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AF - 41575� : '+r�' v-.i'�'w`wr ," e c��r",a 3h=-, - I � -� - - ' � ��` � � Vil1ag� of Fridley,� �.�. � r - ����I��r ��E��� ; . �'� F . .�. � i f. .` �ate � �: ' �`� ,�:` . �� �$� • �, . ...�.,,_ .,., �,......>�. o� ��` '�, , ���.� � _ � : ��� � , . . . . . .. . ��a� � � ;� � Aaa��� : ,��'� , �.�ar� " . w .{. .� .,, � .�—,,.� ' , - L,O ` TiOIV 0�' BUILDtI�[C� - �a ��� Siree� Pari o i; " '�;� � �� Lot .� . ,,� F.• BI�� �.�... Addit��� �ar Sub�-Dixision � � �. . . ... . , �` � � y Corncr Lot 7nsid� Lot , . . . . Setback Side . • d . � � � � �. 3'� �. •, .,. 1 1 ,f . �, " � . � ' : . � " .- . � -; . : DESCR�P7XfJI� C�F �i�fiJtLDiNG = � To � �Tsed _ � ,� ` � s �� �,« � � '" �" •'�����r �roni �"' ae t� r�� ��st�+ ' � : P . , �eYght� Sq, �. . . . ., : Cu. Fi. � •, oIit ,'�,r� �" ` De� '�'�'� ..�€ ht � Sq. Ft. .�!�� Cu. F � ,� � _ � ,'� �� Type oi Gonstrufcti �e�'. Es�. Cost.�..��.� �'� Gb� Tet y . . � .: . ....: .,.. To be p ed ...;.. .,. �� - � ��� � '` i. � �� � ; - �� � - �i � � ;. �� � F `� , °, Y � , � � � � ` � � _ �� - � �_ ��` � ` � �. . ', :�n ec��.side���bn of th� 3ssuaittce to 'me of �a permit t� con.�t�`uct the bu#i�ing. de�i�ed a�y�, ����� � , � � • the prop�sed wa�ck. i� accordanee �vith the descript�n above s�t �brt� and #� eQZi��sliaaee �f�h .� �r� =p� - � r arc�n�nces' o# t�e vi�a�e :of Fric�ey. :' , �. ,� r:I:. � I ?�, �: � ' •� f����. .��: � � �, . ' �- .� , ` � � .- - . � �, � - . � i � � � � Tr1 co�derafiion uf �the a � . ,� ;: � .Ymcnt of-a feg Qf $�; �� . ,� J , : . �, . ,. .�it� is �ie�by gr�utea. tit, - . ...s. u����.are•-.. : . . . . �. �, -. , ,. _. .., , : ,-:I � . . .. .' . . i .. . . � t � s.� � 1.�. �. }�44`� .a"4: i./.t� UUtiWiiii' � W1�1�=4/� � 4�� CLE/17Y�..� � �Y'c+Y++4'1� ��� �� �' y :' tYie •+e�cpres� eondfiinn. tht�t tt�e �an tv wham it is. granted and �iS agents, emA�3!�s and worlartea, ir► alI r�%ork {; do�� �in; arpund �nd.upoa �aic�=bi�ldirig, or any' P� thereof, :tshal.t conform in aii resp� to tl�e ordinaac�e..a:. �p �id�eY, ,Miinnescata rega�d#�� lc�atiaa, apn�truc#or�, �lterafiion; z�ai�ntenar�ce; �eFa3r and movi�s af b k V � in :th� v�ta;ge li�it� and �h% p�rmit ma.y be revoked at g ��� with urdinances,: ,C ; ; axkY'time u�a �iulatia� o€'any af•fihe prnvision� af s�id ,. _ r - „ ��"?���� + � _ *' c�g insgectci� NQif�E: �� .' . _ � �� . < - ; ,. ';� . 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O 0. � � � � e s� � e'"o � IC � ----------- � �. O � R�1 � � � � < � • — �' � O °= Q ': � O °0 � a � e.�.b e� � y � 0 � i � � � � � � � S. � � � a y � 0 �e ' � 0 0 ^ i � (D ro � � � � � , ,� w �� � � F� � CD HOUSE HEATING TEST RECORD ADDRESS � ; y , OCCUPANT APT. FLOQ#2 CITY � HEAT LOSS OWNER� C� SUBU����' ----_.DATE HTG. INST. SOLD BY GAS C0. METER Bq E# � Eleetrical Work By INSTALLED BY TYPE OF HEAT GA pq � Gas Line By STEAM SPACE HTR. UNIT HTR, GAS ESIGN OTHER MAKE _ , - � CONVERSION M°de� MAKE OF BURNER -�_�., Serial ���� � � � � Model INPUT Max. BTU Rating MAKE OF FURNACE CONTROL S ModeO THERMOSTA �" � Valve e H.r Plug Vent Size � Limit � KIND OF L�NER/i'°���.. �mp�;��.i �. Limit Sefting � Drah Hood ���F � NUNE_�__ Fan Setting � t.,n,��'� Filters s—�Regularor Size Pilot Type Chimney Laeation u � �� Inside Pilot Make Chimne �--Outsida , Y Construetion Pilot Model Pilot Tim(ng