P - 48184�.11 Y vr rtu1�L�;Y MUVINU �] DEMO [� PERMIT APPLICATION
6431 University Ave NE
Fridley MN 55432 �
(763)572-3604 FAX (763)571-1287
Job Address :�js � S� 1 V�
Legal Description:
Owner & Address: � � Tel. #
Contractor: ��- C _ Tel. #7��-iL�-�Z�f2-
Address: l�b �-e,�-I— p� � State License #
'�°5� �' V' S RIPTION OF BUILDING j�-Gi �
HOUSE: Length �.-�� Width 3� Height �_ Sq. Ft. Cu. Ft. �a�
GARAGE:Length Width Height Sq. Ft. Cu. Ft.
OTHER: Length Width Height Sq. Ft: Cu. Ft.
Estimated Cost $ /�Q(� (� Approx.,Completion Date
CALL GOPSER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. GALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Moving Route:
APPROVAL(S) REQUIRED PRIOR TO ISSUANCE: ' �
�
MPCA: NOTIFICATION OF INTENT TO PERFORM A DEMOLITION O YES O NO
, o � � . , -'���` <� �'
,�. � ��� �� �� �.°�� a�'�
Cd�Water ' 1 Pai . Yes[ or Collect[$ ]Signature �
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❑�
cia
Engineering
tions
Conditions
�❑ �
Fire Marshal � � � �Condit�ions
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict
accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
aze true and conect:
ALL DEMOLITON DEBRIS, INCLUDING FOiJNDATION & SLAB, SHALL BE 1�EMOVED FROM SITE
Date
Movin�
Principle building into Fridley . . . . $300.00
Accessory building into Fridley ...$ 42.00
Through or within the Ciry . ...$ 20.00
Move a building out of City ......$ 20.00
Wrecl�n� � � � :
For each 1, 000 cubic feet or fraction. .....$1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction.
�
PERMIT FEE: MINI,�j�j,j� �.�p �I ffi�2 L1�� Only:
Effective O 1/O 1/2011 rCtt;�u 1 t7
� a l i-aa3 ��
SAC-D form completed
REC'D 0 C T 3 1 2 011
-_ Minnesota Pollution
� Gontrol Agency
. 520 Lafayette Road North
St. Paul, MN 55155-4194
Notification of Intent to
Perform a Demolition
Asbestos Program
Doc Type: Not�cation
Type of notification: � Original ❑ Amended ❑ Project cancellation
Notification must be postmarked or received ten (10) working days before demolition begins. See Item 5 for emergency
demolitions. Both start and end dates should be amended in writing as necessary to reflect current project dates.
Demolition Contractor
Name: Veit & Company, Inc.
Address: 14000 Veit Place
City, State, Zip: Rogers, MN 55374
Phone number: 763-428-2242
Contact name: Jessica Anderson
Phone number: 763-428-2242
Building Information
Building name:
Address/Location: 551 Huqo Street NE
City, State, Zip: Fridley, MN 55432
County: Anoka
Phone number: N/A
Age of bldg (yrs): 40 Size of bldg (sq ft): 1,790
Number of floors, including basement level(s): 2
Building Owner Present use of bldg: Vacant
Name: Fridley HRA Prior use of bldg: Residental
Address: 6431 Universiry Ave NE
City, State, Zip: Fridley, MN 55432 Dates of demolition or intentional burning:
Phone number: Start date: 11/7/11 End date: 11/18 /11
Contact name: Jeannie Benson mrrddd/yy mrrvdd/yy
Phone number: 763-572-3552
Note: If there is >260 linear feet or >160 square feet of Regulated Asbestos-Containing Material (RACM) in the building to be
demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of MN-Notice of Intent to
Perform an Asbestos Abatement Project http://www.pca.state.mn.uslpublications/w-sw4-06.doc must be used to notify for
the asbestos removal.
Is nonfriable ACM present in the structure to be demolished? � Yes ❑ No
Will nonfriable ACM be present in the structure at the time of demolition? � Yes ❑ No
If Yes to both questions above, complete Items 1-9. If No to either question, complete Items 3-9.
7. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II nonfriable ACM left
in place.
