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AF - 33431�� LJ • • • City of Fridley, Minn. BUILDING PERMIT Date: ....._Sept�. �18, 1967 ____ � ^�_�_� �o .� 9 34� � 9�58 pwner; _._._Robert DeGardner �_.._,___.� _ guiider _..__..__North Suburban Blders Address ...__..�4�:0__17_th�Ave;... North.._._.._..._.____...---- Address ._.__. 3218__.._67th_.Ave....North .__......_..._._ LOCATION OF BUILDING No. .._._.._.....�4�._..... Street ._.._...__.�ame�.Y.�,�,�:e._..._.._..._..�---------•--..__.--•---•-----.._. Part of Lot .._.._._._...___._.---__..._......_... Lot ...1.�..._�_..�.�..__ Block ._.._._.. E...____---•-----..........._ Addition or Sub-Division ------•------Riverview Hei�hts �__ Corner Lot ...__....._.._.._.._ Inside Lot ....._...._.... g--_._------... Setback .---_.._.---•---•---__._._ Sideyard .__._....._....___._.._____._.._ ____ Sewer Elevatian ._.._..._._...$.5_Q.._9S?____._._.._____......__.._.._._ -----...._._.__ 853.. OO..T_.,,� . Top of Footing DESCRIPTION OF BUILDING To t� v�a as: Dwelling,._._.._.__.._ Front _... 30 �---- DePth ._..�34..4 � Height ._.._......�� Sq. FL _ 968_ Cu. Ft _._ 19, 360 _._._..__._..........._.__.._.�..__ Front _.___..._.__ Depth ____._...__ Height ._._.....__..•-- Sq. Ft. ____..._...._.. Cu. F't _� Type of Construction _..._.._Frame.__._.._...._.__.. Es� Cost _........�13.,�_000........_........ To be Completed ___._..._.�W SEWER & WATER IS IN THE STREBT In consideration of the issuance to me of a permit to construct the building described abave, I agree to do th� proposed work in accordance with the description above set and in compliance with all pravisions of ordinances of the city of Fridley. � __. S�-_.�.'-___ �/�?��`c�'.� $100.00 Sewer Connection Charge In consfderation of the payment of a fee of a_., 29 :00.._.., permit is hereby granted to.�.. North Suburban Blders ...._._,........__...._..._._._�.._.___....___. to construct the building or addition as described above. Thispe rmit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinaacee of Fridley, Minnesota regarding lceation, construction, alteration, ma.intenance, repair and moving of buildings within the city limits and this pernut may be revoked at aqy time upon violation of atiy of the provisians oi sa�d ordinances. CLARENCB BELISLE g�� NOTICE: This p�rmif doa no� �ewr th� eonshuetion, in�tallMion fee wirin�, plumbin�. ou M�Hno, s�wK er wabr. !� wn to � th� Buildiag Insp�ero� for s�p�nb p�rmits fw Nna N�ms. � / r, � � r„ n�r,,.-- Ti.�:�l.{e'i�`"_'d.i)�� 1!lrZ �1T�SSD..Lc�7` .. � �...�`_.d.� �y.� �i L i{Jli�:�.'�''. �'� rY��ilr'+�il4�A - / OWNER'S NAME �., ' � ,��C' ��.� .�- /i�-.r"--� Ti`��i��SER /C�i� �/.l'��e:r�LG�..� �� --�� . ADDRFSS �� l o �.,� :C� ��,. s'"��a A!J�P,ESS 3� /P C� %� LC(� •/� _ . • � R ,�,� _.., , � L+JCA7'?.CN �P BTJ�LDi�IG � '. � I � �i0. / ,;�, ST1��.F2 'tV� � ; � :: � � �� ; ` PART 0� LOT ' t �a :, _ �; . : � r i LOT ��' `` ; BLOCK �-�-° AD�I�ION �Et SiTBD:YISIdN _ f'� ~ CORNER LOT INSIDE I,OT ��C . SE�ACY. SIDE-YARD SEWER EI,EVATIO�I �� __�� FOU�II?ATIt�N ELEVATION L'�� e=` d•� �� Agplicant attach to this form Two Gertificates af Survey af Lot and proposed ��Idin location drazs*n on these Certi£icaCes. ui � � a.��.