Smoke Bomb � �� L•W. Cut Off �raft � Q� Wiring Door Pressure _ TesT Tae Pressure�� �_ �� =�C�%'�r�� Lighting Inst. � Pereant CQ Dute Tasted - ��' �� Input CFH Per��� � �. Sfaek Temp, Pereent CO �, �� CO1"P°ny Testing _ Form 235 Nama of Tester Building Inspections 763-�72-3604 �.4Tc � �' SITE .hDDR.ESS � TH]S APPLICANT IS � MECHA.NICAL RESIDENTIAL APPLICATIQN CITY OF FRIDLEY YOUR E-MAIL ADDRESS O OWNER �CONTRAC7'OR PROPERTY Nqt,,�:� OWNER/ .a,DDRESS: TEN AI�'T PHONE: CO�'TRACTOR SUBNIIT .4 COPY OF YOUR STATE L�cENSE wrTx APPLIC.ATION PERMIT TYPE TYPE OF WORK: C1TY Permit No. Fceceived By.: Date Rec'd:� 0 � °b�� COMPA2�'Y NAME: ' CONTACT PERSON: ii"�%GfJ Anderson Heating and Air-Conditionmg A STATE LICENSE 11 N/� 4347 Central Ave N.E. — .4DDRESS: � _STATE ZIP rxo� 7���-%?�s"/- �-S"// ��,�� Col. Hts, Mn 55421 � '�SINGLE FAMILY ❑ TWO FAMILY i ❑ �W I� REPLACEMENT r- DET,AILED DESCRIPTION OF V+'ORK ❑ TOWNNOUSE ❑ ALTERA7"]OTJ/REMODEL ��� PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up ta S500.00, whicbever is greater, for the improvetnent, installation or replacement of a residential ftxture, excluding the fixtures. (This should reflect only the cost of ]abor ) Lzbor cost under $300 =�15.00. Labor cost between $300 to $500 = cost of ]abor x.OS = FOR PROJECTS WI-�RE LABOR EXCEEDS $500, FEES ARE BASED ON � 10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: {INDIC� E TOT.4L w.1Li!JIBER OF EACH BEL0�7 SIZE/BTU��+ �_ �qui�ment Installed MfG: MODEL��� J�G: MODEL: SIZE/BTU �G: MODEL: SIZEBTU ,�..'C i25.OG FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00 �A.IR TO A1R EXCHANGEER i15 . FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BOILER S3S.00 �URNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.�0 " CiAS DRYER 510.00 _,POOL HEATER $35.00 _DUCT WORK $10.00 GAS PIPING $]000 VENTILATOR $15 00 : � ' . . . .. . . ;a'nt,y ,,,i:.. v.y�y ��qz`k � zr «. R Nr "��,'i� c. a PER3��II�'�FEE�PR�7EGTS F,OR fi:JNDER�$3D� ;,,�r, .g, , ; :.-�; <:� � k; .��. �:��"������,�������.�O�i'����CTS OVER �500: Permit Fee i_°�_.,�. Number of fixiures @$14.00 x$10.00 —$ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOT.AL DUE ��•� Number of fixtures @$25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLTCATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in i conformance with the ordinances and codes of the City of Fridley and with the Minnesota Cor,struction Codes; that I understand this is I not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the � approved plan in the case of all work which requires review and approval of plans. ; C. L(/l�l�(,P�'�G�-�i1 �_PWNT NAMEC � GC�/! i�1' E/J �� f''Gj L/�' DATE I I��6 � SIGNATL'�tE GF 6.PPLICA1v'T I City of Fridley Suilding Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 '• 763-502-4977 � 0 suo��In�i�� �t� dn axEm� puE uo�snqpzo� .zo asn� aq �EUi axEnn�os sa�aptn� apoa Y��juE�q�arill. �xaII3 �uiod.�a�ua� ��,LOis 3P Q i�� ���� `� � Z'£090'9b£I �L�II �d �?saQ ��ttQ '9 � -- -- - - - _ _ _ -. ZL9L i� OL9L aP�� ��a� � �ad -e � uoqe[quaA 'S ZI£0'9fi£I �Y�II IIOT��T��O� �'°aII IIo parmba2i `� Luooi iad p�eoj �u�ooa � ssoj �eaH '� s�woH nn�N �o� a��int�3� s�uauipuaur�' i�II�I �?� 8��d��i� �L�II �� � ia�o jan3 'q s�uaurpuaur�d NY�I �?