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AF - 43911l� City af Fridley, Minn. BUII.DING PERNII� �_\�� N° 3714 Date: . . . . �: . . � � .e . . .�.�..�. �. .. .. .. . ��~".. Owner ��G.....�4�:.1...... Builder ............................................. Address ...................................... Address ............................................. LO�CA,�TIO�V OF BUILDINC No. . :+: ��. [ . . Street .�A �.�c� . . L-�ia� f��. Sri�vP. . .//. .� Part of Lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lot ..:......... Btock .................. Addition or Sub-DivLs�ton ............................ Coraer Lot ............ 7nside Lot ............ Setback ............ Sideyard ........................... DESCRIPTION O�' BUILDING To be s as: �� a � �• y� ' . ..� .-. . .. . �ont �lZ.:�. n� f.�:.�.�.�. x��nt ./.(. . :� sQ. r t. .1!��d. cu. r�. .�rr�"�'.0 . . . . . .. .... .. .. .. . . . I+Yont . . . . . .. . . •Depth . .. .. . Height . . . .. . . . Sq. F't. G�. F't. .. . . .. . ........ . Z�pe of Construction C��.��"... �t. Cost...�l��. �..... To be Completed ................... ` � /60 � J C� ��r1r� p�� %/� � � In �nsideration of �Che issuance to me of a permit to construct the building desribed above, I agree to do the prop�ed work in acxordance with the deseriptton above set forth and in compliance with all provisions of ordinances of the dty of Fridley. � n �; � . , �j�/ ,q_ � In consideration of the payment of a fee of $.0%. .�..�..�., permit is hereby �ranted to ................... . . . .. . . .. .. . . . . . . . . . . . .. . to construct the building or addition as described above. This permit 3s granted up�n the express condition that the person to whom it ia gisnted and tria agents. employees and worlmzen, fn all work done in, around and upon said building, or any part thex�of, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moviug of buildings with- in the dty limits and this permit ma.y be revoked at any time upon violation of any of the proviaions of seid ordinances. �� r �� .��'�'� � : . � � . - . • . � NOTICE: � / This permlt do� noti cover the construatlon, in�tallation or alte�ation fo� wiring, plumbing, gas heattng, sewe� o� watar. Be su�e to see the Building Inspe�to� fo� separate permits for thesa Itema �� , � . � � � d m � � Ca '� � � � 0 � � a �i Q � � o+ � C � � U � � C Q � �� . Q al� �� \ �� i � � m D4 � O o 30 � � �a � ,O a� � � A w � z .�� d ti c�. � op�-. $ � � �� U�� °��U �ab� t a u � � a .n � wc°~� ,�°, '� .� � ' c� � '.�� '� c� p � ��.y 4� � ��!��. � a � � a �� % a°� � � � � A � .� � � � �. � � �� ' � .� �� o � �; `� o°�i �' �' .% �8 e' � � 'd�o� °' � � � � y � ��a � � o F � o a � � b�+ z � � 'd � ;y u � �� o �: � z� � a� �°', c�� .� 1� z � � � a � �o b � � y � � � O � � � o b � � � „ � z A H w o i � ❑C � J � W M A m 5 � B �, W � 3 a � � � • z • n S9NIN3d0 ! r� 3JM/L � � �� '1ddV � sv� iqHSVM � oirrv p SNISVB () FDlYJ SNIVIIO aoo-� .sa�ws ��i •�wao SAVM1 � � HSVM S71Ni5 � Lw EL �� v �usre .