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AF - 37340.. .. � � � � m � � � � � �1 � � M � � 0 �� o �� ' � --�.r-- � � � � o �. � � � � � � a� � 0 �_ � rn tn � � � -� r � � M M � � � �� r s� � �. � � � � O 0 0 0 � � � 0 0 �� o� �� p � i � � � � � �' � z � � � J1 � � � � °� o� � � O r � a° ( �o � W �. � � o � �� : �: �� a � � � � � I� M 9 A {p � 0 ;''@ �� \ � . � O � � °z � O �a v� � � � � � ,�, M � a � � N o � � y oe�� °� �� .� � �� °� ° o � � � � � � � : : � � : : o v' : : � � : : � : N N � � C7� C7t C O O O G O � �� m�u.m�r.� � W W � A � R° (� � � � ��&�� 00 � At � p � 0 0 0 �� : � � � �- : o � � : � � �o: : � �, o g$: : o � ' � : � � ��m�� N � � t��°� m$ � � � � �° �, � o� �� .°� °` �'o: : � ° : : � O . . o . . o: : : ��,�� 71 p C O O O C C P O � 11 C � �� o� � � � � � Ci b � .� � � � � � � ro � � � � � z a , � I� � N � � � � O O O O {p {p O � � a� � � �� b y �� oq�� o�� a� ��¢° O y � �� °°� � ��'� � � � w� °a�� c�u¢op 0 ��" �`� �� f6 �� y � �� o � � � �� m N _ m C r m � r� d r�► � b0 � � � a � A 0 �`. �, � � � � _. �. � � O � � — � O •• � � rri � � �_ � �, �� N� � �� .=� A � e• �'. �� 70 �. � �� o. � � �o � o �� DJ6 �v W GL"'��Z� , � • ,'�J�D �� , ��l% � ��,�� e s��/ � HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS NQNNEAPOLIS. NIINN. � I Weat6erstrips A.S.H.V.E. Construction No. Insulaticn Guide � Windows Doors Reference Out. WaA Int. Wall Ceiling Roof Floor Kind How. Applied Y�No Y o 19_ Y'� „ '' Fl � Room Length Width � HeiBht � F7.� Room Leagth Width Height Windows and Doors—Crackage aad Area Windows and Doors—Crackage and Area '' �Vldth Helght No. ot Lineal t. Area Wldth Helght No. of Llneal !t Area No. ot Dane o[ pane Ilghte ot crack eq. tt. I'n No. of pane ot Dane llahte � of crack eQ. ft. Y� > 3 Ti In6ltratioa Glasa Eap. wall Net exp. waU lnt. wall � �� i Coef. Btu Total Btu. ' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.� Room ( Length Width Windows and Doom—Crackage and Area Wldth Helght No. o[ Llaeal ft. �Ares� No. ot pane ot pane llghte ot crack ea. t� 1 � Coef. Btu � In6ltration .� .�,� l o D Glaas S� y a � I Eap. wall � ' .3 ei Net eap. wall �-/ � ,�-� � o I Int. wall I Ceiling �g-�� ! v � yr�U Floor �-� Total Btu. Required sq. ft. E.D.R. or aq. ins. W.A. L.eader area F7. Room � Lengt6 Width Windows and Doore—Crackage and Area Wldth Helg6t No. of L1nea1 tt. Aree No. ot Dane ot Daae ifshte ot crack ee. [t. Height Coef. Btu I lnfiltration Glaaa I Exp. wal) � N�t ��. Wau �i Int. wall Ceiling I 1� loor Total Btu. I Required aq. ft. E.D.R. or aq. ina. WA. [,eader area I Inbltratioa Glasa F.sp. wall Net esp. wall Int wall Ceiling -- - - - -_ _- - - - - Floor Total Btu. k. E.D.R. or sq. ins. W.A. Leader area FI.I Room I Length Width Windows and Doora—Crackag� and Area WlBth Helght No. o! L1nea1 It. Area No. of usne of �.ne 1Lrhte ot crack ea. tt In6ltration Glaaa Eap. wall Net esp. wall Int. wall Ceiling Floor 'fotal Btu. Required sq. k. E.D.R. or aq. ins. W.A. L.eader area Fl.� Room I Length Width Windowa and Doore—Crackage and Area W/dtd Helght No. of Llneal [t. Area No. ot nane Of D8R0 Ilahte e[ c�ack ee_ tt_ In6ltration Glass Eap. wall Net egp. wall Int. wall Cei�ing Floor Total Btu. Required sq. k. E.D.R. or sq. ins. WA. Leader a�ra Btu Btu ,q; .