Ci of Fridle 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE UCENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK alteration ta a urall for a rk facili 9 CHANGE OF USEFROM TO STI PU LATION S SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON$TAUCTION ZONING S0. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAdE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OFI NOT. THE GRANTING OF A PERMIT �. COO. .8O 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- ST� CTION OR THE P FORMANCE OF CONSTRUCTION. � �''e@ waived // � PLAN CHECK FEE TOTAL FEE l�� . � . �� -� �', ��l � G . so SIGNAT R tOFCONTRACTORORAUTHOFI2EDAGENT IDATEI EN PROPERLYtiVAL ATED THIS IS YOUR PERMIT � .,�-�� C� : � ��_ � f 9 �' �~SIGNATUNEOPOWNERIIFOWNERBUILDERI IDATEI BLDG.INSP � DATE P� J . - a AP.PLICATION FOR R�STDENTIAL, ALTETtATION, OR AllllITION BUILDING P�RA4IT CITY OE FRIDLEY, MINNESOTA � OWNER' S NAME : ��- BUILbER ; � z�1fr � �� - -��-�c . � � 3 ��,.<°S ADDRESS t � � ADDRESS : ,l �„Z � ,� ��o .� � NO :�Fi 7 _ STREET :___C�'�� . LOT: BLOCK• ADDITION• CORNER LOT: INSIDE LOT: SETBACK: SiDEYARD: Appl:icant attach to this form �tao Certificatcs of Survey of Lot and proposed buixding location drawn on �hese Certificates. r HESCRIPTION OF BUILDING To $e Used As : , /�� i ��a-%� � 0�1 . << r � ��-�-�c �/�G_ . Front : (�� D'� � C- Depth : � Heig'ht : /' Square Fee�C ; Cubic Feet• Fxont: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $%( C e "= To Be Completed ; �%%/� °° eTL[ d� � The undersigned hereby makes application for a permit for the work herein� specified, agreeing to do all work in strict accordance with the City of Fxidley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. � , � DATE : � � u � St�- � � SIGNATIIRE : � . (See Reverse Side For Additional Information.) �� • �,e �1:o..C-Q ,�-�g4 �'to�� c-�`�` _+ � j� �``� �i � �� - _ �- . /� vr� - � ��f� � ��-r�� ` , �� C` `� ��'c �;.-�� ; t �cl v �'c° ¢- 0 ra � ,- _--- '�BUTLDING PERMIT FEE SCfIEDULE SECTION 2. The Inspector of Build3.ngs sha12, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefare, 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: tTNIFORM BUILDING CODE: Z`ype 1, 2& 4-$2.15 for each one thousand cubic feet, -ox fraction thereof, in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the puxpose of computing fees for building permits, the cubical contents o£ ang building or addition, is determined by multiplying the gxound area covered from a point six (6} inches 'oelow the floor line of the basement ox the cellar to the average heights of the upper surface or to the average� �height of the roof surface of the ma.in gable of a pitched roof. For repairs 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. Tn no case shall the fee charged for any permit as set foxth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Pexmits for construction will be issued a mi.nimum of 24 hours from the time of application, to allow for pxoper review of the proposed structure and af Y.l�e construction site. A Certitied Suxvey of the lot, shoc;�ing the location of the foundation, once it has been constructed, will be xequired before proceedin� with Che framing. CERTIFICATE OF OCCUPANCY Application fox a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been . issued; and said structure shall not be used or occup�ed until a Certificate of Qccupancy has been issued. - a ' � �i \\ � � . � A . �.�� r� _ � ' - � = � �" :'` - - -� - �°-�.`-�-��:-:, ---_ _ , a��= -�su+ . :.:_- _: _, ;_., _ ,. _ _ , _ , � _' �� /� .�-� . � - � �j� � � _� � ,� - � � � _ ��-�� _ � � _ - - - - _ d � _. _� ` f' - . � � :- �� _ - _-- - � r�y� � - _ .. . . � _, : � � . 2 J, � ��. �— °� � . � _ � G__ _ _._ _ � � - �� , �� =-"= - i_ � . . FT: �_ ►, , �;.,�, .�-- ---- � i _ � _. _ .._— ! �_ --�-- , � . . _ ___. ;--- - i- � ,� �� . � P - , � , _ ____ _ _ - + ��- � � � � � I _. � � � � ` � f - -- - � o� �.� �� ,� , f � � t�� ,� -� ,� s _ ___ - - 1tilOH1LE Y�,7�! �/ER� t9UT . - �_ . �/J ��.� L.�,�.� ' : : � � /�(. ,� � ' o�' . . , -__ �_� _ ._ , , Phone`- � 9 � °- o� 9�� ' — c��/ to�'°ia /,) Z - Area CQde .Number nsTon _ l-- _- -- � - _ ' � : TELEPHON�D I } E CALL ; I �-! � Z � _ _ _ _ _ - - - _ _- -- GALtE[i'TO SEE YOU WfLL CALLA�d41N , � , � J : ~ __ ��' j �fl/ANTSTO SEE YOU � URGEM _ � ' - -- � �/ ' �� - __ -- — _ _ - --- —" f ' RETURNED YOUR CALL -: ` �j/ � , . � 1r � I_ - _ - - — - - Me�ge � � � ' - -- �� f -/��",�=�-� _._ z _ -- 1 ' � � ;- ' � ._ � � � �� _--- � -/ -- ��-- -- - �, - - � �- ' . .' I" `-� ! ti ' . ` , - - � - A � � � " �- C'�• - _ - - -- - � r �._..__ __ .._. :_ i � • . . -__ . __._: _ ._ ._.