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PRE 2010 DOCS-,W- 0 �?, 1,-�6- City of Fridley, Minn. N9 9445 BUILDING PERMIT Date: Sept. 12. 1967 Owner: G.adbois Builder Metrn AuildArq _ Address 4000 Main St. N. E. Address 2908 Nicollet Ave. South LOCATION OF BUILDING No. 4000 Street Main St. N. E. part of Lot Lot __ Block Addition or Sub -Division Corner Lot _ Inside Lot Setback _ Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Repairs Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Fast. Cost _ 400.00 _._ To be Completed In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in compliance with a'll provisions of ordinances of the city of Fridley. W. In consideration of the payment of a fee of $ 5.00 , permit is hereby granted to Metro Builders the to construct the building or addition as described above. This permit is granted upon 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 ordinances of Fridley, Minnesota regardinng location, construction, alteration, maintenance, repair and movhig of buil�ng� Vthe dty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. H __.3�Lm NOTICE: This permit doer not cover the construction, installation for whdn% plumbing, gas hoding, sawer or water. Be vers to see the Building Inspector for separate permits for those Ilona. CIT OF FW�J .,2Y- r%ItiNESOTA OWNER'S NAMEM i s � a c� In ® c` s RU- •DER Me� •� o� , ry / .ore ✓�s , vi c ADDRESS `f0Q© Mato,. ADDRESS LOCATION OF BUILDING N0. W�V' STREET ` PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used Ad: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft, Type of Construction Estimated Cost To Be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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___! — SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). REGULAR COUNCIL MEETING OF OCTOBER 1, 1973 139 PAGE 5 assessments. He added, he had been assured this amount per 100 square feet would be $7.04 or less. MOTION by Councilman Breider to approve the request by Mr. David Harris to assume the storm sewer assessments of the adjoining property owners listed on the communication, if they are in excess of $800 and that this should appear on the final assessment rolls for the storm sewer Improvement Project No. 114. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. CONSIDERATION OF A REQUEST BY FORREST CORNELIU 4000 MAIN STREET OR A SEWER SERVICE FROM CITY OF COLUMBIA HEIGHTS: MOTION by Councilman Nee to authorize the Acting City Manager to submit a letter to Columbia Heights concerning the request and approve the request. Seconded by Councilman Breider. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. CONSIDERATION OF A REQUEST TO PUT UP TWO TENTS IN WEST PARKING LOT FOR INDUSTRIAL DISPLAY FROM TOBER 2, TO OCTOBER 15, REQUEST BY RAN COMPANY: MOTION by Councilman Breider to approve the request by Onan Company to put up two tents in the parking lot from October 2nd to October 15th. Seconded by Councilman Starwalt. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. CONSIDERATION OF A REQUEST BY WALL CORPORATION TO EXTEND BUILDING PERMIT FOR 90 DAYS: - — MOTION by Councilman Breider to approve the extension of the building permits as requested by Wall Corporation for 90 days with the same conditions as previously agreed to. Seconded by Councilman Starwalt. Mr. Rudy Dante addressed the Council and said the reason for the request was due to the financial problems with the money market. He expressed the hope that the trend would be changing and they would like some time to consumate the purchase. UPON A VOICE VOTE, all voting aye, Mayor Liebl declared the motion carried unanimously. RECEIVING THE MINUTES OF THE BOARD OF APPEALS MEETING OF SEPTEMBER 25, 1973: EST FOR A VARIANCE OF SECTION 45.0 CODE. TO The City Engineer explained in order to comply with the City ordinances, the applicant would have to supply the City with a letter from the adjoining property owner stating he has no objection to the construction. Mayor Liebl read the motion of recommendation from the minutes of the Board of Appeals meeting aloud to the applicant. Mayor Liebl further explained to the applicant that because in the past there had been a problem of some property owner building a construction on some one else's property, there had been an established policy of requiring appli- cants for variances to provide a registered land survey to protect the people. He said this would eliminate the possibility of someone building on another's land. The City Engineer stated he would clarify the matter for Mr. Asp and stated he would either have to furnish a survey or obtain a letter from the property owner to the west of his property stating he approved of the construction of the building. Mr. Asp questioned if the letter is obtained, would a survey be necessary? The City Engineer said the City would encourage Mr. Asp.to submit a survey, but would accept a letter. Mayor Liebl stressed the necessity of obtaining the concurrence of the adjoining property owners. . 