� ti City of Fridley, A�inn. BLTII.DING PER.A�iIT � � .,,:�''`.,�.�...-::4?..,�.�... Date: . . . � °. . . . . . . . . . . Owner....................................... Address ...................................... �. . _„�j,. , lv° 3fi80 ,�,, Builder,� .�`,�s��:�. . . :��{�. . . . . . . � . . . . . . . Address ..........:. ................................ LOCAT1CtN OF BUILDING No. . :��`=!�. . . Street . . .,�".'".":�1.�.�rf, . .. �. � . . . .. . . . . .. . . . Part of Lot . . . .. .. . . .. . .. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . Block . . . . . . v:�. . . . . �'. . Addition or Sub-Dfvislon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ........................... DESCRIPTION O� BUILDII�G To be Used as: .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft ..... .................... F'ront ........ Depth ...... Height ........ 5q. Ft. ........ G�a. Ft. ........ Type of Construction .................. F�t. Cost..��,�-�........... To be Completed ................... (/��" _ ''��^Y. ! T- ��J.;.. Y� /'�'�t'� Yv'L�� . �� i ��_ � . �� n.��:+Gdi,.� I � a � �f t� - �� ►+�i � �,��„�„ � In consideration of the issuance to me of a pertnit to construct the building desribed above, I agree to do the prop�ed work in accordance with the description above set forth and in compliance wfth all provisions of ordinances of the dty of Fridley. ,� .................................................. In conaideration of the payment of a fee o! $��`��""":�., permit is hereby granted to ................... ......................... to construct the bu9ldtng or addition as describe� above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employe� and worlQnen, in all work done in, around and upon said building, or any part thereof, shall conform in all resgects to the ordinancea of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the efty limits and this permit may be revoked at any time upon viola.tion of any oP the provisfons oP said ordinances. � .,�*:�,�r;. ,� �.' . . . . . . . . Building Inspector . . ,_ .3,-�� l.�'��: ,F NOTICE: '° Thla permit does not cover fhe construa6lon� fnstallatlon o� alte�ation for wt�ing, plumbing, gas heating, sewe� or wate�. Be aure to see the Buildlnd Inspaotor for sepa�ate pennib to� thase Items. i�`t � :+�� r� r` t6 �r� APPLICATiON FOR BUILDING PERMIT CIZ`Y OF FRIDLEY, MINNESOTI � , ,�� Owners Name � �%fi f�N �'C�'J Builder ��E � i''�'�,/f% � , �.Ac�dress- , �� f�� /'�� ._ Address ��' f . �� /VdLle�� ,�.� � � �r��o� �� . " , . ' �,OCATION� OF BI�ILDING � No. ._,�_: 3treet � � _ F€art of . Lot _ .� _ Lot ,.�....: � $lock � ddditiori or Sub.:. Div. � � � Corner-�.Lot _ � , ?�side Lot Set Back _ � Applicant atta.ch to thi� farm Certificate- -o� � Strrve� of Lot aad proposecl building 1oc�tion. ' ' � _ � �`o be used as DE�SCRIPTION OF B�TILDING w Front ,�.,�. Depth_.�.iieight Sq. .E't. � � G�. Ft.. � . � , . � Front :_._Depth N�ight Sq. F`t. Cu. Ft. _..__._�____. Type of Construction �' «�'� �'�'s�� .�'' Esti�mated Cos�°�'�� To be comgl:eted . � ' ' ; • The,und�raigned hereby'makes application for a perm3.t for the work herein specified, agreeing to do a7:1 work in strict accordanee with the... City Qr.dinanoes and ru�ing of the Dep�-r:ta�ent of Bui.ldings, and hereby decZare$ that al�'the facts and representations stated in thie appl3catiori are true and correct. . • � . . �. �.t� ...a', . � °'' �� . Signature � %�'� iS.'