� �r ��'� �� l � z �,, -�-��=-�-,�` � . DESCRZPTIO:� 0� BUILD�NG . To Be Us ed As ; . ' ._ . _2 � � Front � Depth � �' / Height S q, Ft , c=„�1„L� Cu . Ft . l�,,,��j � d Front �Depth Height _ � _ Sq. Ft. � Cu. Ft. �r�- Type of Construction Esti�ate� Cost�� , _ cg f> : To Be Completed . The undersigned hereby makes appiication for a permit for the work herain specified, agreeing to do all work in strict accordance with the City of Frid?ey Ordir.€�nces and rulings of the Dep�rtment of Buildings, an3 hereby daclares th4t all the facts and representations st2ted in this appi.ication are true and correct. DATE �,� �" �"t � SZGi�IATURE !�r.•.-.(� ` y ci�°�t c, (Schedule of Fee Costs can be faund on the Reverse Side). �lzq�,�G / � _ Pl.r . � .5 . � I � '�,, � �- � ...� • � _ � � $UILDING PER'•1IT FEE SCHEDULE SECTION 2. The Inspector of Buildiz;s shal.l, before issuing permits for the erection of any building of structure, or for. dny addition ro any existing building;or structure, or fcr any alteration or repairs to any existing building or structure, upon appli.ca�ion therefore, r-quire th` pay�:�at by the applicant for such pers�it of fees to the amo:.int heiein 'uelo,� ser forth arid in the manner herein pz-ovided to-wit: Ur.iform Buildin LCode: Type 1;2, & 4- $1.75 fo-r each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3'& S-$1.S0 for each one thousand cubic feet. For the purpose of computing fe�s �f_or building pernits, the cubical contents of any building or addition to a uniform nei�ht throughout by multipluino the grounc� area covered from a poir.t six (6) inciies belcc�r the f�oor line of the basement or cellar to the average height of the upper surface or to the average ��eight of *_iie roof surface of tY�e n�ai^ gablc=: of a pitched roo= . . _ For repairs or alterations tc an existing structure, the fee shall be at the rate of $3.OG per each Five Hund�ed Dollars ($500.00) ox fraction thereof in the cost of a11 propos�d work. In no case sha11 the fee charged for any oermit as set fortn in Section 2 be less thar $S .00. NSSSD Connection Charges based or. location- A:ea 1 or 2. . ' � . , . ~ + . � • . \ _ - � � � �e:��e�(� C v C .� � � � C $� • u d �� > � C = �a N V � � ^ � � � C T. } L �� a �° C �O V o. 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DATE PAGE OF APPROVED BV �""� � ,'� 612-560-3450 910-F15 7/29/76 � � JOB ADDRESS 543 Janesville Street N.E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 18,19 E Ri.verview Heights SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Joe Schommer 543 Janesville Street N.E. 3 CONTRACTOR MAIL ADDRESS 21P PHONE UCENSE NO. Lifetime Gara es 409 Washin ton Avenue South, Iio kins, Mn. 55343 4 ARCHITECT OR DESIGP1Efl MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK �� Construct a 9'7" x 22' Gara e Addition 8efote di�B Q ca oca ' . TRIC - CAS Etc. 9 CHANGE QF USE FROM TO C�VIR�� Y lAW STIPULATIONS Provide a hard surace driveway. Variance approved by the City Council October of 1975 to come within 2' of lot line. - �-IMPORTANT-- NOTffY TNE FRIOLEY` ENGR. IRED �OR W1E�lNG� DfVISiON R�GAROING•CUR9 SEPERAT� ��S REQU R�MOVAL AND REPLACEMENI` NE�►�NC�, p�M�81NG Ai'jU S«�' AT DRIVEWAY OPENtNGS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. WOOC1 Fl"aIlle THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPEN�ED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOFiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GAFtAGES 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 $1, 576 S• 79 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON, �"], SO ST,RUCTION OR THE PERFORMANCE OF CONSTRUCTION. � PLAN CHECK FEE TOTAL FEE %� d \.,�, II ��.:nti...