140 REGULAR COUNCIL MEETING OF OCTOBER 1 1973 PAGE 6 MOTION by Councilman Breider to approve the request for the variance in the side yard set back as requested by Mr. Asp with the stipulation that he provide a letter of approval from the adjoining property owner or a registered land survey stating the position of the proposed structures. Seconded by Councilman Starwalt. Upon a voice vote, r all voting aye, Mayor Liebl declared the motion carried unanimously. MOTION by Councilman Starwalt to receive the minutes of the Board of Appeals Meeting of September 25, 1973. Seconded by Councilman Breider. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. RECEIVING THE MINUTES OF THE PARKS AND RECREATION COMMISSION OF SEPTEMBER 24, 1973: MOTION by Councilman Breider to receive the minutes of the Parks and Recreation Commission of September 24, 1973. Seconded by Councilman Nee. The Acting City Manager asked the Council if they wished to take some action on the item concerning the use of mini -bikes. Mayor Liebl advised the Council he would prefer to wait until there was a full Council present before there was any action taken on the mini -bikes. The Acting City Manager asked if this should be placed on the agenda again. Mayor Liebl answered yes. UPON A VOICE VOTE, all voting aye, Mayor Liebl declared the motion carried unanimously. THE ACTION BY THE PLANNING COMMISSION FOR REZONING REQUEST BY MOTION by Councilman Breider to receive the action of the Planning Commission on the rezoning request by the North Suburban Hospital District, and set a Public Hearing for October 15, 1973, for rezoning and special use. Seconded by Councilman Starwalt. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. RECEIVING COMMUNICATION FROM UNITY MEDICAL CENTER: MOTION by Councilman Breider to receive the communication from the Unity Medical Center. Seconded by Councilman Starwalt. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. IVING PETITION #11-1973 -IN OPPOSITION TO THE REZONING FROM R-1 TO CR -1 MOTION by Councilman Breider to receive the petition #11-1973 in opposition to rezoning to construct a medical office building. Seconded by Councilman Starwalt. Upon a voice vote, all voting aye, Mayor Liebl declared the motion carried unanimously. RECEIVING THE MINUTES OF THE BUILDING STANDARDS -DESIGN CONTROL SUBCOMMITTEE MEETING OF SEPTEMBER 27, TIM: DERATION OF A REQUEST TO CONSTRUCT A NEW BUILDING FOR OFF Mayor Liebl read the stipulations abud to the Council and questioned Mr. Bill Kalina of Carter -Day Company on each of them asking if he concurred. Mr. Kalina.agreed with each of them and stated he had no objection to any of the stipulations and would also like to -establish an attractive construction. io -7.T 4 City Council and Building Inspection Department City of Fridley 6431 University Avenue N.E. Fridley, Minnesota 55432 Re: Sewer Service to 4000 Main Street Dear Sirs: I request permission to negotiate a sewer service to serve the single family house located at 4000 Main Street N.E. with the City of Columbia Heights. This request is necessary because the City of Fridley has no available sewer lines in this section of Fridley. Your approval of this request will be appreciated. Thank you, D ORREST CORNET S Property Owner City Council and Building Inspection Department City of Fridley 6431 University Avenue N.E. Fridley, Minnesota 55432 Re: Sewer Service to 4000 Main Street Dear Sirs: I request permission to negotiate a sewer service to serve the single family house located at 4000 Main Street N.E. with the City of Columbia Heights. This request is necessary because the City of Fridley has no available sewer lines in this section of Fridley. Your approval of this request will be appreciated. Thank you, r � t ORREST CORNEtN9 Property Owner SUBJECT I City of Fridley ®; 1289 AT THE TOP OF THE TWINS PERMIT r BUILDING RECE O. � ; v -------COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. T5 t �� 1 1 i = 1 /"'I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 812-580-3450 910-F15 4/2/75 JOB ADDRESS 4000 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 Aud. Sub. #39 SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Forrest Cornelius 4020 Main Street N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE N REMOVE 8 DESCRIBE WORK Tear down fire damaged garage 9 CHANGEOFUSEFROM TO STIPULATIONS Area to be cleaned completely after demolition TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES 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, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $100.00 None DOES NOT PRESUME TO GIVE 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. $5.00 PLAN CHECK FEE TOTAL FEE $5.00 ♦• S REOFCO�TRACTORORAU ORIZEDAGENT (DATE)117 WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ap i BLDG )NSP CJLr✓yy� y i o� o� 1 ATE g IGNATURE OF O ER IIF OAGER BUILDER) (DATE) City of Fridley w�,IItGT