�/11. � ; � ., • � , . . � `� �`; (A ��chedu7.e of Fee Costs c,an be found on the Reverse� Sid . . ' G�f/,t� `� f � � c� � � �� ;��.��,� ,D�� 0 � BIIILDING PERMIT FEE�SCHEDULE Ssctioa 2. The Inspector of 8uildi:rigs aha11, before issuing any permit for the erect3on of an�r building or structure, or for any addit�.on to any existing building or structure, or for any alterations or regairs to ang existing building ror structure� upon application therefox�, require '' the �a3rment by the applicant far such permit of fees to the amount herein below set forth'and in the manner herein provided to-wit: � 2.1 For any such pernit for the erection of any fireproof b�ilding� other than a garage,.ware�ouae, factor�r or grain elevator, or for the erection of any fireproof addition, %r similar occupaMC�� to any exiating bui.lding shall be a� the rate of �1.40 for er�.ch on$ tY�ousand cubic feet; or fra ction thereof, in such cubical contents. _ - �.2 Eor any auch�ernu,t _for the _�rection �f`_a� fir�rc3o��g�&g�r ��-_ "�---- -- - -- -- -- h�nse,=fa�tory or grain e-l.evator� or �or the erection of ar� £ireproof addition for aimilar occupancy, to any existing building aha.11 be at the rate of �1.25 for each one thousand cubic feet, classified as "��'eproof" b�r Section 502 of the Minneapolis Buildin� Cod�. .� HOUSES 2.3 For any such permit for the erection of any nontfireproof.building other than a gaxage, wa,nehouse,.._factory or grain elevator, or any non-fireprobf 'addition, for similar occupancy, to any existing bu3lding.` Permit �1000 for each one thousand cubic feet. . GAR.AGF5 � 2.4 For any'-subh permit for the erection of any non-fireproof garage� warehouse, factory or grain elevator� or for the erection of any non-, fireproof addition, for similar occupancy, to any existing bui].ding�or for each such build�ng:or add3tion. Ninety Cents for each one thousand cubic'feet or fraction thereof, in the cubical contents thereof with a minimum.,of �/�.00., � For the purpose.of.computing fees for building permits the cubicsl contents of any building or addition to a uniform hei ht throughout by multiply3:ng the g.raund arerj. covered from a point six �6) inEhes below the floor line of the basenent.or cellar.�o the average he�.gh� of �he upper su�face or to the average�height of the roof surface of the main gable of a pitehed roof� •.. • • ' �"' ` � 2.5 For repairs oi� alterationa to an exiating strt�ctur.e, .the fee shall be at the rate o£ ��e00 for each Five Hundred Doll�rs (�500.00), ox fraction thereof in the cost of all proposed work. 2.6 In no case shall the fee charged for any permit as set forth in 5ection 2 be lesa than �1.�00� � �,�„� �! s,j �, � G /c� 9 G� , _:�.H � � 13 �l �� , � � �'1 City of Fridley, Minn. BUILDING PERMIT N� s 2 l� Date: ,.�" � """'. I' `i ,/�!. , r / • �' Owaer: �� - Builder Address Address ,� LOCATION OP BUILDING No. �y�� Street �.� ��.�,�€��- Part �! Lot Lot _ Block Addition or Sub- on .�C `� �'��'� � �� --�� l�i •"`°�,' .�°�":`�� ' Corner Lot _ Ine3de Lot —. �"'� �tback _ Sideyard �+� . Sewer IIevatian ____ � F da.tion IIevation DESCRIPTION OF BUILDING T as: _ _..L_ Front �l�..