�-, `T..�y �`i ? � $8.29 SIGNATUREO ONTRA TORORAUTHORIZEDAGENT -TIDniE� . WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT fi -- � ' � �,'� 7-�Q' ��2:...= SiGNATUREOFOWNERIIFOWNEFBUILDERI � IDATEI BLOG.INSP DATE CITY OF FRTDLEY APPLICATION FOR RESIDENTIAL ALTER�TION, ADDITION, OR REPAIR 6UILDING PERh1IT OWN�R'S Nl�ME: �o •e.. SC1� omYriQl� BUILDER: �,�E.-�.v, ,�.� Qrry-� oTsT_ ADDRESS: S�I �J �c�c�e� � J�,II { ADDRESS: �/Oc'] �ac� ;�,6 �-�� Q�� , So, /`�o i� K � � s Y�, , � ti , ,. `s�3Y3 NO : ��j 3 S TIt�ET : `�' n �� F c i� I�� LOT : ( g �' ( g BLOCK : � ADDITION : �� C � � `� � � �_, I �QS �,� 5 CORNER LOT: INSIDE LOT: SETBACK: SIDL'XARD: Applicant attach to this form �ao Certificates of Surve cf Lot and proposed building location drawn on these Certificates. � DESCRIPTION OF BUILDING To Be Used As: �c� Front: �% � �i � ( Depth : �`� � Height : Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: �(��(K � c�-�or��-� Estimated Cost: s l" S%�o .To Be Completed: The undersigned hereby makes applicatinn for a permit for the work herein specified, agreeing to do all work in st'rict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. � DATE :�) :;Z Q �� S IGNATURE : � (See Reverse Side For Additional Information.) • � � � �� '�.� � C' � F� }3i1I1.11ING F'I�I��1T I' I�I_;L' SCl1IillULI: SECTION 2. The Tnspector o£ Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repaixs 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 tlie manner herein pr.ovided to-wit: NEW CONSTPJJCTZON: S.i.�g],e Family Homes and Garages: $�.00/1000 cubic feet PLAN CHECK: 25 percent of building permit fee. AllDITIOA�AL INFORI�9ATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches 'oelow the floor line of the basement ox the cellar to the average heights of the upper surface or to the average.f height of the roof surface of the main gable of a pitched roof. For repaixs or alterations 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 a11 proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50. VERIFICATION OF POUNDATION NOTE: Permits for eonstruction caill be issued a minimum of 24 houxs from the time of application, to al1�w for proper review of the proposed structure and of the constructian site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, wi11 Le required before pxoceeding with the framing. CERTIFICATE 0}� OCC:UI'ANCY Application for a Certificate of Occupancy shall Ue ma.de ten (10) days prior to the use or occupancy of any struc�ure for which a building pennit has been issued; and said structure shall not be used or occup�ed until a Certificate of Occupancy has been issued. �, . � •,> � ..:�..... F- � w n.. 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O 0 � � � w v t�, G' O .� � U v a � q .