Category I: Linear feet
200 Square feet
Cubic feet
Category I nonfriable ACM means asbestos-containing
packings, gaskets, resilient floor covering, and asphalt
roofing products containing more than one percent
asbestos.
Ca�gory I nonfriable ACM is not allowed to remain
in place for demolition if it is in poor condition.
Category II:
Linear feet
Square feet
Cubic feet
Category II nonfriable ACAII_means any material, exduding
Category I nonfiable ACM, containing more than one
percent Asbestos that, when dry, cannot be crumbled,
pulverized, or reduced to a powder by hand pressure.
Category II nonfriable ACM is not allowed to remain in
place for demolition if it has a high probability of becoming
crumbled, pulverized, or reduced to a powder during
demolit7on, transport, or disposal (e.g., transite, cement,
slate roofing).
www.pca.state.mn.us • 657-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats
w-sw421 • 7/9/10 Poge 1 of 3
2. aescription and location of ACM remaining in place (including number of floors and rooms):
9"x9" gray floor tile located in the living room under carpet will remain in place.
.
3. Company and/or individual that conducted the building inspection and the procedure used to determine the presence
or absence of ACM (including analytic method): (Note: Prior to demolifion all structures must be inspected by a licensed
asbestos inspector who has been certified through the Minnesota Department of Health.)
EMSL Analytical Inc. using the PLM method.
4. Description of planned demolition and the specific method(s) that will be used:
Loading of debris using a hydraulic excavator.
5. If the demolition was ordered by a government agency, please identify the agency and attach a copy of the order:
Name:
Authority:
Date of order (mm/dd/yy):
Title:
Start date (mm/dd/yy):
Notification for an eme�ency demolition must be submitted as early as possible befone demolition begins, but not later than
the following wo►lcing day. A demolition is considered an emergency only when the facility has been deemed st►uctura/ly
unsound and in danger of imminent collapse. If the st►ucturally unsound building is known to contain any regulated ACM or is
suspected to contain any iegu/ated ACM, specia/ procedures must be followed. If you are unawa►e of the special procedures,
instnicfions✓regulations can be obtained by contacting the Minnesota Pollution Control Agency (MPCA) at the addiess or
phone number listed be/ow.
6. Description of procedure to be followed in the event that unexpected RACM is found or Category II nonfriable ACM
becomes crumbled, pulverized or reduced to powder:
We will shut down the project; we will keep subject material moist and contact the owner, regulatory agents, and abatement
contractor for action.
7. Demolition waste transporter(s) information:
Transporter name: Veit & Company, Inc.
Contact name: Vaughn Veit
Tranporter address: 74000 Veit Place
City, State, Zip: Rogers, MN 55374
Phone number: (763)428-2242
8. Demolition waste disposal information:
Landfill name: Vonco 11 Demolition Debris Landfill
OwnedOperator: Steve Halgren
Address/Location: 15301 140'" Ave SE
City, State, Zip: Becker, MN 55308
Phone number: (763)262-8662
9. 1 certify that the above infortnation is correct and I am a bonafde representative of the demolition contractor or
building owner and have authority to enter into agreements for my employer.
Print name:
Signature:
J sica Anderson Title: EstimatoNProject Manager
Date:10/24/11
Important Note:
Ensure you are in compliance with Minn. R. 7035.0805 prior to the commencement of renovation/demolition.
This rule requires that the following items be removed iwo days prior to demolition: mixed municipal solid waste; household
hazardous waste; industrial or hazardous waste; waste tires; major appliances; items containing elemental mercury, Poly-
Chlorinated BiPhenyls (PCBs), and chlorofluorocarbons (CFCs); oil; lead; electronics; and other prohibited items. See MPCA Web
site at www.pca.state.mn.us/publicationslw-sw4-20.pdf for a P►e-Renovation/Demolition Environmental Checklist Guidance
Document to assist with completion of this rule.
Submit to: Minnesota Pollution Control Agency
Industrial Division — Asbestos Program
520 Lafayette Road North
St. Paul, MN 55155-4194
Questions call: 651-296-6300 or 1-800-657-3864
Fax: 651-297-1438
E-mail: asbestos.demolition.pca@state.mn.us
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats
w-sw4-21 • 7/9/ f0 Poge 2 of 3
UT470I01 CITY OF FRIDLEY CXLIB
Account History - Combined Inquiry
Customer ID: 108015 Name: RUDNITSKY, CORY
Location ID: 510940 Addr: 551 HUGO ST NE
Cycle/route . . . . . 03 88 Amount due . . . . . . . . .