� � b �� O Fuva � � sivwren � � m� a�ve► � 'i � $� �d��s � � a '� w � 00 ., e� e+� w • '� W J 0 W U � W H �.�L J H � a � � � � _ B � q � .� � a � � C,�\� � �`u 3C � � \. � � � z °a � �� E h �sa �s es� v�a �s csr 4 � N O E'�H O N (� .y .-i .-i di N M tR >S iC k >C �4 k 0 z : : : : � : : : : � : . pp . O '�O : � .� : o GD Vd . � N N '�O H : �� .�o a a ° �o :�r� � � � � � � �� a`°i � � `� � W � x C�7 � � � r W � x z w z �� z 00 �a Ar � H srr v� cs 4 �°n. �°n_ o° �j +-� N � C4 6C IC � z . . � 0 : � o 0 : � o O N � � � � � � W ° M � �� 0 vl �, v, . � . � : E�+ b • ci : M • w : m . d� � O � • W a 4 � .� � � o A a a� ��a Cit,y of Fridley, Mi.nn. ' 6431 University Ave. N. E., Minneapolis, Minn. 55432 BITII�DING PE�.MIT ��; _ Au�ust 30. 1972 , p�; _ F.d� w��. R, R�Sh Suilder ..��g� Address —6 AZ 8 6 ex�txa.l-A�veaue AT . E. Ad�lness LOCATIOfV OF �UILDING N� _ 6028 s�t Centxal Avenue N.E. Part of Lot Lot - �L�_ Slack - �� Addition or Sub-Divlsion Cornpx Loi Inside Lot Setback .._._._... Sideyard Sewer IIe�ai3an Foundation IIevation DESCRIPTION OF BUILDING To 1� vsed as: �ara-,4 Front �_ Depth � Height 10' gq, �, 308' :�, �_ 3Q80 r Front Depth Height .,.. Sq. Ft _._ Cu. Ft. Type of Construction Wood Frame �� $1�395.00 To be Completed 3 months Stipulations: Provide a hard surface driveway. Building Inspector wants to talk to builder about structural design before building. In consideration of the issuance to me of a permit to construct 'the building described above, i agree ta do '� proposed work in accordance with the desCription above set forth and in compliance with all provisions oE asd�hanc�s of the dty of Fridley. � - _ 7 State Su.Y'chaY'gye . Ia consideration of the payment of a fee of $� , permit is hereby granted to Edwaxd �tish to construct the building or addition as described above. This permit is granted upon, the eupress condition that the person to whom it is granted and his agents� employees and workmen, in all work $One 3n, around and upon said building, or any part thereof, shall conform in all respects •f,o the ordinances of I+'rYdley, M3nnesota. regarding location, construction, alteration, maintenance, repair and moving of bwtl�g�a �� city ]imits and this permit may t� revoked at any time upon violation of any of the provisiona of 88.id . u g Inspector -- CT.AR'F'.N�:F. RET.TG'f.F. N0710E: 7hia permit does not cove� the eonstruetion, installation for wiring, plumbing, gas heafins� aewer o� water, Be wro to ses ths Building Inspacta� fo� aeparate permifs for theae hems. e- ° $ AP.PLICATIO� �OR RESIDENTIAL, A�T��ATION, OR AllllITION BUILD�NG p�RNj�T CI�Y OF FRIALEY, MINN�SOTA � , � / ' - �'' � ' �� . �.� . � w ..1i � �+' � � � � �i��/ r� •i�� //. i %uL ,� � ��, � � - �TO :� STREET : IA1' ; BLOCK • ADDITION t CORNER LOT: INSIDE LOT: SETBACR: SIDEXqR�� .�...m.,.