� v a �'1 d �� a � x � i V 0 z v � � �(1 ° a w � a a � o w ro z c � v � � H � � � � w s a 0 o W s O � p�., �a � N U A E z � m a '� ro P�i U O 6 C � z � � � ro a � x � c� � 1 � � � � A ' fa � O �, a H N UI w H H ro > � a a a° w ,� a x z° w N � a 0 w +� W q` � � z� b roM E � � � •U w w � w � ro z° v � �n E O O � �t � H H � � a � HW �� x� U �N OH wH W� wN �� H (A Ha ra i � i � � O I � i 3 � � N ►+ b � �� k � a � v ro •� .� C a •.+ A 'C � ro C O a w u a H � N 0 � " a 8 °' � � � 3 . `J � 0 � � � � ! � � � � � � �.1� � � \ CHIM�JEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (,) 2. Is free from rust or deterioration Yes () 3. Has no foreign objects lodged within Yes () 4. Is securely supported Yes () 5. Meets all current Code requirements for size and total BTU connected 6. Has �Total hea ti ng BTU' s of All other BTU's TOTAL Rema rk s � Com pa ny _ �igned By Da te No ( ) No ( ) ' , No ( ) No ( ) Yes ( ) No ( ) . z.. ,,4.. �. sue�ecr PERMIT City of Fridley 20 2 8 4 AT THE TOP OF THE TWINS gU ILD ING PERMIT r ; � REC O. � i L_ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �57�0 1 � `-_-_ � ��;,� CITY HALL FRIDLE� SS43Z NUMBER REV. DATE PAGE OF APPROVED BV i �1� 612-571-3450 910-F15 4/6/90 / / JOB ADDRESS 543 Janesville Street N,E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED �esca. 18,19 E River�iew H.eights sHeEr 2 PROPEfiTY OWNER MAIL ADDRESS ZIP PHONE Judy Schommer 543 Janesville Street N.E. 786�-2162 3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO. Minnesota Exteriors 295 High�ay 55, Hamel, NII�I 55340 478�6001 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CIASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CpNSTRUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SUFTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5�8�5 $2�g5 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO C'iIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $H�..00 PLAN CHECK FEE TOTAL FEE $83.95 SIGNATUREOFCONTRACTOAOFlAUTHORIZEDAGENT IDATE� WHEN PFOPERLY VALID ED THIS IS YOUR PERMIT _ � �� SiGNATURE OF OWNERIIF OWNER BUILDERI IDATEI LDG �NSP � ATE � . CITY OF FRI�LEY � � ( ) Effective 5/1/88 ADDN ..[ J �1 AND R-2 ALTgt [� Buildit�g P�ermit Applicatioaz c;onst�vction 1�ddress: S�`�3 �%/3n�<s v i l/� S�- . N. �� l� i�ll�Y Legal Description: ow,�r x� & �S: ��r,�l �, S e-�iorn vH �.. s �-� � � �. # ��1� - a/�r �' --, contractor: �l1 �ll � �-��;arzs Tei. # �7?�- GOO/ �: � � s �.� �s �,�--m� � m� S s � �o -- - — LNII�IG AREA: Gds,tiAGE AREA: D�CK.AREA: O'i�R: Attach to this application, a Oertificate of Suxvey of the lat, with the prq�osed oor�stxuctioa�► drawn on it to scale. �CRIPTI�T OF II�H�Tr Ler�gtti Width Heic�t Sq. Ft. Iength Width Heic�t Sq. Ft. Ier�th Width xgtJGrou�3 sq. Ft. Corner L�t [] Inside Lot [] F't. Yd Setback Side Yard SetbacJts Z�pe of C�anstruction: S; �( ; N.��'. Fstimated c:ost: S �p 9 S. D� Approx. Cxn�letion Date�_ � 5- �? � �roposecl Driveway Width If New Opening Is Desired: Ft. $ $ � Wi + 6' See Back Page �: � 5�9 ��: J �.. # �� 000 i P�ermit Fee $ �'� - �a `� state sum�an�e $ �i' • °/� G� SAC Charge $ Driveway Esc.�ow $ Park Fee $ S�w�er Main Ct�arge $ . v� s'i'z�TTCa�s: QTY OSE �Y Fee Schedule � Revers� Side $.50/$1,OOQ Valuation $575 per SAC Unit - Alt. "A" or Alt. "B" Above Fee D�te�aityed by IIx3��4 14gre�aerit Neoes.sarY I] Dtot Ne�sarY [] $ �r'�� y � :�cx�:� °_ �} o �iv -� �, oa L�l � � 3� �S ' :�� . . :�•. � - �+: : �:�:�. � - Zhe Ct�ief Building Official shall, before ��Q>; *±� petmits for the ere�c.