__- ____._ - ; 0{�eJ8i0i i j ' � Ef�[CIENCYp UWE NQ. 5T25 AIU AMP/lD PROQlif:T 50 SFIEE7S - __— -.--. ,-- ___ _ �.."-°--•--..,._ _ , _ - - . __ ��,,,; �� - z a � 6� / _ -- - - -- �� - - . . ,. � � ,� Z- - ��?° -- - _ .t/ � � . � 7 - - - �- - - - �s`�.}� . _ � _ �� - � - - � � � _ _ - _ _ - f- � _ � � � -- �: 3 -----� _ .3. . /- z- __ _ . s" �. � _ � i, � _ - _1� �,3 f'� G�� l� °-� _ _ : _, -_ : :. . ,� � . . : ,� - _ SUBJECT Clty Ol FI'1dley �ECKING AT THE TOP OF THE TWINS ��1� P E R M I T r � � � �` __�_ COMMUNITY DEVELOPMENT DIV. r � �' � PROTECTIVE INSPECTION SEC. � '_ �-"1 � CITY HALL FRIDLE� 55432 NUMBER �----� � �`� 612-571-3450 9t0-F15 JOB ADDRESS 5890 Centra,l Avenue NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. REV 2 PROPERTY OWNER MAIL ADDRESS City o� Fridley. 3 CONTRACTOR MAILADDRESS Ea,rl TnTeikle & Sons 2514 24th A�e �,N��ls, r MN 4 ARCHITECT OR DESIGNER MAIL ADDHESS 5 ENGINEER MAILADDHESS 6 USE OF BUILDING ' Heach House UATE 4/22/92 21P ZIP ZIP PAGE Of / / ' 21295 T NO. �3 d� /U APPROVED BY SEE ATTACHED SH EET PHONE LICENSE NO. 724�961 PHONE LICENSE NO. PHONE LICENSE NO. 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WOF;K Remove beach_hou�e 9 CHANGE OF USE FROM ro STI PU LATIONS See pro�ect ��e.ci_�ica,tians, SAC credit. to. be trans�ex�red. to .new building �e�riit, TYPE OF CONST. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UN I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO $3o2QQ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FiEGULATING CON- ND �EE T UCTION OR THE PEFFORMANCE OF CONSTRUCTION. PLAN CHECK FE /�� _ _�� - NO k'EE OR AUTMORIZED AGENT 1DATE1 .�co ei w nco� IDATEI � OCCU STALLS LOAD CU. FT. OFFSTREET PARKING IGARAGES SURTAX NO FEE SAC CHARGE Cxed.it TOTALFEE NO k'EE :D THIS IS YOUR PERMIT �- -� ��J �� [ ] �1-1�9 � ] Wr�Jt�ng M •I' " ' i� • � � �:• ..I'J'✓M'�� r. �. Job Addr�ess: S�l�' � GL�Ti�ff L-- %�//� • Legal Description: owner & Address • G'l � /�/OGC"� �el . # contractor: �A�e G- L.,�= l,�' � � :�- � cv.s _ Tel . # 7� -� � � Acldress: .� /�'" Z��/E • �o . �i,Il�GS . State LioPnse # D�tIPTI�T 0�' BOIIDII�IG Livir�g Area: iP�h Width Heic�t Sq. Ft. CU.. Ft. Garage Area: Iength Width Heic�t Sq. Ft. Ctii. F't. Other: Ler�gtlz Width Heic�t Sq. Ft. C1i. Ft. Estimated Cost of Wrec3c_ing/Mcsving 3Z oz7 °= Apprnx. �ompletion Dete / ?,� .�. . :� . . .�+. City Water/Sewer Mpls. Gas Caanpany Narthern Stat�s Pr�wer Northwesttrn Bell Tel Co. 571-3450 [�] 372-4720 [�Cj 566-9120 [�(] 293-0665/293-1319 [�] Water Bill Paid: Yes (� Amount To Be Collect.ed [$ ] Initials Mavit�g Route: FEES Mwing: Principle Building into Fridley . Aooessory Building into Fridley . Zhrnug�z, within or dut of City . ... . . . . . . $ 80.00 $ 20. 00 M� *+� �a++ Fee: $15. 00 $ 15.00 Wrecking: For each 1,000 cubic €eet or fraction .$ 1.25 For structures which wrwld be impractical to cuk�e, the fee shall be ba_�ed on the total oost of wrec,��ing at the rate of $6.00 for each $500.00 or fraction. The undersigned hereby ma}ces application for a permit to wreck/move the building deseribed aUove, agreeing to do all w�ork in strict aocordance with the City Ordinances ar�d ruli.ngs of the Building Depaztment, arxi the State C�ode which requires ar�y water well on �he pro�rty to be sealed by a State livensed water well drilTer, and hereby declares that aIl facts and representations stated in this appl ication are true arxi carrec.'t • , �T �: - C� siz�io�s: \��6, ��'C� �� °° �j i � � _.� . �� i � `� -- ., � -- SUBJECT � City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � i � i �• COMMUNITY DEVELOPMENT DIV. r � � � PROTECTIVE INSPECTION SEC. � 't i"'1 � CITY HALL FRIDLEV 55432 NuMBER RE�. �•""� � �'� 612-571-3450 9t0-F15 JOB ADDRESS 5890 Central Ayenue NE t LEGAL �OT NO. BLOCK TRACT OH ADDITION DESCR. 2 PROPERTY OWNER MAII AODRESS City of Fridley 6431 University.AVe 1AE 3 CONTRACTOR MAILADDRESS Earl Weikle & Sons 2514 24th.A�e S Mpls MN 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS DATE I PAGE OF 4/22/92 � � ZIP r ': y � � yv APPROVED BV SEE ATTACHED SHEET 571-3450 PHONE LICENSE NO. 724-j961 PHONE LICENSE NO. PHONE LICENSE NO. 6 USE OF BUILDING Beach House 7 CLASS OF WORK C� NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a Heaah_Housa . 9 CHANGEQFUSEFROM STIPULATIONS See.�roject s�eci�ications� TO SEPARATE PERNIITS REQIlfRE� F-4R �V0R16��, HEATlh1G, PLlti��3l�;G �►�1D SjGNS. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AfTER WOHK IS COMMENCED. NO. DN I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUAT yY��►�� Before ai-�gi,7g G�Ir for al! uti{ity tocat;ons ��i��,��Y �� ST. UNITS AND ORDINANCES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED $167 44� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTiNG OF A PERMIT r DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING Cow- NO k'EE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE ,��_.I� _ ��/�✓�l/ NO FEE SIGNATURE OF C NiRACTOR OR AUTHOR12ED AGENT IDATE) �DATE� I�- BLD i OCCUPANCYLOAD CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX $83,i2 SAC CHARGE Cxedit �rom 21295 TOTALFEE $83�72 IUR PERMIT _/�Z - ...�,'t.._ --�° a:..- f r� .�.-, ; -.eC`�.. �,re•..�'.�. `";ybi�-�:,i �.i�.v. �r;� - x:.a�;.,: : . .. •� � �' . �'1.� . _. -. � `��'�'�-w,�y�,,�.:.-� i:�%;� . . . . . . - . . �ti-.,. �.-�, . _. , ...._..�.a-�....�- _. .�.d-a.r, _ .. . . _.,_, _. _.>, � __...__._ <..A.__. ....-�.. ... .-._.... _..- - -. _._... ...,_..v.s-____ ° �-� . . _._.. .KZ--.'<. .. . _. ....... ...,,- : _ �,. - , ' _- .a..�-- .. . �� //�.��y � � pp � � � � �' N ' �� d�� p n@�� YF� •", - ' I . , ' ., � - - � . a °�� :�ti P °-.� � P � y , _� � ., ' , ,\ �'. ^�,1� _ .- ' . �✓i. ;Y.�. . . . -1 �. � , . �1 1 J � .. � . _, . . , � � � i �� -� _ -_ ,.. . _ _' __ _� ._'_".� __'} _� " '_ .'" ' .� ' .. .. . � ._ , , ..':n _ '.yi .., , -.� , i _ . � -,� . . . ' _ •_ � , ; � � _ s.�'� . , e_ __ � � �....,.-,. .-,.-` . 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Tel. � --3 Uate� � � 9 '� :�1�� 1_ 1�, 1 fYIG��Gi • �. j�, Wld,tl] , H21ght � SCj. .1't. � Of StOr].eS OFC. ARFA: I�ea�gth Width F�ei9ht Sq. Ft. �iSE ARFA: Ler�th Width HPight Sq. Ft. CyII�.t ,�rREA; Length Width Heic�ht Sq. Ft. ' VATT��,7TQ�j St�,, �• X ,�? — C�06't�SCj. �. = V1�.U3t.'1.�'i ,�`� � � r $C;. i''t. X $ ..�t.t� .I�._ __ �I�E�f:7.�32 �` � _ $ $Cj. �. X �` Q05t�SCj. I''t. = VS�.LiA�.031 �` � � �iAL�IE • � �- � ��± � r •� •- (� v. G •��+ l�: t'i •�� i• � a •�? ,• r' • - i1 • - • - •' e •ic• - �( • ':a • n, r :�; .• • n�' i '- '�_ - - • a• - a�- a• - • Penmit Fee $ / V � � � Plan f�eck $ ° � ' Fire Surcharge $ ._� ' state surcharge $ � . ��. sAC c�arga $ �% D� � (�C� Park Fee $ ' � � Spec. As.r�s�uetrts $ ' � " Drivet,�ray EscY�ow $ � � "� • v� See Fee Sc�edul.e aa1 Rever�.,e Side In �s of Prepaid Amo�.�t - See Revet�e Side .001 x Pertnit Valuatio�t (1/lOth %) $.50/$l,00o va�uation (see schea. for > $i r2iiiion) $700 per SAC Lfiit (Plans to NgiJOC far det�mination) Fee Determiried BY ��J Agr+aemerYt rteoessaYy [ ] rrot xeoessary [ ] feet x $13.50/foot ADDIR'11Q�t. �rnamr� Q�1 I�THtSE SII� C,jZ � � r� �2 � �-° �`� � �� (c ��r,�°'+ � i -� .. � � �I1 �• 111 11 �• ,.. 111 ,.. 111 r• 1 111 �'1 t Il �• 11 11 I 11 111 �• 11 111 11 !11 �• 11/ 117 1�� $1 ` to 2,000 2�007. t7D 25,000 ... IU �• 1 I/1 "`I 1 i) sa � 1 111 il 1�1 r• V. Ii1 ••- `tL. !1! BUILDING PERMIT FEE SCHEDULE � 1►ii ii �o- . c i.r:i .c '1 [• 't.11 • � Y ��. c:�� :�• '7 11 •. ir.�w • �• .: • •� • 'Y �i1 [• Y 111 • • _:• :�• '7 111 •: i :vw • ■• :� • •Y • `Y,r I 1 1 YN� �•'. �YN 1 11 • 1 �r cc • : � • '1 11 t •: ■ . vM • ■• :� • •1 • `L1 111 1 �r "+1 111 • 1 •: c.• :�• 111 v ir.�� • r• :• •i • '1 11 111 :l�' 1 •: `1 11 111 • � 'X 1 •: o:• :�• '1 111 • it:fw • r• .� • •� • `V 11 111 Y.IL• "'1 • ■ c 'L11 111 • � '1L •: ca�� :�• "} 111 • ■r.v.� • �• :. • •� • 111 111 't'Y• �1 [�� r�- `7 Iil 111 • _ "Y • a:• .�• '7 111 •: ■r:«� • PREPAID PLAN CIiE� FEE SCHEDULE �►,,: ,�. 'Y.y ,�. r Y �!I • � '�. :v x�. c:• :�• !11 v it:�w • a• :��, � •1 • Y,.. Itl :C :'1 �• Y,.. 011 • ,Y,.. ��: _:�� :�• '1 ill •: rr•w-w • •1 • "r 1 111 "► .r . c�. "r 1 I I 1 • _ 'Y • ,�. e�: _. • . � • '1 1 I 1 • ■ . v.� • •1 • `7 11 111 r 1 11 /11 •. � 't� [�: c:�1 :�• :1 1!1 • rr.f• • • • °ti . 111 111 _i •o • - -�i � ti :: •- •i • � sl • •c��n PERFORMANCE BOND PULICIES �• • r• • i• - • - • � •1 • •c:�tu ti c• •: •�iiEia s+ o • ; �r = v i� w • - • ..- • c� •c �N . • • or �� • C• 1� �� • Eti�1 •" II•. O� =U= Iti . �M •'�II:. •" :• • !: - ��C.: �+� ♦ C�i�. ^i: •- � •111 ■fC• ■• ■ C �1 ��' •• • / •• G • Is�'i •- n• • cilc I� •1 • • 1 • nl rc• ■• -'. •G��:I�T • r�l •:�w • • u�l • • .��u��l • �v cc � • [a •a� • tw • � � -�u:ni •ir: :►' � -J.rcii_ t: • . w • •i •• • . n• �s� - i •- •c:r::�iu c• • ■ - • � • • •c:�u� - I - �• • :�ii• i •- •; ■ - • 1 •� • •urw - • �• . ❑i • •• :i • a =� •' - .f 111 •• • •�■ : .�i�• tti � •- • •c• �• r - -:i c 11 1 M - - ��- r • ■• c• � - •i c.;r� •: c�c; •• • : ii• ��_ •.�c• • N • ii� r. •=� ' • C«s� �J • • • Iti'1 •� II• i -CII� iti •G - �/ •� C• 1 � •• • :• •c u � ou: •�o. i� ■ e • c++ •�n• o• �• •.. .� r - • • - • � rn; • ■ i • • • - �� •i •� 1 • �- �• r• � r a • - � i •� - •��:1�- � r. . � • 1 - M � 1 ■ - ��c� ■ - - • •�� w c • c •i ■ - -:i • • i • ■ - � w . • .