��. Depth -�,� Height �� Sq. F't �,�� Cu. Ft �,� Fron Depth _�^ ITeight ._..�_ Sq. F't. Cu. Fk Type oP Construction ��i�� E�t, �.�j��'�� .�.."'� To be Completed In consideratioa of the issuance to me of a permft to construct the building described above I agree to do the proposed work fn accordance with the description above set forth and in compliance with a�l provisions oP ordinances of the dty of E'rYdley. ��. In consfderation of the payment oP a fee of $�� , permit is hereby granted to to construct the building or addition as desc�ibed above. This rmit is granted upon the express condition that the person to whom it fa granted and his agents, employees an�worl�aen, in all work done in, around and ugon said building, or any part thereof, shall conform in all respects to the ordinaaces of Fridley� Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings ��th�e dty limits and thia permit may be revoked at any � pon violatis�, of any of the provfaiona of said � Building Inspector NOTICE: '11ds psr�eit d�s aot eorer �hs coesfrueHoe, tnttatlaHoe hr wGino, �Mmbteo, �a hsaNao, swwr o� rnhr. B� sun to su t6� Buildine le:p�etae iar aparab psrmh� Po� f6a� t»mt. - - �, � ,y� .s.�• - � r - ... .m =�' APFLICATION FDR BUILDING PER1�T CI1`Y OF �'RIDLEY, MINNESOTA Owc►er's Name Addreas � �� d'L� � � � / 7 � LOCATION OF BUILDING ��' � .9 Y % �'�i�� 1Qo. � 7 � Street h�Z.A / '� � �� rt of Lot �� ➢�°� Lot Block_ Addition or Subdivision j� �� Corner Lot ineide Lot �Setback ��'�°' Side Yard '�% 'P SEi�ER EL�VATION 1�OUNDATION ELEVATIOAI Applicant attach to this form Two Certificates of Suzvey of Lot and proposed building location drawn on these Certificatea. DESCRIPTION OF BUILDINO To be ua ed e�s :�� "`�� ` �.. C � � , � �� Ftont 2 Depth � � Height �� Sq. Ft, Cu. Ft. ' Front Depth Height Sq. Ft. Cu. Ft. Type of Conatruction�� -�-��s EstimaCed Cost � l� �� To be Completed '�'he uadereigned hereby makee application for s permit �or the w�ork herein specified, agreeing to do all work in strict accordance w�.th the;�,City of Fridley Ordinances and rulings of the Department of �uildings','=anifi<,hereby declares that all the facts and repre�entations stated 3,n this applicaCion are trne and correct. � ,� DATE � I? — %�° _ (� � SZGNATUR (Schedule of Fee � oetsoc�an be Eouad on I 1 0• ' � l+ �, � +r � ��e � � � � �` � �A`.` � d °s r �� .. c.c�+n c BUYI,DiNG PERMZT F'BE SCHEDULE Section 2. The Tnspector of Buildin�a shall, before ieauing any permit for t�he erection of �'eny building, or structure, Qr for any additti�oa to any egise- ing bu�.lding or structure, or for any alteretion� or sepairs to.any existing buildin� or st�r�c'ture, upon application therefor, require the payment by the applicant for such pesmit..of fees to the amount herein below set forth and in the manaer herein provided to-wiC: 2.1. For any such perm�tt for the erection of any fire-proof building, other ichan a garage� warehouse, factory or grain elevator,-or for the erectioa of any fire-�roo� addition, for similar occupaacq, to any existing building shall be at Che rate of $1.40 for each one thousand cubic ieet, or�fractioa thereof, in such cubical conteata.. . 