•tion of ar�y buildir�g or structurn, or for arry addition to arry existir�g kuilding or structure, or for ariy alteration or r�air tfl ariy existir�g buildiux3 or structure, upon application therefore, require the payment by the applicant for sud�i permit of fees to the amwnt herein belaa set forth ar�d in the manner herein provided to-wit: Z�OR'AL VAIiJE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 i �� $15 (Minim�nm F�ae is $15 plus surcharge) $15 for fiYSt $500 plus $2 for each additional $100 or fraction tr�reof, to ar,a incluair�g S2, o00 $45 for first $2,000 plus $9 for each ac�itional $1,000 or iraction thereof, to arr3 including $25,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fracti� thereof, to and includirg $50,000 $414.50 for fixst $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thexeof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional $1, 000 or fraction thez�eof �tIVL�C �SIa[d ESQ�7W (do�crete Cxirb Streets on1Y) Alternate "A": Remaval and replaoenent of curb ar�d gutter only - Driveway width plus 6 feet tlmes $13.50. Alternate "B" : Remaval ar�d replavement of curb ar�d gutter arid install a 3 foot wide approaCh with 6 i� dep�th - Driveway width plus 6 feet times $15.75. � :�• �' v •; •i 'ru u • •; Permits for oonstruction will be issued a minu�ann of 24 hours frc�a the time of application to allaw for prcyper revie�a of the prapoe�ed structure arxi of the vonstruction site. A Cextificate of Survey of the lvt, shawing the location of the faur]ation once it has it has been con.stnict.ed will be required before pz�oceedir�g with the framir�g. _ _ C�TY OF FRiDLEY FR(DLEY MUNICiPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 August 8, i995 Judy Schommer 543 Janesville St. NE Fridley, MN 55432 Dear Judy: I am sending you a copy of the report our contractor filed with the State Department of Health for the well capped on your property. Please retain this with your property records as proof that the well was properly abandoned and sealed. I will also put a copy in the City's address file for both your property and 533 Janesville St. If you have any questions, please feel free to call me at 572- 3591. ' cerely Grant Fernelius Housing Coordinator Enclosure Minnesota Well and Boring wELL OF BOA�NG LOCATtON MINNESOTA DEPARTMENT OF HEAL7H Sealmg No. rj h h/S A.� i.! � �� WELL AND BORING SEALING RECORD V i2 "t lJ aJ Courny Name Minnesota Urnque No. OKA � ^"�' �_��nnes a St �utes. Chapter 103/ or W-senes No � � ILeave b1aM A no� knOwnl Townsh�p No F7ange No. Sect�on No. Frac�ron �sm. • g) Date Sealed Appro:�mate Dale Wetl �� 30 24 3 yS,%f �;lW�„ JULY 31, 1995 or8°rmgConsirocted I950•s Numencal Slreet Address or Fi�e Number and C�ty ol Well o� 8onng Locatwn 533 JAMESVILLE STREET Oepth Before Sealing i� S fl Orginal Depih ? n. Sfaw exad bcatan o1 weil or bonng Sketch map o1 well or bormg Slatic Water Level � Accurale xi sedwn gnd with'X . �T Iceatwn. showm9 propeAy hnes. lv ❑ ApProximate N � � � ( ; -i- -; - -, � � Single Nquiler ❑ Muluaquifer � h. below above land suAace . � � � � _ - � - - � - -'- CASING TYPE . W ' ' E , � � � �{ -�- - i - - � - -�- � yer Steel ❑ AlasUC ❑ Tlle ❑ Other �" , mi � i � � __ _ ,_ _, _ _; � il 112 lls � 1 S Screen Irom to it. Open Hole trom to H. � � ^"k � OBSTRUCTIOWDEBRIS/Flll ❑ Obstructron � ❑ Oeb*is ❑ Fi!! � r`��E��LEY Type ot debris/obstruction Madmg Address d ddferent than propeny address �nd�cated above. 