� t� • :• •, i�: � - r - - o• •��:: •; ■ :t -:i - ur, • ona !� .i - :tw tir.va�;r •�ii• crc• � � �^-e 0 a r � m m � �� l/� � � �� w m � � � � � cQ � in O � r � o r" � ON <_� � � O �� nv`D ,x� o o�'' � � o c° �p o o � ny � �• � �a � z v D � m a --� z i � � -a a °< a � �� 0 C � ? S v � � � � v �. � k..� 1 � V-Y� 1 N � z m v � m r Z 0 � v � � o� G� G� S�, �� Ci o0 00 � Z W ¢t A� � N A� p �D � � � �' �' m � � 3 So � m a v.,� v 70 �-. -, -o � � � �-n co�m�mzmz��W��c � � � � � � 3 � � m � o m m� c� v, y w m � � � m Z �m � tn n � �. � co m "' ��°—•� � � � � � � � � � c c m � a � � � � I z l I� I I I I( I I I�� 0 �� .i � �i �l � 000v � V V V�7t, v g o 000000 0 000000000 0 C ' y � 3 � � Z Q, c� a �- .a'. D Z � � � � � ,° -v m � � =�i Z O � � � � � �/ /� I f� � W �'0--- a � m � c � � m o. N � j� _ - �v � � � � � � � �`, � � � `� "V `� \�y •V � � � c � a °� m N y N y .�D3. o, m �° r. � m m O m � C' y W O � "'� �. a p' ,,�i � O �G 0. � � � v � � y O � R �y > > 'O a 3 � � n c� � � m � � �m�-* ��oo waw�' � � � � � �' 3 3y�r. ? '"' a ? � o o � � � m � � � � � � o � � Q � t�n N @ � � r c � � Z � � � c � m � � m � z O � � m � L O W a v v � � C � � V � � � N fl. W � � rn��0 'A Z �m °T� -� �i �� v w=,m � � -< Z Z m� v m n � 0 z v < � � m O � � � c � �..1 �O CO � R1�: ��;y� ��ti u - MEMORANDIIM Clyde Wiley, Bui-lding Inspector Curt Dahlberg► Park Supeivisor August 27, 1992 l �!�� r � � � /j , 80B�TECT: Bathhouse at N�ore Lake and Litt�.e League Building �-�c�p ('�ti��.�rt� �k-��_ `` �37� ��i2Sb�) It is my understandirig that the contractor has . f; n; �t,c�7 c;onstructim� the Moore Iake bathhou.se arxi the final inspection w:ill be corxlucted very soon. I would like to bring to your attentioal a few it� that have been �ntioned to me by the Parks NlaintexLanve crews. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 1. 2. 3. Interior wood riot sealed or varnished. Floors riot sealed. Hockey lights not corme�ted. Elec.-tric service panel. circ,uits (switches) not identified. Pltmtbing in warnen's bathraoa�n is not adecNatelY Protected from freezing. A security system may need to be installed (sca�one has already tried to breal� in) . Locks - r� keys for panic bar. 5c�ne deacmolts missing'/�lete. Scnne locks don't work. No pull haridles - 4 doors. No hand gulls on sevexal doors. No interior lights. Exposed wires and outlet boxes inside and outside. In service box (electxical) pTugs l�ocked out exposing access to live or hot wires. No heating ele�ts for building. Only o�e mirror per bathroom -�xit eac�i has 2 sinks. Utility room has no sink. Or� sheetrock cei.ling arid wall not taped or painted. No outlet cxyver. Ceili.ng fan mounting bracket e�sed. � No caulking on corners inside 2rid stozy. No caulk,ing on top plate. No door closure.s on sca�e doors. Gap on roof door - water leak. Glass wind� rio header plate - could fall out. Samne block work with no grout. Gaps in wirx� shutters. Water leak on entire north wall. Southeast door when wann can't open. C�apressor rooan walls r�t painted- W]ndcsws not Caulked on bottom. Little League Sti11 has wire exposed on irrigation box. Staizway to upstairs was painted over taping before it was saryded. S�en water fountain redone, brackeets arid holes exp�d on inside of ba'rhro�ns. .� ,.� � , � � m n � o �' -, q � O � � O y � o � 3 � a " o m �� o a 0 � y �m �� 1 1 C � 0 c .» � � D r O n C � zn �� v Zm ao n� m � � � < m � � � z Z � m z � '9 ci -� Z � m m � 0 °o D 'a � < a � � � 1 0 c � � s � v a: � � v m m � : %,� — � P`� � a , :� i i G� ' , � >� � � -� i� i� )� '; m 1 9� � m �� = � . i : ,� � � �� _ � z m m � c � m � � C � m � a m z � m _ � � m z 0 � � � O O � �� c � m � o, a '� H � � � 0 0 R �a � � < `� � � � � o, w, 8 N �• � � � � 0 0 �� N �� Z � ci � �./ � � � � c � � o � C p, ' _ m °, � _ m � � c � � _ o � n i�i m 0 0 � m m m N a tn � °� m m ,. a p o = � � o � � � � � � � � v � Ci 0 Q O ? � m D v_� m H v N c� � � z O c � a c� m �Z v � � C z m � N v � � � H � � m y �a � Z m a o. � � � c � � v tfl tff 4A tfl o � o 0 0 � � � � � � � � � a � m v n � � � � 'v m � � Z 0 �� 1 � W C v z � c � v v_��c � � � .° � � �� m m � .�+ C. �v m � � o � � � 3 m � 69 o �p � � � � O a r � m ci _ 8 � � �► � 3 -� � �?�co� a m �► � � n � �' �3 � D a ... � y a ��N�� . �w�=� � � N c °- a � Q�� v o, �. � � � y�`Q� � �com � _ a � N � _� N � � � v� • � 1 a ° H � � � � � � � o i� y nm� � �m�, �m a� Q � � ° �°•�� g � � y m � � � � m 0 V � � � Np.i� m o.