� �pplicaat attach to thie form 1t�o Certificates of Survey of Lot and p�ro�9�e+d buildiag location drawn on these Certificates. HESCRIPTION OF BUILDING To �e IIsed As: /l Froat: Depth: 2 Z Height: Square Feet . �i� Cubic Feet • �� (� !!! W ' Front; Depth: Height: Square Feet; Cubic Feet: �►pe of Construction: ? � Eatimated Coet: �' � -�� ,� �'a Be Campleted: ,�t� o�� The undersigned herebq malces applicativa fvr a pes�nit for tt�e .ws��ci� '�� pec�f�,ed, agreeiag to do all work ia sttict accordance with the Q��► q��' k'��,d�.ey 0=dinaacee and rulirigs of the Depar4ment of Buildings, aud '�e�eb�r d��la�ee that all the facts aad representatioas stated in tbie ap��,��G�,� a�re true and correct. Y ea e�� r� A�� i tiss � (J ' ��@� �� Q-u-c� -,� v sicruzv�u.: r�.�u/ � Z-�� - -�...,�,� Rever� Side For Additioaal Iaformation.) �� . � ' � r � . , ,� , , , , � , , ,,�,3" � r t.::�� '{`a , .- ._,. - t�� '�� ,�'�� . °" � �_ . �., � .� � ��,�.� � � , � � �' � s . `� �, � -� a:� .��' �°`�� -,�� `� � � , " . �` � .' `� � �.` _,�¢ � ��r.� � ' ' r„�, �'�'��' � � (,�F,, ,��'° �� '�"�;�"yLl,�' t �,,,fE r.''?s �� .^ " � _ � � �`' f� �_,%� s�. � k�,.l�s'"l G�"�' R v_ .,�;'� � (``R.,.�,�.�' C. n. .,.� � • � `� � °-�'�� a $UILDING PER�IIT FEE SCHEDULE sECT�ON 2. The Inspector of Buildings shall, before issuiit$ permi.t� fox the exection of any building or structure, or for any addition �o any existi.n$ buildin� or structure, or for any alteration or repairs to any ex�stiag bui,lding ox structure, upon application therefore, require the payme�� by kh� appl�.cant for such permit of fees to the amount herein below set foxth �d i.A tt►e manner herein provided to-wit: UNIFORM BUILDING CODEs 1j►pe 1, 2� 4-$2.15 for each one thoueand cub�,c ��et, or fraction thereof, in auch cubical contents. Zj►pe 3� 5-$1.$5 for each oae thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing feea for building pesmiits, the cubical contents of any building or addition. ie determined by multiplying the ground area covered from a point six (6) iaches below the floor line of the basement oY 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. �'or repaire or alterationa 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. Ta no case shall the fee charged for any pern►it as set forth in Sectia� � be lese than $5.00. VERIFICATION OF FOUNDATION �1pT�; Permita for eonstruction will be isaued a miaiimim of 24 houxs f�co�a the� �ime of application, to allow for proper review of the proposed structuze aRd o� the con�truction aite. A Ce�tified Survey of the lot, ehowing the location of the fouadat�,p�,� A�4� �� haa been constructed, will be required befo�e proceediag witi� the f;aat�ng, CERTIFICATE OF OCCUPANCY Applicatioa for a Certificate.of Occupancy shall be made ten (10) days p�1Ax xp the use or occupancy of any structure for which a building pennit has ��AA iseued; and said atructure ehall aot be uaed or occup�ed until a Certificat� o� Occupancy has beea iseued. . ., � � � _ � . _ �� F. � �� a �� :� fb �A f° � f� �� 4 � � � � � � �� `� � � � � � � CH � � � � � � � 0 � &ai � � � � � � � � � � � \ �� b ^' O � � �� dMr �iU�° �$� �� ' � Tro ( � �eq,�D,d w � w��«� ��"� a��[ w � � ..v.