431. UNIVERSITY AVENUE obstruction/Debris/Fill rertroved? ❑ res ❑ No RIDLEY, 1KN 55432 P""A° , 5 . . . . . . � . . . . . �Removed ❑ Not Present ❑ Other . . : ,_ �._«� ..._ .. . _..... ..;.. _.. . ._ . . . . . . . . . _,. . . _. CASING . . . _ .. . .. . . . �� GEOLOGICAL MATERIALJ � . COLOH HARONESS OF �M TO � � • � - FORMATION - Diameter Oepih Set in oversize hole? Annular space inAially grouted?. �� I�t known. indicale eslimated formation log irom nearby well or borirg. . � :° � R0� 2 4 in. from � 1� 12 tt. ❑ Yes � No ❑ Yes ❑ No ❑ Unkaown AND CLAY Y 2 � �� ^ to n. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown �&��g Q� $ I 5 in. from to k. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OH CASING AND BORE HOLE: RAVEL ROi�IN 1 � 1 $ R% No Annular Space Exisis �tFa � . �� ' � � � � 1 '-. 1 %.r ❑ ��Annular space grouted with iremie pipe . . . : � . . . . . . ��P�. tJFE i 4 2 Q � Casing Perforation/Removal � �KQp�+�+ � 2�j 2 3 in. irom to tt. ❑ Perforated ❑ Removed � � in. irom to � fl. ❑ Pedorated ❑ Removed . . , . . .. . . 7ype d pe�torator . - ❑ Other GHOUi'ING MA7ERIAL � � . . �. .. �.. � Grouting material PO�T�� from i� 5 t��E N. yards 9 bags . . .. . . . � - . � from to R. yards bags REMAqKS, SOURCE OF OATA, DIFFICULTIES IN SEAUNG � � . �. �. � � � � . � EOLOGY FROIK : FRIDLEY SR HS t�om �o it. Yards �y5 ATER LEVEL IN 1�1BOVE WELI.: 70' TE _ WATER, LEVEL _ TAKEN : 4/ 18 / 7 2 t�om �o e. ya� t�ys UNSEAIED WELLS AND BORINGS ' , . � . . . . Olher unsealed well w boring on propeAy? ❑ Yes . �No . . � " . . � ' ,+ �, - ` _ '_ : UCENSED OR HEGISTERED CONiRACTOR CERTIFlCATION ,- r._ , ,, - i �� " This weN a baing was seaied in actotdance with Minnesota Rules. Chapler 4725. The infom�ation contamed in Mis repoA is �� , true to the best of my knowledge. - " ` . H : 8ffiJNRR ` & . SON3, INC. 71015 � �� . Na license w Regishatan No.. 8/2/95 . , ., ... . ._: .,. .. > _ . �. . . . � . .. .. Aufl�orized tative Signature . . . � .. - � . . Da(e � . . � u��r,u+r-� wrr►i Paoa� - �1A /2CEVIN HOPPE . -- _ ....._..__ .__.. _ _.. _ . . . ' PAPERS-WELL OWNER COPY" H' s +var�e d ve�son sea��ng wen o� eori�g . .. . . �1-'� HE-Oi434-0t ',: . :. , -. .. � . .. . � ..... . . . � . . . . . . . . ' .. � . . . _ . � . . . . . . � . .. . � - _. . . sue�ecT MIT NO. City of Fridley 3 3 3 21 � � AT THE TOP Of THE TWINS g �� L D I N C P E R M I T � ` RECEIPT NO. • COMMUNITV OEVELOPMENT OIV. � ; V �� , r � � PROTECTIVE INSPECTION SEC. �`�� Ei i___-�: �"';,i CITY NALL FRIDLE� 55�32 NUMBER AEV O�TE P�GE OF �vPqOVEO Br 1 763-571-3450 910- F 15 1/ 10 / 0 3 / / 108 ADDRESS 543 Janesville St NE t LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED oesca. 18 & 19 E Riverview Heights SNEET 2 PROPERTY OWNER MAIL AOOHESS ZIP PMONE Judy Ann Schommer, 543 Janesville St, Fridley, MN 55432 3 CONTRACTOR MAIL ADORESS ZIP PHONE IICENSE NO Dr. Remodeaing, 15239 Fairbanks Trai1 NE, Prior Lake, MN 55372 952-447-7587 a ARCMITECT OR OESIGNEfi MAIL ADDFiESS ZIP PHONE LICENSE NO 20233533 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO 6 USE OF BUILDING Residential 7 CIASS OF WORK p NEW O ADDITION O ALTERA'T{ON p REPAIR O MOVE O REMOVE X 8 DESCFIBE WOfiK Replace 9 windows within existing o enings. 