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P - 48182�.i i Y vr r K111L�: Y 6431 University Ave NE Fridley MN 55432 (763)572-3604 FAX (763)571-1287 MUVINU � ] DEMO�] PERMIT APPLICATION � Job° �ddre s s: � O � ��d t�l �U /l% �� S��-� N� Legal Description: Owner & Address: � ; Tel. # Contractor: � Tel. #' % -y2� 2'-YZ Address: '��Q� � State License # �-a �e ►�S, yh v, S; 31 `� DFSCRIPTION OF BUILDING HOUSE: Length '3 2- Width � Height � Sq. Ft. Cu. Ft. �J� GARAGE:Length 3o Width Z� Height 1 Sq. Ft. Cu. Ft. OTHER: Length Width Height Sq. Ft. Cu. Ft. Estimated Cost $ l`� U(�l� Approx. Completion Date ll � /��n y7a- CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCP,TIONS. CALL ALL UTILITIES FOR DISCON�TECTS BEFORE WRECKING MOVING STRUCTURE. Moving�Route: � � � � � � PaPPROVAL(S) REQUIRED PRIOR TO ISSUANCE: MPCA: NOTI �( Water u � YES ( ) NO �y � � r�l� F�.` ��,�..e� ���,.: � :; � a - . . - , , 1 • _ - ii�i�/��i'� - � ... � / .� onditions ❑ Engine�ring, Conditions � � � �� ❑ - Fire Marshal Conditions The undersigned hereby makes application for a pernut 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 are true and correct. ALL DEMOLITON DEBRIS, INCLUDING FQUNDATION & SLAB, SHALL BE REMOVED FROM STTE � �l � ` /� � J Date Signa re Mo�in� Wreckin� Principle building into Fridley ....$300.00 For each 1,000 cubic feet or fraction. .....$1.25 Accessory building into Fridley ...$ 42.00 For structures which would be impractical to Through or within the City .. ., .$ 20.00 cube, the fee shall be based on the total cost Move a building out of City ......$ 20.00 of wrecking at the rate of $6.00 for each $500.00 or fraction. ;- , PERMIT FEE: D M U Of�' Use Only: SAC-D form completed �� �°t� �'��� E�e�c��e olioii2oi i d!�a C-� REC'D 0 C T 3 1 2011 ��1 �� , ����-��- Minnesota Pollution -�Control Agency Notification of I ntent to 520 Lafayette Road North Pe rfo rm a De m o li ti on S� Paui, MN 55155-4194 Asbestos Program Doc Type: Notification 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 Building Information Name: Veit & Company, Inc. Building name: Address: 14000 Veit Place Address/Location: 381 Ironton Street NE City, State, Zip: Rogers, MN 55374 Phone number: 763-428-2242 Contact name: Jessica Anderson Phone number: 763-428-2242 Ciry, State, Zip: Fridley, MN 55432 County: Anoka Phone number: N/A Age of bldg (yrs): 40 Size of bldg (sq ft): 1,600 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 University Ave NE City, State, Zip: Fridley, MN 55432 Phone number: Contact name: Jeannie Benson Phone number: 763-572-3552 Dates of demolition or intentional burning: Start date: 11R/11 End date: 11/18 /11 mm/dd/yy mMdd/yy 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.us/publications/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. 1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category 11 nonfriable ACM left in place. Category I: 25 Linear feet Square feet Cubic feet Category I nonfriable ACM means asbestos-containing padcings, gaskets, resilient floor covering, and asphalt roofing products containing more than one percent asbestos. Category I nonfriable ACM is not allowed to remain in place for demolition if it is in poor condition. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 w-sw4-21 • 7/9/ f0 Category II: Linear feet Square feet Cubic feet Category II nonfriable ACM means any material, excluding Category I nonfiable ACM, containing more than one percent Asbestos that, when dry, cannot be crumbled, pulverized, or reduced to a powder by hand pnessure. 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 demolition, transport, or disposal (e.g., transite, cement, slate roofing). • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats Page 1 of 3 2. �escription and location of ACM remaining in place (including number of floors and rooms): 1x1 brown floor tile located in the livinp room will remain in 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 demolition all structures must be inspected by a licensed asbestos inspector who has been certified through the Minnesota Department of Health.) EMSL Analvtical Inc. usinq 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►g�ency demolifion must be submitted as ea►1y as possible before demolition begins, but not later than the following wo►icing day. A demolition is considered an eme►gency on/y when the facility has been deemed structural/y unsound and in danger of imminent collapse. If the st►ucturally unsound building is known to contain any ►egulated ACM or is suspected to contain any ►egulated ACM, special procedures must be followed. If you are unawaie of the special procedures, inst►uctions/ regulations can be obtained by contacting the Minnesota Pollution Control Agency (MPCA) at the add►isss or phone number listed below. 