�?O� A Z � :T1 y � � � 0 N m -mC Z Z mN � n � Z v m� c �� a -m � a� z�a vp >m �� 0 vz -� N Z� �v _ N � mZ �� agz 0 vz �< n� � �i � Z � m m O � � c � 0 � � CHIMNEY AND STACR VgRIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No () 2. Is free from rust or deterioration Yes () No () 3. Has no foreign objects lodged within Yes O No O 4. Is securely supported Yes-( ) No O 5. Meets all current Code requirements fo� size and total BTU's connected Yes () No () 6. Has total heating BTU�s of All other BTU's TOTAL BTU's � List Alteratians Being Done: HEATING COMPANY Signed By Date � 0 � � z 0 z b D . . ' � e � Y � - . � * . * '�� Y � � � .. l � : �. �, � � ao �' N. C � � °�� o � � � � �z d �'. �u,' �: � "' � � ,, c�e ,F'"�, p' O� C� e'q "• � O - C_� � � � `�{' O' : � "*+ O' �:�� g� � �, � � � � .... �, �', � g � �. 5' � � � y a�� t"` fl'°• C�?` o � � i� o � �° 9 �,, � `� � -m . �� , v� ►e� � e � . �,,, . - : � , _ a #� ►z� � �:. � � � a - �� : . � :-. �, � � � �, a .� . � ... � � �, — � . .� �► x � `� � �.x, � _ � �� a ��'o� o. �, � C� : . r-+ _ G (� � �� . �` � z � ° a° Q' Z tr1 � o�'� � �� :� rn ►� �:. o . .�a, �: ,� � -�'s' re �. ►— C ` ts � � � � o .: � . � `e ,�,r,' f�:�:� .,� � o � � � .. '�: �.�,� _ - � � O � �� a� �.o:_ . � � : .w �� p . V�i N �� (D� �`� � ` w �e ,� �i' N _� �. � �. � c � o��.� �, � �� a� � � � �' A' r3' a � N � � �C� '�*,� � � � � �• �• � v � �' � � � C�A "" � � � � � n � � d O F"n' O p�., `'� ;�,' c�o s�' � � �°. � �'' � � c� �-- �; ,r�,► ' ;� o�C.� y: 0 ��a� b � � t�. � � � � e r �V�Q��►p*' :N (T �' , . . � r e �-��y - - c��re�� o� c�cur�rc� c�c�sT �-- � � �� od � �: �� [ l Final � �j _ , :� . D� Ju].g 15 �� ; t �U1�t�lII� ' P82tII1# NO. , 21296 �r l�anle/1�ddres�S af' 4wnei' : C.ity . o�' x'x'i.aley ' � TENANT > Moc>re Lake sea�h fiause - A�T�SS BtU�diil� 589Q Gentx�l Avenue: NE �n� ` ` ��!/ �'7' ` r'�� - /a.S. %' �� G� �°�� r��v�..� i� Legak / � r� t �P � : �� ..,�TIl'_,� i�ATI4��`L P DATE DUE COMPLET� � ��„�''�1,��.11 ; f':n �i.i.�.�� ,�r� ,�'I�w. S:Z.� �.Z,r�- al'!� �BG� ° � 'fN�'i+� �s�o l^ � �%ds�`�e� � e3a��„,; d Gar.rrs �t i S Sj � �► .° � 4 �� -- C..t �T-,�... - � - �� . _ � � - � �� .� : _ < < - - � DATE AP�R4VED ` OF�CIAL'S SIGNATiJR� 1. /G-- Z�- 9� �1�,..,....�Q,,�'�_-�°�-«�- Fire Departnrtenx ` 2. l l��, y y Police Deparfinen� � � � -� # �� ,� �� . � �. : . �: � � ; 3. �� °-� � 1 �. cj�. � ��. �9c.� � �� - Plwmbing�Iea�ng In�p. 4. ��'' -� l"`t"" f � c.. �lectrica� In�Ccor � , 5, f6 '?�t �i ��2� Flarmting Associate 6. 1l -- l 6�� Buiid'mg Inspectrn' '7'. % � �- !�a-- ,��✓�� Asst: Pab. Works Di�r. 8. 1r ��i�v L- - - Public iNarks Director � _ 9. _ . - Anoka Caunty :�ie�1t� . ; ' �- . . : � � �� . _ , z,; � _ - �� - r� _ � : ,; _ ,;: R U �� 0 "■� � � d� � �� t�� _ cl�r oF FRlDLEY � a FRIDLEY MUN[CIPAL CEVTER • 6�t31 UNIVERSITY �VE. N.E. FRIDLEY. VIN 5�=132 •(61�1 �71-3�150 • FAX !6l?) 571-I?�7 October 26, 1992 Willard Weikle Earl Weikle & Sons • 2514 = 24th Avenue South Minneapolis, Minnestoa 55406 Dear Willard: Several of the remaining items at the Moore Lake Beach House proj ect have been completed in the last few w�eks, howeve�, several other items have still not besn attended to. As I've indicated to you in several previous phone calls, I want to�complete this project as soon as possible and to do so I need your assistance. The remaining work needs to be attended to promptly, and we neeci to schedule a walk-through inspection of the Moore Lake Beach House as well as the Little League Building so we can finalize these projects. I don't believe that the remaining items from this punch list will take a considerable amount of time, but none the less, we need to make sure that time to complete these items gets scheduled as soon as possible. I suggest that we set up a time this week when I can meet with your repres�ntative to discuss the remaining work (preferably Scott, your foreman on �he job this summer -- who should be familiar with most of the items). I would like to identify at tMat time any items that you are not going to be able to complete immediately, or at least within the next two weeks. For those items which cannot be completed in that time, the City will have them completed and backcharge the contract accordingly. The following items are still to be completed in order for us to final out the Moore Lake Beach House. ✓1. Several of the doors in the building still need a handle so that they can be pulled shut by someone using that door. ✓ 2. The exterior doors need some weatherstripping on the bottom. J 3. All but one of the windows on the south side of the building do not have any caulking just below the frame. There is�caulking on 3 sides, but not below the frame. ✓ 4. f 5. There is som� painting of wood that we agreed upon above the interior wall that still has not been completed. The ceiling fan needs to be fastened better to the ceiling, or a wedge of wood put in so that is has a more finished appearance. � , � "Willard Weikle Earl Weikle & Sons Page 2 r 6. �We've identified a place where the roof ineets the upper level that needs some caulking. f 7. The panic bars and locks need to be replaced. I me that these were on backorder, but it should be the time where they should have arrived.