9 CHANGE OF USE FROM TO STIPULATIONS Provid� smoke detectors in all sleep�ng rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Cau?.king and fTashing for all exteriar open�ngs. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PEfiMITS ARE FEQUIqED FOR ELECTRICAL, PLUMBING, MEATING. VENTILATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL AND VO�O IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OFi IF CONSTpUCTION OR WORK IS SUSPENDED OR ABANDONED fOR A PER100 OF 120 OAYS AT ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFfSTREET PARKING 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STA�LS GARAGES AND KNOW TME SAME TO BE TRUE ANO CORpECT. ALL PFiOVISIONS Of LAWS VALUATION SURTA% AND OROINANCES GOVERNING TMIS TVPE OF WORK WILI BE COMPLIEO � 1 706. 3(� �. HS WITH WHETMER SPECIFIED MEREIN Ofi NOT TME GRANTING Of A PERMIT � OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE Oii CANCEL THE pEqMtT fEE SAC CMAFGE PROVISIONS OF ANV OTHEp STATE OR IOCAL LAW REGULATING coN. �63 . LS Fire SC � L. T 1 STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION CNECKFEE TOTALFEE Lic nse 5.00 $70.71 S�GN4TU�7E OF CON"RA(;TOp OA �UTHOAIZED OGENT iO�TEi WH PROPERLV VALIOATED TMIS IS VOU PERM , / � S�GNnTUAE O� OWNEA ��c OwtiEQ Bu��OEp� IDATE� lO iN$� «<E FROM : A FAX N0. : 9527466977 Jan. 03 2003 02:46PM P1 t}EC-12�-��092 16�62 f'RGM :1T'� OF FRIDLEY TO G5�7�6b9i'' P,pJl•'(12 �EW � � � �no+� cinr oF Fwot,t�r �.�'ER ti� 6431 Jnivers�y ave NE, Frid MN b5a� �ective 1J11�p02 y�+� SII�LE FA�d11lY�N� DUPI�X S�t-�! AlVD � Z �S3' S7�-�� t�� In�� l.DINCi p�RMli APp�ICATION Con=`trUCGOr1 Address: �� L�s�► D�scri�ation: Owrtet Name � q�r�s�— iie' �� .�. C�nu i1{�1�� V � • � � � • w � me Y `�.��rr YY��e i ��. # . Address-15�39 F� �`r bQ,n,�s rai � �tittv l�CENsE �a?0�335 33 N• E' • A-�orL�ct �Ge M� � 9"'.a�- S/ At�3c� iQ ihis appfic�R� a�c,�te of 3urv ' 7S 8 7 iot, wiit� the prnp�� ovnstruction eY of ihe dral'K1 on it ta sCa�e. l.tYlld�3 q�q; GdiRAGE Ai�: D�K �R�As 07'i�l�R n�SCR1PTION OR IMPRC3VEMEP[T ��`""' �+dth,--._.._i Heiqht Leng� ^�~ � --""'r"` Ne�9ht--�.--._ q,Ft,,,_,-�_ —��""— �_ H9vCr0�nd,�____ c� � WOaL��t� �� ' t`4�1 i Yl ZXl`''r: —�---.�. c�sttia�, �y�. Es�mated ccsF s 1 �I4C i� �riv�e'way Cunb Cut W3qth ��; FL � 6 Ft = .�Ft x $ D/liE: — 3 ^ O� • . `--.�-- = $ �PPtic,nntr: �, �r. �'em@�ie(ir'C�e� # cj�- ck.�7' 75$'J �(763} 57�„35�4 fot Pen�tt F r�' ca!! you for c��►d na�r, �S rf ma�t�g'n �P�k,ation o� Fax � 709.b71,1287 I� usi � �$ u�d� card and we wiU C� U5E OML.Y - Pemtit Fee �'u� S�r�� Surrt�arge SAG ��e t''ce"se Su�charge ��Y Escrow Ero�ion Coratrot Park Fee Se�wer �Ilain Charge �or� $ CO3.1S $ j • '7 1 $ �8S � v� 5.ap S $ $. $ .` s �d.�J fee Sr.F�edslle oR Reverse Side ��--- -�� P�mit Valuation (1/?.t�tt��) �.501$4,000 Valua� $�� A�' SAC Un�t $5.00 (Siate ticasnsed Residential Con�rat�or�) �t. "A" or,alt. °g° qaove 5450.00 Cot�servai�on P!� Rexiew Ree D�mtined by Ei�ineerir�9 Agreement NetaessarY � � Not NecessaFY ( � ��1e,�tSP� ea l I �. i�„ k;� i . praU�I �r . � � .. C re�� Ca.,�d PaV�'-� � � ��u� oNS: o►�.