2.2. For aay such permit fos �he erec�ion of any fire-proof garage, warehouse, facCory or grain elevator, or for the erection of any fire-proof addition, for s3.milar occupancy, to any existing building shall be at the ar�te oi $1.25 for each oae thousand cubic feet, classified as °1fireproof" bq Section 502 of the Minneapoiie Building Code. �� LaOUS�S 2.3. For any such permit for the erection of ��y non-fireproof bu3lding other than a garage, warehouse, factory or grain eleva�or, or any noa-fireproof additioa, for similar occupaacy, to any existing building - permit $1.00 for eacla one thousand cubic feet. GARAGES 2.4.. For any such permit for the erection of any non-fireproof garage, warehouse, factory or grain elevator, or for the e�ec�ion of any non-firegroof addition, for similar occupaacy, to any.existing building or for each such build�Lng or addition - ninety cents ($0.90) for each one thousand cubic feet or fracCion thereof, in �he cubical contents thereof with a.minimum of $4.OU. For the purpose of computing fees for building permits, the cubical coatents of aay buildia� og addition to a uniform height throughout by mul�tiplying the ground area covered fram a point six (6) iaches below the floor line of the basement or cellar to the average heigh� of the uppez surface or to the average height of the roof surf.ace of �he main gable of a pitched roof. 2.5. For repairs or alterations to an exis�iag structure, the fee ahall be at the rate of $3.00 per each Five flundred Dollars ($500.00) or fraction thereof in the co�t of a13. proposed work. � 2.6. In no case ahell the fee charged £or any permit as set forth in Section 2 be less than $4.00. �l -."- `"� l�l rt �. � „� n � City of Fridley, Minn. BUILDING PERMIT , �� N° '7439 D$�: �,.� � � f� � � _ � a �: 8�� _ Address Addrese � � ��J 1 LOCATION OF BUILDING No. ��L ��. Sir�et "' ' Part oP Lot Lot _ Block Addition or Sub- on Coraer Lot _ Inside Lot � Setback Sideyard R° Sewer IIevattoa _..._._ ._._ Fo dation IIevation DESCRIPTION OF BUILDING v �: , Ft,ont � Depth � Height Sq. FL � Cu. Ftt� Fro t Depth "'C'd�t ITefght �_ Sq. F't Cu. Ft Type oP Conatruction �. F�t �� To be Completed Ea coneideration of the issuance to me of a germit to construct the building described above I agree to do the proposed work fn accordance with the description above set forth and in compliauce with a'11 p ns of ordinaaces oE the dty of FrYdley. � ' .��2 i. In camsiderat[on of the paqment of a fee oP $�_ , permit ia hereby graated to to construct the buflding or addition as described above. Thiap��mi t is granted upon the express condition that theperson to whom it ia granted and his agents, employees anc� workmen, ia all arork dnne in, around and upon said building, or anyp� thereof, shall conPorm in all respects to the ordinance� oP Fridley, Minnesota g la:ation, construct[on, alteration, maiatenence, and movin� of bufldinga ordinanc:�. dty limita� a�thia permit may be revoked at ar�'� O�_ /r on f aay of the Pravisiona of eaid St�lding Inapector � NOTIC� 'Ihb p�neb das eot �rorse t6s eoeatrucNee, I�taUadoe �er 'ririn9. P�+�e. 6a hudne, rs�we or wdsr. 8� wrs to ss� ths 8uildtng I�ee ter ap�rafr p�emifs /or f6�a kems. , . ' , , . • ' , ' S60-3d50 � . • - �� . . . r • ;� � �;i; � [�� O B"��!'