� believe you told getting close to J 8. The �aood beam ceiling in the main room of the building sti11 has black streaks through it, and you told me that these were going to be sanded out before the project was complete. � 9. We are still seeing a lot of moisture coming thraugh, at least on the upper level af the interior main room. I believe that block should be sealed again, or sealed for the first time -- whatever � the case may be. � 1Q. One of the window shutters still does not have a lockset on it, and it is impossible for us to lock it up at this time. ✓ 11. The plumbing in the women's bathroom appears to be completed at this time, however, we are seeing a water leak coming from behind the.new wall. I've been there thres times in the past week and 'each time there is a puddle of water, and the water appears to be coming from behind that new wall that was built to take care of the plumbing problem. f 12. .We had a timer and photocell that were used with our hockey lights that were taken from the proj ect when construction was starting and these still have not been returned. The foreman, Robb from Lakeview Electric, told me that he had those and was going to return them, but we still have not saen them. � Willard, I am sure that you would Iike to finish up this project as quickly as we �aould. I really nesd these things taken care of immediately, or the City needs to look somewhere else to get it completed. If you have any questions, or you have a date when I can mest with yourself or a representative of your company, please give me a call so we can keep this th�ing moving along. Also, you.had mentioned in a previous meeting that you had some changes to the contract that you were identifying and I have got to see a list of these changes. I, too,.have identified some things we modified, and I want to check my list against your itemized list of changes before we finalize any payments on this project. Thank you for your assistance. Sincerely, Jack Kirk Director of Recreation and Natural Resources JK92-49 -- -- _------- -- - - - -- - --- - - � �� //� G G• - V , � �— — ° MINNESOTA DEPARTMENT OF HEALTH Mmnesota Well d Boring WELLORBORtNGLOCATION �yELL AND BORING SEALING RECORD �'ngNo. H �„�� counry niame Minnesota Un' ue Weil No. � Minnesota Statutes, Chapter 1031 or W-series No. NO t�ae�ar�tt�) Township Name Township No. Range No. Section No. Fractlon (sm. �. Ig.) Date Sealed ' Date Well or Boring Construded � �.�' � �wY�i�i'ti � -� '�1 '� ba S� 29 - �' 7 p8 Numericel Street Address Qr Fire Num¢er and Ciry of Well or Bonng Loca� n ,, ' � r •��` ��T�` � �'� �� Depth Before Sealing �� R. Original Depth d� tt. Show ct loca6on of Nell or boring { Sketch map of well o bonng A UIFER(S) , STATIC WATER LEVEL in section grid with'X'. A� location, showing propeRy Single Aquifer f"s�� MulBaquifer � �1 li s, roads, and buildings. N � WE�Ug�p�N� easured ❑ Estimated , , �, �6 . , � � ❑ Water Suppty Well ❑ Monit. Well �T �u l6i� �be � �T� �'�_ �l__ . Env. Bore Hole ❑ Other low ❑ ebove land surface -. W -r 'r- �i- 'i-- E +�c{?� �� CASINti TYPE(S) , �►� 3 �lY '', �f5� -+ -;-- -t -�-- � �bt i �' ❑ sceat p Piesnc ❑ r� ❑ ou�e� � , , , �„�" o� •� _�_ ° � cns�Nacs� -�-- -�-- --i-- � Diam� gr �r Depth Set in oversize hole? Annular space INtfally grouted? �—' "'ue—�f° ��l ••� - r in. nom � to � e. ❑ ves p No ❑ v� ❑ IVo p unknovm pROP O ER'S NAME � in. from to• ft. ❑ Yes ❑ No ❑ Yes Q No ❑ Unkrrown �, " P�1...� Property owrrete rtaGing address H diHyrerrt than wep location address imiicatad above. �' `� in. from to �.�� ft. "_ ❑ Yes . ❑ No ❑ ves ❑ No ❑ unknown ��0'� i��'��'3 � ��r � SCREEWOPEN HOLE � ' '��3 6 -� e�� t2.Et�r�ao �+� �3 : �. �� /� �5 �� f��,,, Screen from to ft. Open Hole from ro ft. OBSTRUCTIONS WEL�„QVVNER'S N/�ME ,�,,,, - ❑ RodslDrop Pfpe ❑ Check Vaive(s) Q Debris ❑ FlU �No Obstruction �ti* �w{Q�.�r weo s aaaes�s ns d�aeren► mm� � owners u�icatea� a`nove � � �.A� � �i �Yi�� {i� rV � �� OERl:OOICAL WTERUIL I CQLOR I f'»n••'�"'�' •• FORMATION If na¢ Imown. 6d�ete �d lcmieBon a9 hom nearby weq or boring. � — . •. �� Type of ObsVUdions (Describe) Obshu�Sions removed? .