� �,pp1 icc��c�� i 5 + �t-� r rnc��'1 -�; (r ��.k� � .�... .. d�- �� N�W [ ] CITY OF FRIDLEY ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: ,� y 3 �� e-S �' t� � Legal Description: Owner Name 8� Address � v� S c.� rr► v�.Qr Tel. #� Lo �-7 0�- al ((�,2 Contractor: `�w � � C � � � .�rLC MN LICENSE # � (��u S d 1 � Address: � I Lo ( �l `7 � C � r� �•c Te�. # �7h 3 - 3Sv— 73 �� LIVING AREA: GARAGE AREA: Attach to this application, a Cert�cate of Survey of the lot, with the proposed construction drawn on it to'scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: �- I�a�� Estimated Cost: $ �t��' �°��v Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ =� DATE: -� G APPLICANT: � �''' `h C�� 17DYx�;�.�w�(�) Tel. # %lo �^3Sv �73�T Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ $ $ � •�� 1� $ $ .S.O � $ $ $ Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] i TOTAL $ � f � � STIPULATIONS: BUII,DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or struciure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such pernut of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23,50 $23. 50 for first $500 plus $3 .OS for each ad.ditional$100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.00. VERIFICATION OF FOUNDATION Pemuts for construction 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 Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only r 1., -: -��.�E�9 `�", � 'g : State of Minnesota �; yp14• 01 A,�� .' �., Department of Commerce -� ��•'�' 85 - 7th Place East, Suite 600 ��,; ...'`.. _ _;: -�' ,- St. Paul, MN 55101-3165 ,!�+ '+y�. ie'ss,.:.. Residential Buildin� vepartment of Commerce Licensing Division Telephone: (651) 296-6319 E-mail address: licensing.commerce�state.mn.us Website address: commerce.state.mn.us Contractor License �eya� Name: TWIN CITY HOME WORKS LLC Business structure: oBA: LIMITED LIABILITY CORP Address: 11617 ZANE CIRCLE CHAMPLIN, MN 55316 License Identfication Number: BC- 20045212 Qualifying Person: MICHAEL KEVIN LUNEMANN �icense F�cpiration Date: 3/31/2006 Continuing Education: 7 Hrs CE due by 3/31/2006 Building Inspections 763-572-3604 DATE SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: PLUMBING RESIDENTIAL APPLICATION CITY OF FR�DLEY YOUR E-MAIL ADDRESS ❑ OWNER '�CONTRACTOR aDD�ss C-vY PHONE; l'�� " NAME:__� � STATE LICENSE # 6 PxorrE �_,�,�_ �SINGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK CITY Permit No.: Received By: Date�Q�:�A 9 20 �1 EXP DATE I ct °" U/ ��/�/ c � f 1✓ (� • ,� CITY VI I`�1 STATE+`��`IZIP✓53�� V FAX ❑ TWO FAMILY ❑ TOWNHOUSE �'REPLACEMENT PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING ` BATHTUB GAS PIPING � crrrrrc� SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAY TWATER HEATER ($35) FOR IRRIGATION — WATER METER _ OT'f�R Permit Fee $ Surcharge TOTAL DUE $ � Number of fixtures @ $10.00 x $10.00 = $ .50 Number of fixtures @ $15.00 x $15.00 = $ Y 1 Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is 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 al�i or� which re�,qfi3r� revie�r�nd approval of pla�s. �_ '� � � �^� ^^ SIGNATURE OF APPLICANT City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977