� ...Vi � � Qy�� Q � � Iy � � C ' � �; p � E�°� �o >..- � c �; '� � � � ��R� �°Qy ��d� ti�� :� £ ��F � ��,�� '� z « ,� � O �� ` � u �� O � � � q � tl � 8 8 � M $ Y w 7 � �� .y. �o�YV � � � s � � � C � �� . pQ. a �e ,� a a` � tl w c �: � � � M N p ei! e! � � $ � 8 o:�� R � � ~ � �i s � s � � � � 7 � ��p� F � ��`��1 � � � ~ '\ '^� � � � � � � � � a � � � � S '� a e E� � � 0 z .� a � 1'L�J w � t� � E w I 0 z � a m � ao � � z v O � r/ r9 rb K � � � 8 c o d ch �� « � � � � M a a q W M �M � � � � pe � x � i � � 0./{'''�� y f W W � C G 3 � � z � .� .� � � � d 5 S � � � t!i ,� O �S � 10 � �� ; i a f � � � � � � � W � � � 0 z � I I N � � � � � 0 � < � 0 �� , m i N � � � p ro a O '� � d � � z I d � e a F� U M � �' � •� 1 . � \ " �, , � � � :�-� F: ; ..� " ' P. J `- 0 � _ ��' � � ' i _ - ;3 L � L .', -'� G� � � H � � u�j� � h 'I � � v � � M �b M � � � � � � N � � � 1t N � � 4i � � � I U I � E� � � � � � � � � � �� .. � � 8 °"� � � x ;� .7e � U � C � � M w� � � � � a � oa C � v . � � � i F Y_ .� � � 4 :� � �, .� 2 a . � .r � �t~ ' � x : '� . . � � 4 � � � � � SUBJECT Q. City of Fridley � 13583 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T • � � � R COMMUNITY DEVELOPMENT DIV. °"� r � v � PROTECTIVE INSPECTION SEC. �' C�� / � � �i 1 i � 'l �� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L""� � ,�� 612-580-3450 910-F15 6/10/76 � � JOB ADDRESS 6028 Central Avenue N.E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. p�Ce�. 540 North '� of Section 24 SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE Ed 13ish 6Q28 Central Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Suburban Siding C-12 Maple Iiill Estates, Hamel, Mn. 55�40 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE % 8 DESCRIBE WORK Reside house 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. �j]_�+mi n� THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 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 LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WfTH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �. OOO . SO DOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRU IO�HE PERFORMANCE O C NSTRUCTION. C.00 �' /� PLAN CHECK FEE TOTAL FEE �//e/? � $6. �o SIGNATUREOFCONTRACTORORAUTHORIZEDACaENT IDATEI - WHEN P OPERLY VALIDATED THIS IS YOUR PERMIT � � I cQ..e„� _i(� -7 , - SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI BLDG INSP pATE APPLICATION FOR RESIDL'•NTIAL, ALTERATION, OR AllllITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: �� /f �/J,S � BUILDER: .� � 6 ��'�� '�i �'� � ADDRESS : � D o� � C B °l% �/PI� � I�� ADDRES S : � � � •L d`?;i"�/'O% �Q�o� /� � ��e-� , NO:�� STREET: �i9 �' C e. t, � .