� S ia�d�[� � J� sa�uer�d�e se� -z • �II4uaA ' £ . � s�ua'�Pua� NY�I �?m S ia��� �L�II `� (�eoiaq a�ou aaS) i?jd dn-a�ey� 'Z - ��mnIIa�r � �t� £ lal�� �3Uacredoid �o se� re-�N 'q 6 s�aatapaa� i�IT/�I �?� L sa�d�{� �T��IC tan3 P?Ios io �p `� • (n�ojaq a�oII aaS) zc�' IIO�snqut°� I F S3WOH JNIISIX3IM�N �10� a3��n�� ��y dm3�W ❑ 3WOH JhI11SIX��, SNOIlIaCPd/S3WOH M3N ❑ ` �tl/�H NOIl`d�lldc�d 11W?!3d 1tl11N3QIS3?� lIW�13d SS3�021d Ol a�a33N N0111/W2�O�N1 a3�ilflb32! ° ... _ - � WELL OR BORING LOCATION County Name Name �Township No. �Range MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Minnesota Statutes, Chapter f031 tion No. FracGon (sm. � Ig.) Date Sealed �....: �--�e _.�-q--��_ Q: --,...���.^ Minnesota Well and Boring I,,' ��� Sealing No. Minnesota Unique Well No. or W-series No. n� nmu� n �c �> Date Well or Boting Constructed GPS ��de degrees_ minutes seconds Depth Before Sealing 1�� ft. Ortginal Depth_ 1 LC LOCATION: Longitude_ degrees_ minutes seconds ��T — � R(S) S�WATER LEVEL Numerlcal Street Address or Flre Num6er and City at Well or Boring Locatlon ngle Aqu'rfer ❑ Multlaqu'rfer 501 ELY S't'1tFF't' � ��ORING as��� ❑ Estimated oete W t S iow exact Iocatlon of weli or bodng section grid with °)(." N W. . � �ET --a--- � -- ---�-- ---f-- , � � � � � � Yz ATi�e ���1 s —= ,—imna--t— - PROPERTY OWNER'S NAME/COMPANY P a 2� forest Ave � Mahtomedi, MN 55115 _L OWNER'S NAME/COMPANY NAME Sketch map of well or boring loc�tlon, showing properlq lines, roads, and butldings. addresv a er- upply Well 0 Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) ❑ Steel ❑ PlasKic ❑ llle ❑ Ot Outstde: ❑ Wetl House ❑ At Grade ❑ Pitless AdapterNnit � B°�� ❑ wan P� � ou,a. CASWG(5) Dlameter Depth �in.hom� to�pft. 1 VlJ in. tram to ft. in. from to ft. ❑ elmve land surtace � Inslde: semerrt Offset Well PR ❑ s��� ❑ otner Set in oversize hole? Annular space Initlally grouted7 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown ❑ Ves ❑ No ❑ Yes ❑ No ❑ Unknown WeII owneYs malling address H differerrt than property ownePs address inmcated above �reen from_ 1 LA to 1 LGft, Open Hole from � tq n —�OC/ —�QJ . OB TRUCTIONS �rop Pipe ❑ Check Valve(s) ❑ Debris ❑ FlII ❑ No Obstruction � Type of Obstructions (Describe) pinp �n��� P' GEOLOGICAL MATERIAL COLOR �DNESS OR FROM TO Obstructions removed? s FORmunON ❑ No Descrlbe �� If not known, indicate esdmated formaBon log from nearby well or boring. PUMP � MARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALING Geology above from: 470 Ely Street Water Level in Above Well: 19' Da.te Water Level Taken: 9/23/1949 Unique 206647 Hired by Michelle Nelson • LGCr".� r�py � �"� HE-01434-11 IC# 140-0423 Remwed Present ❑ Other METHOD USED TO S ANNULAR SPACE BErWEEN 2 CASINGS, OR CASINO AND BORE HOLE: Annutar Space Exists ❑ AMnular Space Grouted with Tremie Pipe ❑ Casing Perforation/Removal in. from to ft. ❑ Perforated ❑ Removed in. from to ft. 0 Pertorated ❑ Removed Type of Pertorator ! � Other GROUTING MATERIAL(S) (One bag of cement = 841bs., one bag of beMOnite = 50 t6s.) Groutlng Material--�T$�–.(3�'A� from_A to��3, yards_� bagy from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes How manyl LICENSED OR REGISTERED�CONTRACTOR CERTIFlCATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The infortnalion contained in this report is true to the best of my knowledge. �j(]��'j I Kevin Scheiterlein Name of Person Sealing WeII or Boring uoaa _ �