�� . � � . ' `i�•'�%Y ,; "- � • `� . .,. ,; • � ... ^ . • �i,, 'L� ` � ANOKA COUNTY � � � . �--;�...�,.t;-�- . . �:._ �,� . . �� ' 6431 UNIVERSITY AVENUC NE September 2, 1975 . FRIDL[Y, MINNGSOTa 55�3� ' • lZinneapola.s Post Oiii_ce Department • ' � � Supexintendent oi n�x�.V�xy � . � ' lst & Ai�xquette Avenue ' � . . � pii.nneapolis, Piinnesoi:a 55402 � � � ' .' . � � Re: Change of Address - Effective Oct. l, 1975 • �� • .Cit� oi �xidley . • � G�ntlemen : ' � ' We are•listing the follo�ain� change of address in the City of Fridley; • : � ' � �t�� ; Ms . Agnes Burh�te ' _ . • � ' � FROM• 540 Highway #100 N.E: , . • . . . '' . , T� . 517 Cheri Lane �J . E . � ' . . _ LEG�1L D�SCRIPTION • �t 15, Bl�ock� l, Murdix Park ".� .• � . • • . � We have noti.fied the occupant of L-his chanfie .and Cae would appreciate . i.L' vexy mucli i� you would change your xeca�:ds acco'rdingly. ' � ' � � Sincerely, � � ' • . • • . . . D � L G . CL11].:K . �� . � � Communii:y Development Adm. ' � DGC/mh � � • � • � �CC: City tdatcx 13i17.ing Dept. ' • � • Ci�y Assessin�; Ucp�x+:.:nent . � � , . ' ii�.nneapolis C,a.s Con�P.�ny - II�:ool:lyn Pa�:lc Ofii.ce • � .-� Nor. tl�cru S tatcs Powcr Com��any •' � ,Noxthwestierii Tcll Telei�hone . ' . • • C�.i:y �TOtCx3 Rega.stxaL-ion '. .. . • liomcowner . ' � . . . � ' ' • ' ' ' 560-3450 �� .� . . . . . '�' :' . ' ' . . �;; fi; �'1'"� . . , . • "� • t! ,�•�;,�. ;~-` a '� •�� ::1. �;' t.0 1 � a • �L �i. , � �� :`i�f.J:;t:i �,�� -: �1; � . � � � . .-,� � :�::,t�; ;:, �� . . �i...;,'."�f�if�t ' . • . . � . � '.==''' "�c� I � ANOKA COUNTY , � . i � i E:k„-�� 3��-�;.� . - . . ��"Y Se tember 2, 1975 FRIDLEY, MINNESOTA 55421 1 ' �': �� 6431 UNIYERSITY AVEt�UE NE' P � ; _ . i� • . . . t . • W .t � ' . � . . � � . Ms. Agnes Burhite . • .- , � 540 Highway #100 N.E. � ' ' . s • Fridley, b"rl. �55421. � � � . , , _ Re: Change of House Numb�rs - � ' . Effective Oct. 1, 1975 • � • • �Dear ris. Burhite:. � . . � � �. . • ^ �•.• Tt has been necessary for this ofiice to chanqe the address ' of y.our house ' • ' � � ' FROi4 �540 iiighway #100 td.E. TO 517 Cheri Lane Pd.E. � ' � ; . • "_ ' . - ' LEGAL D�SCRIPTI021 Lot 15, Blbck ��1, R4urdix Park � • � '� We have notified the•Post Office Department, Minneapolis Gas " . �� Company, Northexn States Power Cor�pany, Northwestern.Bell Telephone , Company and varia.us departments iri City hall of this change. � � � . •, � . • . Sincerely, . . .. � . ' • � DARR�L G.. CLARIC � _ ' . ' . ' Coramunity Developmen� Adm. � . � ' � DGC/mh . ' . . � - - 0 , • . , . c:�� ,'r�. �,� �a a � 1. LOCATION OF WELL I Coun Name �� STAT� OF MINNESOTA DEPARTMENT 0� WEALTH ABANDOPJED WELL RECORD b Township Name Township Number Renge Number Section No. Fraction N E '�� 'r� of '�. FRIDLEY 030N °s� 24W w 23 —SW—S] Numerical Street Address and City ot WeA Loratlon or Oistance hom Road ��te��n�, 517 CHERI LANE NE FRIDLEY, MN 55421 Show exad location of well Qn secUon grid with 'X� N � SketcFi map of well loca ��5� u� E � . � ��{` S 1/2 Ml. 1l � I I S � 1 mile 2. PROPERN OWNER'S NAME BURHITE Mailing Address it diHerent than property address in�icated above $AMF HARONESS OF 3. FORMATION LOG COLOR FORMATION FROM If not known, in�cate tormaUon log from new well or nearby weil. MINNESOTA UNIQUE WELL N0. (leave blank if not known) 4. WELL DEPTH (completec� � Date sealed 58 n• � 11/28/92 5. DRILLJNG METHOD (1 known) 1❑ Cabte tool 4❑ Reverse 7 Q Drlven 10 � duq 2❑ Hollow Rod 5❑ Alr 8 � Borad 11 ❑ 3 � Rotary 6 � Jetled 9 � PowerAuper 6. OBSTRUCTIONS Weil obaWCted [�es ❑ No ObswcUons removed �ea ❑ No If obswctions cannot be remaved, contact MDH before sealing. 