� LOT: BLOCK:_ ;�° � sV Tf�� L f¢�� ti!< ADDITION: �ld 1T/� �/i� /�/g�� "r� �• z � CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Cextificates of SurveY of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: � , ��S rQ� ' ��-- Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Fe t; Cubic Feet: �LU�YIi �uct>� � � Type of Construction; 'Estima,ted Cost: $ �� D� � To Be Completed: � �/� �% S � The undexsigned hereby makes applicatian for a permit for the work herein specified, agreeing to do all work in st'r.ict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and repxesentations stated in this application are txue and correct. � rv.� 0 �97 �,. �� DATE: c� � �IGNATURE• / (See Reverse Side For Additional Information.) C� - �-°v �(O ' �� r � � BUILDING PERMIT FEE SCH�DULE SECTION 2. The Inspector of Buildings shall, before issuing perniits for the exection 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 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: UIVIFORM BUILDING CODE: Type 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 thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for buildi�g permits, 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 ox the cellar to the average heights of the upper surface or �o the average.� height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee sha11 be aC 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 sha11 the fee charged for any permit as set forth in Section 2 be less than $5.00. VERIFICA�ION OF FOUNDATION NOTE: Permits for eonstruction 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 construction site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding c�ith the fxaming. CERTIFICATE OF OCCUPANCY Application for 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 occupied until a Certificate of Occupancy has been issued. e `_ � � w ti .� g I x��,� w+�+a � � �ua�7 a, . $y�S��. m • ta s •� i+ p N U ro s� 3 b O I � G m d wb m � � M �C .-1 '�uva o b b � ' M Y . .WI p..ui C� a+ � . � � � � � . - � -� ; � b w x -+ m °3 ° � w x.,�� y .i O O B � � � �„ o s+ � c ro s°,c m � x m a ba� m � �>. ema� � M .-�i v�1 �.�1 M O 'O � 0. �� w�f H b 00 � V. � m�h C+i ri O •-' . 4 � �� oa �W 1~-- A W u rt E m�ot m � � ►i �UE m �6� y � .� - �a � c� A z . a � . � H M w a �- �- m � N g � fh.) O M � �a a � � � � .z. � � � � �i � °° 8�� O 4 OC p W . � 1 �2t� W �o Hy � iG � E W O � m '� � r' 3x 4 • ��O O � 3 ++ a6�t s� � 3 ��'F3 �c78�Q . •T�� s� � 3 saqseEl ,d ' �F��=n�t � u suFseB m :,.. �� e� sooi3 . � SSdM01[S Su�eauno3 c ti, B�x�� e � sd8sy qsgM . _4 ` . � O C - s�NiS . . ' O 'O ` - �- p 8�[FBQQ .. . 4C1. • C M �t�w �tage • � � m w sjcu�s�. , � _ � � « 5�,30i� � � t� r. �+ v �u r� a " m r, w �' s�tsots .� N n v • •' -. . G U � Q � W z � � � � c b z m � � m v1 H 0 u c�ii a Z _ H v Y�.