Initiation date . . . 2/26/98 Pending . . . . . . . . .
Termination date .. 8/24/11 Customer/location status ..
Type options, press Enter.
5=Display
Trn Trn/Due Description Trn/Prv Refex
Opt Type Date Cancel Comment Amount Date/
FB BILL 8/30/11 FINAL BILL 88.12 8/31
UT PMT 8/24/11 CHRISTIANT08231102 365.06-
10/31/11
14:46:05
..
.. ��
F
ence Running
Num Balance
/11 88.12
.00
SP ADJ 6/29/11 SEWER PENALTY 20.09 5/26/11 365.06
WP ADJ 6/29/11 WATER PENALTY 9.59 5/26/11 344.97
RP ADJ 6/29/11 RECYCLING PENALTY 2.33 5/26/11 335.38
GP ADJ 6/29/11 STORM WATER PENALTY 1.18 5/26/11 333.05
BL BILL 5/25/11 CYCLE BILL 92.78 5/26/11 331.87
SP ADJ 3/29/11 SEWER PENALTY 13.74 2/25/11 239.09
More...
F3=Exit F5=Adjustments F7=Pending F8=Charges F9=Print history
F10=Change view F11=Payments F12=Cancel F24 More keys
31-Oct-11
City of Fridley
6431 University Ave. NE
Fridley, MN 55432-4383
763-571-3450
Special Assessment Search And Statement of Charges
To:
On all that tract or parcel of land lying and being in Anoka County, Minnesota described as follows to wit:
Parcel No: 03-30-24-23-0046 551 HLJGO ST Lot: 19-24, Block: G, RIVERVIEW HEIGHTS
LEVIED SPECIAL ASSESSMENTS
This is to certify that I have examined t6e records in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for
such search, certify that the following special assessments appear unpaid with respect to t6e above described tract or parcel of
land:
Term Certitied Initial Interest Remaining Current Current
Proiect Number Project DescriDt�nn Type (yrs) Date Amount Rate Balance Princiaal Interest
3000-0013-00 00 W/S 1100 20 11/12/1958 $210.00 6.00% $0.00 $0.00 $0.00
3000-0021-00 00 W/S 3230 20 07/23/1959
9100-0000-00 OOREG SA(Water/Sewer 2100 15 12/31/1960
6000-1966-01 O1 ST
6400 10 09/18/1967
6000-1966-01 OOST 6400 09/18/1967
4000-1999-01 OORIVERVIEW HEIGH74100 15 OS/08/2000
Amount Cettified to Anoka County for Current axes Is:
$1,492.11 6.00%
$41.28 5.00%
$1,153.50 6.00%
$276.25 6.00%
$1,000.00 6.50%
$88.33
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$266.63 $66.67 $21.66
PENDING SPECIAL ASSESSMENTS
For the purposes of this document, t6e City of Fridley 6as determined that an assessment is considered pending after the City
Council passes a resolution ordering the improvement, the approval of ptans and the advertising for bids. This is prior to the
City Council adopting the fnal assessment roll. If you seek furt6er information, you s6outd do so upon your own independent
inquiry. Any amount given as to pending assessments is informational only and may or may not be the amount ultimately
assessed.
Term Iaitial Interest Estimated
Project Number Proiect Descriution (Yrs) Year Rate Pending Amt.
NONE
NIISCELLANEOUS FEES
Descrintion Status Date Fee Amt.
NONE
UTILITY CHARGES
You shali be responsible to verify the status of any outstanding utility charges. To check utility c6arges
( water and sewer) contact Fridley Utility Billing Department at 763-572-3529.
The records referred to above are public and may be inspected by anyone during regular business hours. The search of these
records was made by the undersigned as a public service on request. The undersigned certifies that t6e above indicated
searches were made and are believed to be accurate, however, the undersigned or the City of Fridley does not insure the
accuracy of the above statements and does not assume liability for errors and/or omissions.
T'he above figures are good through November 15, 20
Date Prepared: Monday, October 31, 2011 By
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