7. USE 1[.'�Domestic 4❑ Monflorinq 8❑ Heat l�op 2❑ Irriqation 5❑ Public 9❑ Industry 3 L� Test We�l 6❑ Muaicisal 10 ❑ Commercia! 7 ❑ Air CondRioninp 11 ❑ 8. CASING(S) 1 ❑ Black 4 (�Threaded 7 ❑ 2� Galv. 5 0 Welded 3❑ Plastic 6 0 Stanless Steel 2 in. to �J g ft. TO in. to ft• 16. REMARKS, ELEVA710N, SOURCE OF DATA • CASINGS NEMOVED, CPSINGS PERFORATED, ETC. WELL LOCATED IN PIT ON NORTH SIDE OF BAS E1�IENT . . . DISTRIBUTION OF COPIES: STATE OF �IINNESOTA _ LOCAL CITY ' MALENRE WATER SERVICES CUSTOMER COPY CUSTOMER FILB OTHER PID# 23-030-24 43 0048 (0301) OFFlCIAL ABANDONED YJELL RECORD (May be used ta Property Transfe� IMFORTANT: F1LE WRN DEED 9.SCREEN [� Saeened well from ft. to 4t (�� „�� ❑ Open Hoie from ft. to ft. 10. STATIC WATER LEVEL 5 6 n. ��oW p��e 11 / 2 8/ 9 2 land surface Date Measured 11. WELLHEAD COMPLEfION 1❑ Pitless Adapter 4❑ Found Buried 2 ❑ Basemant oHset 5 ❑ 3 � We�l Pit 12. GROUTING INFORMATION 1[� Neat Cement 2[� Bentonite 3❑ �rout materia� NEAT CEMtrom Q_to1.� ft. cu. yds. _ 13. NEAREST SOURCES OF CUNTAMINAIION ��feet SOUTH direction SF.GTFR rype Well disinfected before sealing4 [�Yes 14. PUMP [�Removed ❑ Not Present Ty�' 1 � Submersible 3 �L.S. Turbine 5❑ Reciprocating 2� Jet a❑ CenVitugal 6❑ 15. EXISTING WELLS (Please sketeh locations of abandoned and adive wells In remarks section or on back.) Other unused well(s) on property? ❑ Yes [� No Abandaned: ❑ Permanent ❑ Tomporary ❑ Not soaled 17. WATER WELL CONTRACTORS CERTIFICATION Thia well was sealed under my �urisdiction end this report Is Vue to the best ot my knowledge antl betiaf. MAT,ENKE WATER SERVICES #27600 10550 COUNTY ROA Aaa,�9 . MAPLE GROVE Signed -...-, D.e ,�, ..� Name of Driller 81 SUITE 2 Date 11/28/92 � � � � � Z o y 'V � � C) 3 �'o' � N .:,� Z . y �� m � � � 3 0 � � " ocl� O �• � � � 3 a c� co N �� ti � � . � � c° rr � � °c. a fl � m � � � � �' � ' R � ) � \ ' �/� � Z@ii0'd 509868L ►-� 'p � � � � � � �. � �u. M � '� W a�' � O 0 � O� � r � m � m � S7� � D 1--'' : ps � O S < � N �� m m O � D N D�' A m � � � � O � N �- r � O � W n v D � 0 � 0 � O�R � � N � N <s9 N � $ � o �i C�P! lA i a � �� "� N R � j � � � �� 'Q � �.��-� o��y � � � � � �� . � �. � ��z i �p�Q � t�9 �� a. I � � � Q ��i� �N � �;�� . 3 � W � A � N � °'.+', � ^ ci c� , � �. � .� �'� o �I`, ,,.� ~ � � � � � p O � ' � n tl. � c� � � .a � � � � �. a -+ � � c> � �. �o r+ � '., , � �y o � . � r. -. �� m `�" ��{�° �� iy ,� y � 7C' ��. � a � �� w � � � � oi w t�i� v�i � C � ° � �°,-,�� .� � -o u_> ee � .r m � � Q-��d eD ff � � tAp � °' � � � cu o. � .;� �. i .t a =- -rt d '� � O � o ni ^''�s �. s+� '''' � 's W � O t0 � �i` e�Y 7C' r.' v � v � � � � . � d� �*i E�A b'1 G7 c� 4 O g � o o � � � fA � � i � �' O � ? I �` � av go � a�v � o �� o � � nZi �`' � �� `° �' v � �� i H I �� z Z o ro n '+? .. � +7 � � A � G� � o p � � ! � � n � � � M 2 (A !p `° �" i n�' a� t7► o °�' m Z � O v • ap � '� '� I � � c � V L � f � y � A3�Q I2i� �0 1,.11 � W02L- � °° � S o � C N � � v � � � f v m � � z O V i � i � � �I �° , If� I,� �' \ �� I � ' �� i� Y �� e WO'W � !