- a _ H fb N H �? fl► 41 0 Vl f/l [-+ O O O O O O O O O � A1 N �I tfl tfl O� v1 MI 4/ NY f/1 fb N ri N W (? h �a •x x x� x x x x a Z M 2 G~a 0 m �• N O1 - _ ~ f, � a � �e z M{q � , a a � " � �a O � w � � a w �Q � CG M d �/C s, _, . Ci � � . cn rt; ' � � � , ' '� y 4Y p..3 �� , W N � OF �? , °o v g °o °o • • , � � � � ...�.�� .. ., H �I 11 1t . . � _,_. . ' . - -_ � " R � - � �q Z . ' �', w - ...� ' Uj w � " :: M .� 0 0 � . . � ;� w o �yJ � fA � M v � `� _ . O . , OC ¢ . • � o° � ° � ' .� � :M� �E+ • � � +1 O O� � M . . d � Q vs- d. OC � 0 . .. O1 �-1 � ~Y , p h'� Q - . - . � .. o� v - p� p, g' os .ba � vl � � � � ` ° M . . . O �d Y' O 7C W � � , � � �,�( E"� Ci M O �� Mu !�' m �y � �7 d�� , w � � M ..�H YN O � � 'i1 i /. � � tl � O • _ � w �•" x � x o � � � ..vi �'`y" � � �g y a'�► � � a� w w t w.°i w u�.�.. n iy o'� �: m .e � � s u.�i u 7 m u' u� m .� la n . a � �� a'ci . � � z c'a� � " � � � a � a - .. WELL O,�plNti LOCA7tON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H�, 41 � 2 3 c�,ry t�e �/� WELL AND BORING SEALING RECORD M a', '„��°;,�;�ie1�o. rJ � Minnesota Statutes, Chepte� ia31 or W-series No. j� 1 ��a�,.�� Township Name Township No. Range No. Sedion No. Fraction (sm. i Ig.) Date Sealed Date WeU a 8ai�g Co�etl f^ _. . -i � � � �� i y% ��J� ��*_��i �'' `' �� ` �� Street Address or Fire Number emi Ciy of Well or Bormg Locatlon Qepth Beto�e Sealirtg IL Original DepU� R Show exact location of wrell or boring Sketch map of well or boung ApU1FER(S) , STA71C WATER LEVEL in seGion grid with 'X'. location, showing property S� � 1/� lines, roads, and buitdings. � �� ❑ �W�� N !�/-eI�{� WELUBORING �'I Measured ❑ E�a[ed e f-. � � r � �•- ,�]- Water Supply WeU ❑ Mrnut. Well .-, _T_ _T_ _T_ � ;__ .�(� � � �/! �� i � � � (- �� ❑ Em. Bore Hole ❑ Other _ � a� t! R� Gebv ❑ a6oae I�d srAace W'7' _ j_'" 'Y_ _•+'_ E L.-�°" CASMfiTYPE(S) -ir- --i-- �-i-- -i-- � Steel ❑ Pla� ❑ Ti10 � Other � Ja mile --� - -�-- -i-- -i-- � CASING � � �.e�_, Diameter Oepth Set m ov�ae MIe? A�alar s�e inme9Y 9�� l mae-qr s�� / !,� ': � m. lrwn � tu � R ❑ Yes �(] No ❑ Yes ❑ No ❑ Urdao�n I PROPERTV OWNER'S NAME in. from to R ❑ Yes ❑ No ❑ Ves � No ❑ Uriaioa� ., _ `�-�' G� � 1� L °� . ProPeny owrrers mairug aaaress H amarem u�en Nreu �ocasoo aaaress ��dcetea a�ve. m. horn ro tc O r� ❑ tvn ❑ ves - ❑ No ❑ unlno.o SCREENfOPEN NOLE ' Screen fran _l,,,� °! to �� (t Open Hole Uam b R OBSTRUCf10N3 weu owni�ws wunE - ❑ Roaa�orcc a�me ❑ a,e� va��ets) ❑�❑ Fm �] r� o� k�.�� weo oarrera maoinp edaress n d�trerert uien aropenr ow�mrs adaress Ndicatea above. TyPe of O�s (De�r�be) o�sm,mo�s remo,reaz k7 ves . p nw o�m PIqIP T,� . �I_ � QEOLOQICAL YA7ERIAL COIOR HARDNESS OF FiIOM TO � Removed ❑ Not Presenl ❑ OUrer FORMATION d not Imown� 6d1� es�mtad tmrtmtla� log trom neaiby we0 or boring. YETHOD USED TO SEAL AM�ULAA SPACE BE7WEQ12 CASMGS, pl CA�YG At� BONE IIOL� : � No Aruddar Space E�dLa , . ❑ Annular space grou[ed ai� tremie pipe ❑ Ceshg Perf�/Remwal in. hom to R ❑ Per[aalad ❑ Ranored in. fran ro R ❑ PaMo�d ❑ Hamovad Trae m ven«am. O oe� aROUnNC wn'�uu(s) a� � � �Y� ��'�i� na„ � m � � � r�s � � tra" �o . tt p� � tran eo d 1�ds ba�s tran 6o R Ymds bs�s REYMKS. 