❑ Yes ❑ No Describe PUMP � Type TO � Removed Not Preserrt .: ❑ Other IAECtiOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINQS, OR CASINGS AND BORE HOLEi !� �lo Annular Spece Exls� ` r- ❑ Annular spece grouted wRh tremie pipe � Casing PerforatlonlR�novel ;� in. hom W ft. � Perforated ❑ Removed �• ' in.from M ft. ❑ Pertomted ❑ Removed �t1� t'� Type of perforeWr � � �3 � ❑ o►ne� �� `� fiROUTINO IIAATERIAL(Sj (One bag of cemeM = 94 Ibs„ o� bag of bentonite = 601ba.) � �-�" u�t�t �i�� , � C,,routlngMaterial�e�'[ll�Yfc`�rrom � m � n. y�reg � �es.-,.-; i from to ft. yards bags trom m ft. yarda baga ;r from to iC`' yerds be8s REMARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALINti OTHER ddELLS AND BORINGS � f ��/s',s �aCQ � Other unsealed end unused well or boring Lin property7 � Yes ❑ No Now meny? V \:J4+:A ` �� LICENSED OR REtiISTERED CONTRACTOR CERTIFICflTION �� O'1�r1N(as° � iC �` +,� � ��e�+�� 'fhis well or boring wes seal� In accwrdance w(th Minr�ote RWes, Chapter 4725. The infortnetlon conteined in ihis repert is ��a��cT: �i 1° "" true ro the hest of my knowledge. ��, ��s �.�s c�� e�c.vc�s -- �� u��n �� m�� ConVector Buslr�ess Nama Llaense or Reglstratlan P�. _ �d — �C} � ��S – � �i r ��i "�� -- ?�' � ��'! -'�t►� %/ 3 � � � � �,J � � Autho�lzed ReErnesen Sf �e . D ��` -�fQ � Bn r � '� ��7 � � �� - � � �1�� 1� L�a3 � R� ��fF9�P�E��if�'€'d�V��ed��3u'd H+� �M��'%� Nemeo/Pe�sonSealtneWeAorBonng a�#� •4 Ii MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �� WELLOR BORING LOCATION �ELL AND BORING SEALING RECOgD ��ng No. H counri rvame Minnesota Unique Well No. Minnesota Statutes, Chapter 103f or W-series No. _ J - � '--(�vacimu�nnatnmm> Township Name Township No. Range No. Section Na. Fraction (sm. -� Ig.) Date Sealed ° Date Well or Boring Constructed ',� � � � ��jl �wr�i �' 3 � F3� �3r d +b Numerical Street Address or Fire Nutnber and Ciry of Well or Boring. Location Show e d loeation of urell or boring i� Sketch map of well or boAng in secdon grid with'X'. .�/ location, showing property � li s roads, and buildings. N yy � i i i E � -i-- - �-- -�-- --�-- fi j,�1�� Shmee � - --�- --{-- -�-- --�i-- I ' ' �M ' ..i �� i---- f m9e---� PR PERTY OWNER'S NAME , �g� I�t- _ Pmperly wmers mailing e�klresa n dmerent u�an wen loca6a� addresa trwicacea abwwe. ``�y�+.�4r�S�ovzYRY� N k�� 35 �oN� �� uE�e i�+.v�a 'S�. �hcbl�y �N �u I A� N/FJ�OWNER'3 y�1ME �,.� W�I ommPs - address if �fferent than P��Pert1l owners a irWicated ebove. ��3! �t1�t v�nS�;� /�v� /i�� t �3 t� � � 1�1,v S5'�/3 t- �iEOLOQICAL YATERIAL � COLOR It not knarm. k�a esdmated lormation lop from 43" r or boring. �f��,r I �`E pEYARKS, SOURCE OF DAYA, DIFFlCULTIES IN }��i ol- c�a�o� ��1G '� 3 � � Depth Before Sealing �� 1t. Original Depth �.� fi � A IFER(S) STATIC WATER LEVEL Singis Aqu'rfer ❑ Multiaqu'rfer �,,/ WELL/BORING L�Measured ❑ Estimated ❑ Water Supply Well ❑ Monit. WeII /� Env. Bore Hole ❑ Other �� ft. ��low � above land surtace CASINti TYPE(S) �;Steel ❑ Plastic ❑ Tile ❑ Othet rl �� `{ � � � CJ�SING{S7 Diemete `� Depth � Set in oversize hole? Annular spece iniNally grouted7 t �1 Yes ❑ No ❑ Yes ❑ No ❑ Unkrrown in. from � to � ' �`fl. ❑ in. from to ft. ❑ Yes ❑ No ❑ Y� ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unkrrown ------�•----..._. _ �, _ Sc�een from tp ft. Open Hote irom to it OBSTRUCiIONS ❑ aoasro�op �roe � cnec� va��rets) p oeeris O Fm 'L�,NO o�n,c�io� Type of Obstructions (�cribe) Obstructlons r�noved? ❑ Yes ❑ No Describe T,� - FROM TO ❑ Removed � Not PreseM ❑ Ofher METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINQS, OR CASINO AND BORE HOLE: � �� o Annuler Space F�ciata L' � Mnular spece grouted wfth tr�nie Ph� 2 � ❑ Casing PerforatimJRemovel • Z`� in. from to it. ❑ Perforeted ❑ Removed l` �� in. from ro R ❑ Perforeted ❑ Removed � Ty� of perforator .� s�/ Ofher ��' �(iROUTINO MATERIAL(S) (One bag of cement = 94 �., one ba9 oT bentoNte = 60 Ibs) �� arouting Materiel��i`E�� 'r" Tro�m � to � 1t. yards � bags �u � frwn tn ft. yards bags `�G � fram ro it. yartls bags J�� hnm to ft. yerds ba9s OTHER WELLS AND BORINGS �JYJ�SO� Other unseal�l end unused well or tioring on property? ❑ Yes ❑ No How meny7 UCENSED OR RE�ISTERED CONTRACTOR CERTIFICATION This well or boring wes sealed In eccordance wRh Minnesota Rules. Chapter 4725. The InMrmatlon conteined in this iepoR le true to the best of my knowledge. 2tc�t ��rr��k�u�ab �I�.sTt�v� <�[�� Buslness Neme L&aense or Reglsbatlon P�o. j 1 i 3 �t3 Rep Sl pete. Irt� �t}+�►431� : -` _ �. 