-+ c�s�:�c� W � m �T � �� WD"� N � z 2� m� n � � � v G N y O '� Z r �^ �� .� O � Z 1+1 .n �O �� 0 � � � a� �Z x N A �v L � � � 2 -�i D L: 2 � � � �� j ^� O H� � �1 � � ,� v �z'' � /'� �a � y -�I � �r � v � � ea � � I" O � L d Y � � � O E'}'$':�:%.� Ze ' d �ltii0l CO�QN VEPlT�,� T CONNE�,�?R AND COi1PiBU8TlON ABR VERiFlCA710N When �gplaeins� an pac4st�e�gLf�ranc.e, the undetsigrted hereby v�rifies �at the vent�ng has been examined and !s free from rust, deteriocation, o�struci+ons, and is securety supported �nd fir�stopped wi�ere tequire�. Yss (� No (} The venting sy�tem is piasticlPVC and rneets ai1 cuRent codes and manul`aGurer specifications inctuding sizing. f�gth� �urnber of elbows and t+erm�natior�. Yes (-�No () ihe undersigned a{so ve�ifies ttiat the replacement unit is a listed assem�ry and meets the c��nt codes and manufacture�'s spedficatfor�. 'this daes ir�ude AGA GAMA Categomy 1 Cerlbdl IFumas� Venting �°ebles for fan assisted and naturaf d�aft apptiances. Tlze existitta aambustion a�r �s sized and insta{led to meet the currettt �odes and manufactute�s speci�irtians. �ec� required to insta�! a new com�ustion air. ift will �e siz�d and ir�st�lled To meet the current cocies and rnantdfact�.►re�s sgecFficadons. Yes ( �'1Vo ( ) Yes t,j'No i ) Yes (�-No t ) When install��a a ngw ventie�a�s�yste-�n. Y�e unttersigned hereby varifle�s that i� ds a Ilsted assemb�y and meeis the wRent codes and rx►anuiaciu�ers specificatlons. This does trstiudo nGA-GAMA Category 1�enVaf F�a�e VCtlting Tables 4�r fa� assisted and naturat draft appiiane,e�. ��s �o l) Is the coMmon vent a�d v��t conne�ors sFt+ed and in5taAed cot'rectl�► ��ter an app�iance has been� remov�d fram Yhe :.smmon vent and vented separatety as per wRet�t cades. Y�s o() ,�p�(i�nc� TT'sm� aa�t� �ixelCa�moa Vent and Vent Cqn �g� I�nforma�i_oe Ap�lia�c� #1 Type _ � ��'� '�, BTU t�put ��Fan �lssisted or Nat - - �,r.�. Apptiance #2 Type _, �TU tnput ____.s Fan �sslsted or Nat �, Appliance �3 TYt�e �... �TU Input ��an Assisted o� Nat � Tatat Appliances _, '�otal Btu [nput � Colnmon Vent Type �.� Ver�i HelghR _ Diasneter inches •Appiiance #'t Vent Connecyt� N�ight bt Letagth �fi t�i2imeter in Type _,,,_._,_ Appliance #Z Vent Conn��tor Fieight � Lerx�th t# Diameter in Type Apptiance #3 Vaant Connector Heiqht 4� Le+�@h f� i3iam�t+er ire iy�pe ___ .� � ��`. %°2C�-�'•� � e��r�w►raoNS: ru�en�ea �� ,5�- � �j4i "'- l2 e � �r , HEATING CO: � '�- �°> � �Z � �- ` � Signed By: i�ate : , �� Z0�Z0'd S09868L Ol J+3�Qt�i� �D J�II� Wf.�l� BS:Zi 009Z-zZ-nON '�� City of Fridley 6431 University Ave NE �Fridley MN 55432 (763) 572-3602 or Fax (763) 502-4977 Water and Sewer Permit Application ❑ New Connection �xisting Date: �-l�'�� Job Address: �,� C ��' L-� ��o��`��`� �Utility Line Repair/Relocation ❑Water and Sewer Connection Name of Applicant (Plumber): / J�7179 ' �c�°� °?�D �j� / �Yl Name of Property Owner: U��Ce %�C /' �'G 1 _ Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee• Repair Fee: Relocation: State Surcharge: SAC Charge: Special Assessment Fee: Total: $ ��0 Applicant Signature: Inspector approval: 04/04/OS