30URCE OF DATA, DIFFlCULTIE8IN SEALINO OTHER WELLS AND BOF�IGS Other unsealed er� unusad we0 or borm9 � P�oPertyt ❑ Yes ❑ No F{o� �i � LICENSED OR REGISTENm COIi�HACTOR CEIiTff1CA71QN Thls wse0 or boiirg was sealed m�ordm�x�h [d'uuresote Wdes. Ch�6er �725. The 6�on m�i�ed in Bis �aport is 0'ue to tl�B be� d irry laro�dedpe. � � � �`'� `�'�y� � r��, __i'('. �ll � �G��` � � �a�r,�. � r !�'�°' �y�>! �� - � i� -� � � �l �<� ,: � � ��P��T�--�� P��P��-� � 4 3. 2 2 3 „� �� W�a� k'�4P�RSVV�LL OWNER COPY H t HE-01434-03 ?J87 H z O H H � v H � H � W � t:7 Z H J ¢ t1J fJ? � f z O H F- U w � H Z w E w c� ¢ z ¢ E J J w 3 I _ � � ¢ W i � O H z W � N � d a w 0 Q F' 0 �? w z Z H � RS � O a � � Mf � • v a..l � ri .-i A1 S..) 3 z H � j..) J f0 J � 3 � C Q � U � Z �o 0 U V1 � � � w �.i (9 i� � ow cm v �, o► .o � � tv N u .-� o> >o L m N N � o� i � N O U � � � � �.-1 O r-. iA M •.i N S N 3� � ? 1� +--I �m i S i-� L �N �- � •-i E L � N Z 7 � o � � o� 3 iN ..� w � N �S � � i � i--- � � 01 01 .-i 1 {,() �t �z 01 N O lh ,At ct tu tA .•(ntn � m } > .id' W �.i W J A►tn0 U H � � � .Aa � F- t� ¢ •� w x F r co w o a � «� o u w H U � � N Z r.� cn w � Q •• c� N N J E ¢ � � � F- N Z a rnw ti-i � U s �a N � OD C N 3 m O�tO F- tr? a S N S: •• N o . � � o ¢ z v` v � Q .. �.-1 �� o� � � y � 3 L O O J� C..1 F- CiT N � � �I i 0 � � � $ N .--I .--i m 3 C O N m � 7 � rt � O � Ol � � c � � «� E ►i � m o� � N .-� � � �-+ 3 3 d m i v � � � � 'O U � a� o a U (0 U C � r1 C O •-F d-� v o� N i-� �� iN Q1 N C O N .n � � �-7 N ?, E E �� •-� 4- N �B 3 � N �n '.� _ L G i � � � O � F- H U O � w � 0 H {r' � t- � S W _ F � O Z itJ � � w > N d M ? >- tt? � � H � �z 3 � H ` } = w r, n th h'+ Q � � � l_ � � . sue�EeT � PER . Clty of Fridle� W R E C K I N G r� p O�� AT TME TOP OF THE TWINS P E R M I T L O r ; � RE EIPT NO. � ; y �.�� COMMUNITY DEVEIOPMENT DIV. r � � PqOTECTIVE INSPECTION SEC. � _ � � /'�'1 � CITY HALL FRIQLE� SSI3Z NUMBER REV DAT@ CAGE Oi APPROYED 8• �'"'"�� ,'� 612-571-34b0 910-F15 / / JOB ADDRESS 6028 Central Avenue NE t LEGAL �OT NO. 6LOCK TFiACT OR ADDITION SEE ATTACMED oescp. par.2540 N 1 2 of Section 24 SNEET 2 PROPERTY OWNER MAII ADORES$ 21P PMONE Cit of Fridle 6431 Universit Ave. Fridle MN 55 2 5 1-3515 J CONTiiACTOH MAIL ADORESS ZIP PHONE LICENSE NO R bak Excavatin & Contract n a ARCMITECT OR OESIGNER MAIL ADDRESS 21P PMONE LICENSE NO. 5 ENGINEER I�IAII AODIiESS ZIP PNONE LICENSE NO 8 USE OP BUILDING Residential 7 CIASS OF WOiiK O NEW O ADDITION � ALTERATION O REPAIR p MOVE ��} FiEMOVE B DESCRIBE WORK Wreck house and ara e 9 CHAN(3E OF USE FROM TO STIPULATIONS Clean site of all demolition debris and disconnect sewer and water at property line and call for inspection of same. TYP� OF CONST. OCCUPANCY GtiOUP OCCUPANCV LOAD SEPARA7E PERMITS ARE FEOUIRED FOR ELECTRICAL, PIUMBING, MEATING, VENTILATING