9pV'� ��'�Po�agUpY�TG5�@L�+Eqg`�"��sq"6ap°�Ip�R�gG�Py�Y�o�;' H ��j�� I NameolPersonSealingweprnBort�' I� ��c3°V1q61SL 'SdG�OV�4R ��y�L" �l �� - Building BUILDING Inspections CpMMEI�CIAL/INDUSTRIAL 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-I-08 DATE U-' Z 2- - C� � YOUR� AIL AD RESS SITE ADDRESS O �2-`+� �� TENANT NAME: u'�+� Pernut No.: Received By;� Date Rec'd;/� 7 SUITE NUMBER PROPERTY OWNER I NAME: �, .� �� L- ADDRESS: CITY STATE_ZIP PHONE: ARCHITECT � NAN�: -CpTTTRACTOR �` NOTE: CITY LICENSE REQUIRED FOR COMMERCIAL, INDUSTRIAL AND MULTI FAMtLY PROPERTY TYPE TYPE PLEASE CITY STATE ZIP ADDRESS: �%% �%,3�� '�' L✓' CIT �STAT�ZIP�� PHONE:Gt'J�Z �/��) 2 — oZ �o O � CELL: �riC� FAX: �; ! - � '�1 I --'l S� I CITY LICENSE # : ❑ TOWNHOUSE ❑ MULTI-FAMILY ❑ ADDiTION ❑ REMODEL L 4 SETS OF DRAWINGS 2. SURVEY/SI'fE PLAN �3 LANDSCAPE PLANS 4. ENERGY CALCS BUILDING TO BE USED AS: i I TOTAL SIZE: DETAILED DESCRIPTION OF WORK EXP: IAL/INDUSTRIAL �NEW CONSTRUCTION ❑ ROOF 5. CONTRACTORS LICENSE OR LICENSE APPLICATION ❑ [NSTITUTIONAL � OTHER ❑ SWIMMING POOL 6. SPECIAL INSPECTION SCHEDULE 7. PERFORMANCE BOND AMOUNT $ OFFICE sF WHS sF OTHER sF STORIES FIRE PROTECTION (Y/N) AC(YM) ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOIt A1�TD MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) Sq � X$ Cost/sq. ft. = Valuation $ Sq. ft. x$ Cost/sq. ft. = Valuation $ S �. �` X $ Cost/s� = Valuation$� t� a A- 7 w�A�SI-�_ ,nr� r T�� \/�9��J'l (�C:('.i JPANCY �`'� TYPE 1� � TOTAL JOB VALUATION: $ Permit Fee Plan Review Fire Surcharge Surcharge SAC Charge Erosion Control See Back Page for Fee Scheduie $ 65% of Building Permit Fee $ .001 times the total job valuarion $ �� .0005 x Permit Valuation Minimum $.50 $ _�. $1825 per SAC Unit (Plans to MWCC for determination) $ $450 Conservation Plan Review E ' erin Park Fee $ Fee Determmed by ngine g Special Assessments $ Agreement necessary () Non Necessary () Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$ 'd'otal Due $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED I hereby apply for a buitding permit and I acknowledge that ihe 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 ction Codes; at I understand this is not a permit but only an application for a permit and work is not to start without a petmit on site; that the work will be in ac ance e appr ved lan in the case of all work which requires re� 'ew and approval of p� s _ SIGNATURE OF APPLIC PRINT NAME ^ ��,- a- DATE , _ �,.. _ �� _ DA'�° � APPROVED BY ./.�/�-- �//� �T c�- y h Page.2'- Building commerciaUIndustrial Application ' TOTAL VAL�JE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 BUILDING PERMIT FEE SCHEDULE FEES $23.50 (Minim�m Fee is $2�.SU plus sttrcharge) $23,50 for ls` $500 plus $3.05 for each additional $100 or fraction, to and $69.25 for ls` $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $391.25 for 1 S` $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $643.75 for I$` $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,0(i2 to $500,000 $993.75 for 1�` �laEl,00� plas $S.bO fcsr-=g�t�� $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each a� fraction to and includin $1,000,000 $1,000,001'and up $5,608.75 for the 15` $1,0OO,OQO plus $3.15 for each fraction PERFORMANCE BOND POLICIES or $1,000 or When a building permit is issued for a commerci�l, industrial or multipl� dwelling residential project which requires outside improvements, a Performance Bond or aLetter of Credit sha11 be � submitted to the City. The bond will cover all outside improvements, including but not limited to landscaping, irrigation, cwrbing, blacktopping, screening fences, lighting, water & sanitary sewer services, and storm drainage systems. � Calculation of bond amounts will be determined by the building permit values. The bond amount will be 3% of the building permit value up to a$Z million dollar project or a $60,000 bond. Actual amounts will be rounded to the nearest $100. The City reserves the right to require greater or lesser bond amounts based on unusual circumstances. Projects with no outside improvements generally will not require a bond. Bonds must remain open until the project is fully completed. Reproducible "as-built" drawings � of all exterior underground uti rties must e su mi e o e i n' eei'�`ng-I�p�rtme�— - before the project is considered complete and the bond released. All bonds will be held over one winter and through the next growing season to insure the survival of all landscape installations. The City will then inspect these properties in August of the year following the initial planting. Bonds may then be released in October of that year if all improvements are satisfactorily completed. . City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Faz: 763-502-4977