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: 14000 Veit Place City, State, Zip: Rogers, MN 55374 Phone number: (763�28-2242 8. Demolition waste disposal information: Landfill name: Vonco II Demolition Debris Landfill Owner/Operator: Steve Halgren Address/Location: 15301 140'" Ave SE City, State, Zip: Bedcer, MN 55308 Phone number: (763)262-8662 9. I certify that the above information is correct and I am a bonafide representative of the demolition contractor or building owner and have authority to enter into agreements for my employer. Print name: 'ca A on Signature: `.. Title: Estimator/Project Manager Date:10/24/11 Imporiant 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 two 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/publications/w-sw4-20.pdf for a Pre-Renovation/Demolition Environmental Checklist Guidance Document to assist with completion of this �ule. Submit to: Minnesota Pollution Control Agency Questions call: 651-296-6300 or 1-800-657-3864 Industrial Division — Asbestos Program 520 Lafayette Road North Fau: 651-297-1438 St. Paul, MN 55155-4194 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 • 7/9/10 Page 2 of 3 UT470I01 CITY OF FRIDLEY CXLIB 10/31/11 Account History - Combined Inquiry 14:48:32 Customer ID: 154155 Name: MEHALOVICH, CHRIS Location ID: 511450 Addr: 381 IRONTON ST NE Cycle/route . . . . . 03 09 Amount due . . . . . . . . . Initiation date . . . 10/06/06 Pending . . . . . . . . . Termination date .. 6/09/11 Customer/location status .. Type options, press Enter. S=Display F 26.58 .00 Trn Trn/Due Description Trn/Prv Reference Runninq Opt Type Date Cancel Comment Amount Date/Num Ba UT PMT 6/14/11 CHRISTIANT06131196 60.46- 6.5 FB BILL 6/13/11 FINAL BILL 26.58 6/14/11 . 4 BL BILL 5/25/11 CYCLE BILL 60.46 5/26/11 60.46 UT PMT 3/21/11 CHRISTIANT03181197 124.09- .00 BL BILL 2/24/11 CYCLE BILL 60.46 2/25/11 124.09 SP ADJ 12/29/10 SEWER PENALTY 4.74 11/24/10 63_.63 RP ADJ 12/29/10 RECYCLING PENALTY .70 11/24/10 58.89 GP ADJ 12/29/10 STORM WATER PENALTY .35 11/24/10 58.19 F3=Exit F5=Adjustments F7=Pendinq F8=Charqes F10=Chanqe view F11=Payments F12=Cancel More... F9=Print history 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: 03-30-24-24-0001 381 IRONTON ST Lot: 8, Block: , REV AUD SUB 103 LEVIED SPECIAL ASSESSMENTS T6is is to certify that I have examined the 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 the above described tract or parcel of land: Term Certified Initial Interest Remaining Current Current Proiect Number Prnject Descrin�ion TYPe (Yrs) Date Amount Rate Balance Principal Interest 3000-0013-00 OOW/S 1100 20 11/12/1958 $156.92 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 6000-1964-00 00 ST 9400-2008-01 002008 64 9/07/1965 atem9400 1 10/27/2008 Abatem9400 1 10/25/2010 $787.87 6.00% $24.66 5.00% $844.-56 6:@A%n $517.50 6.50% $290.63 6.50% �o Anoka County for Current Year Taxes Is: $312.99 PENDING SPECIAL ASSESSMENTS $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 '�0.00 $290.63 $22.36 For the purposes of this document, the City of Fridley has determined that an assessment is c sidered pending after the City Council passes a resotution ordering the improvement, the approval of plans and the a ising for bids. This is prior to the City Council adopting the final assessment roll. If you seek further informat' u should do so upon your own independent i�'eruir.�c._Anv amount�iven as to endin only and may or may not be the amount ultimately assessed. �� Term Initial Interest Estimated Pro_iect Number Proiect Descriution (Yrs) Year Rate Pending Am� NONE MISCELLANEOUS FEES Descriution Status Date Fee Amt. NONE UTILITY CHARGES You shalt be responsible to verify the status of any outstanding utility charges. To check utility charges ( 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 t6e undersigned as a public service on request. The undersigned certifes that the 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. The above figures are good through November 15, 20 Date Prepared: Monday, October 31, 2011 By Page 1 of 1