OR AIF COND�TIONING THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTqUCTION IONING SO. FT CU FT. AUTMORIZEO IS NOT COMMENCED WITHIN 80 DAYS. Ofi IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANQONED FOR A PERIOD OF 120 OAYS A7 " ANY TIME AFTER WORK IS COMMENCED ' NO DWLG. UNITS OFFSTREET PARKING I HEREBV CERTIFY THAT I HAVE REAO AND EXAMIN�D THIS APP�ICA710N STALLS GARAGES AND KNOW THE SAME TO BE TF1UE AND CO�iRECT. ALL PROVISIONS OF LAW$ VAWATION SURTAX AND ORDINANCES GOVERNING IHIS TYPE OF WOfiK WILL QE COMPUEO WITH WHETMER SPECIFIEO MEREIN Ofi NOT. TME GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHORITY TO VIOIATE OR CAMCEL THE pEqMIT FEE SAC CMARGE PqOVIS10NS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON- STRUCTION OR TME PERFORMANCE OF CONSTFUCTION Fee waived PLAN CMECK FEE TO L f EE S�GNGTUpE O� CON'FACTQA OA AUTNOp�2E0 AGENT �DATE� EN PROP VALI D� ISOIS F PE 17 �_ � � � S�GNOTUAE Of OWNEQ�� OWNEA BUILDEp� �O�tE� . , i o r��TE SEP-28-1998 10�47 RYBAK EXCAUATING 612 788 �166 Po02 �1�� 1/11 J� C1TY OF FRIDLEY 6431 �3niversity Ave NE Fr�.dley..Nnv 55432 572•3604 MOVINC� [ , �li�]ECK�I�i� C� PE1tMYT APPi.ICATION ' �d}, p��gg: 6028 CENTRAi, AVENUE NE, FRIDLEY' MN 55432 LI!gal Descrip�i�n: � RESIDENT2AL STRUCT�RE OWrier � Addre�s- CITY OF FRIDLEY, 6431 UNIVERSITY AVE,FRIDLE7Pe1. #571-3515 Coatractor- RYHAK E�CAVAT2NG & contracting, �ac. T�1.#g788-6577 Addresi : 31_34 CALIFORNIA ST NE . MPLS a M„ N _, SGate Licerase i� D�.SCRIP1ZOl�i OF' B1UII.DII�1G HO�SE: Length Width Height Sq. Ft. �. F�. GA�AGF: Lengt� widt�: I?eig�sv Sq. Ft. cu. �t. OT�3ER: Length Wxdth Height Sq. Ft. Cu. Ft. Estxmated Cost S Approx. Completion Date DTILi'1'xsS City W�ter/Sewer Miiutegascv N 5 P U S West N�TI3!]�_ 572-3529 [ , 3?2-4�20 ( ] 330-5500 [ ] 663-6000 � ] Water 8i11 PaSd: Yes I� or Collect [S � I �ig�ature � , q'�"��. Moving Rcute: �e undersigncd hereby makes application for a perrmic co wrcc�//mo�re d� buildin� describe�d above. ag,�►e��n� to do all work in stricx accordance witli thc City Ordina�es and nilings of the Buildin� Div�sion, and the St�te Code wbich �equires any water w�ll on the property to be seai� by a State uccnsed water well dtilkr, affii htreby declar+es that all facts and r�presestiauons stateci in this applic�tion aze crue and correct. „ LY. �,�O.N,�E,�$�. l,NCLUDING �!(}UNDATION & SLAB. SHALL BE REMOYED FROM SITE._ �i��/q g £ nate . signature � Mo.mg: Priac�ie Buildiag �ntv Fri 'aiey ... o $300.00 Acoes�ory Buildrqg irnto �ridlcY --.. S 42.00 �gh ar within the City ...... S 20.00 Move a build�ng out of Cin► ...... � 80.00 Wredd�g: For r�61,000 cubic feet or fraction ..$ 1.25 �or � which wo�uld 6e impractical to cub�e tbe fe� shaq be baszd on the total �8 of w�+ocldog at the rate of $6.a0 for eacb $500.00 or fraccion. , PERNIIT F�Ea � S'Y'YY"[TI.ATIONSs Mimim�en Feea $Z0.00 Minimwa Fe� 515.00 � �z�r roTra� P.Oi �