Permit No. AT THE TOP OF TME TWINS I L. WRECKING PERMIT APPLICATION Receipt No.! r j-------^LOMMVNITY DEVELO>rNENTDIV. i MCTEGTIVR M/ItO►ION K", 107 5 q? ^--1 OITY WALL /INOL9V iMt `.J Vx- *00- 4460 / DATE PAY OF APPItOVED BY i I ,Job ,Address � / Legal Lot No. Block Na. T Txa t or Addition Des c . Pro pe Own r Addx��,s e �rh� 7o -a Contractor Address Phone �� ► Description Front Depth Height Sq. Ft. Cu. Ft. o Bldg. 3a O No. of Dwelling Units Taxes Paid Tax Receipt No. Estimated Cost of Wrecking ITo Be Completed�� Utilities Notifieds State whether notified and date , Minneapolis Gas Company Engineering Department 372-4850 Northern States Power Company�� Customer Business Office 330-5540 Northwestern Bell Telephone Co. Business Office 332-4112 Approved By Water & Sewer Department-. All Bills Are Paid Services Are Disconnected i i The undersigned hereby makes application for a permit to wreck the .building described above, agreeing to do all work in strict accordance with the City iOrdinances and rulings of the Department of Buildings, and hereby declares that .all facts and representations stated in this application are true and correct. Contract J� ,, � 7'6- Date Date r Air S mn and Da jic z GRAT1'Y'3: WARM AIFI: FIATS TOTAL Pe jr=ce Shell & Duct Worts $10.00 S Replacement of rurnare 6.00 41— Repair- Repairs & Alterations— up to $500.00 6 (p $ Repairs & Alterations each add. 3500.00 30U ; %1:rnace Shell & Duct Work to 120,040 BTU ..$1000 ; each add. 60,000 BTU 3.W 3 Replacement of P%n-nace 6.00 3 Repairs & Alterations—up to 35W.00 6.00 i Repairs & Alterations each add. ;500.00 3.00 ; STEAM ox HOT WATER SYSTEM F`urnace Shell & Lines --to 400 sq. ft FZR Steam 110.00 $ Furnace Shell & Line ---to 640 sq. ft. EDR Not Water 10.00 $. Each add 200 sq. ft. ED.R Steam Ann 3 Each add. 320 sq. ft EDR Hot Water 3.00 S OIL SUENEP—to 3 gaL per hour 6.00 3 over 3 gal. per Four—See Fee Schedule GAS BURNER (up to 199,000 BTU) 6.00 ; 00 war 199,000 BTU Sae ree schedwe GAS FMING TEEM: NO RATE TOTAL ist 3 Fixtures x$ zoo 3 Additional Fixtures x .75 $__. Gas Range to 1 .Wo _ M. sae. MGState Surcharge FAR HEATING SYSTMI Sw FeeGcbkWk VzX71L&TW3 =T=1 L w _.. Ab Dvpt, of BldoL Fhwm MO -M hl& 00 The undc-rsigned hereby makes application for a permit for the work herew. specified agreeing to do all work in strict accordance with the City Ordinances= and ruling of the Depaitment of Buildings, and hereby declares that all five facts and rep'"Pntatiuns stated in this application are true and correct. towner Kind of Building lJsed as To be rompleled about Estimated Cast, E Ol New. Building Permit No. _ _— — Permit No. HEATING or POWER PLANTS --Steam, Not Water, Warm Air—No Trade Name.size No-- S� 0 O 0 Capacity_.. _ Sq. rL ED.R BTU— Total TU Total Connected Lod Kind of Fluel BURNER — Tree Names size No Capadty Sq. VL ISD -R BTU 1 teza-.oemel CITY Or FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND $ AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE s GRAVITY WARM AIR: RATE TOTAL fob Address Furnace Shell & Duct Work $12,00 $ ` Replacement of Furnace 7,00 $ Repairs &Alterations-qp to $SQ0.00 7.00 $ Department of BuildinBS Repairs & Alterations each add. $500,00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 *replacere.:t of Furnace 7.00 Repairs & Alterations -up to $500.00 7,00 Repairs & Alterations each add. $500,00 4,00 STEAM OR HJT iTATER SYSTEM: Boiler & Lines, up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU 4;2. PO 4.00 $ 7! PP $ P. -PA s OIL BUR`ER- to 3 gal. per hour S�Q.Qq each add. 3 gal. per hour 1q.PQ GAS BURNER from 100,000 BTU �o 1Jj,8Qq s}R.qA (over 199,999 BTU see Fee schedule) GAS FITTING FEES: - 1st 3 Fixtures X A!ditional Fixtures Gas Range to 199,QQQ $TU XIA;AA AIR CO\DITIOXING FAX HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS & REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date ($10.00) FI23AL INsp. j . g 4 Date APPROVAL FOR PERKIT P.IA-1WUH FEE FOR ANY HEATING PERvST IS $7.50 PLUS ' $. 50 STATE SURCHARGE *Attac:ed stack verification form The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Ccdes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. /® ' t® ' 19 9 Plip PF BUILDI23G TP FE POMP?.F-TR AppPT G /7 FSTTM. TP.P CPsT Lye U; r PR - NR Pq�R: q PTIL TT NQ. �ER•I7T NO. _� 7 RESPR.TPTT0.q PF FURNACE/aUFuNER NP4TTNG Dr FAWpa FATS, gteamr #iat (rater No. Trade Name Size No. /-7ifee e Capacity Sq• Ft. EDR RTU M Total Connected Load / o cc' Kind of Fuel��� BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company � c Signed By >�i Peer e/2t e Tel. No. �/0{b—q34� STATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD _ I O 41 Q ST. PAUL. MINNESOTA S5101 j� Date oni Authority o '-j Street Address City 6 State Zip Code RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject:(D, Name of Day Care Home Applicant z6c) o l� A_. Street Address City State Zip Code DHS -2722 (9-85) PZ-02722-02 AV Type of License: Family Day Care X Group Family Day Care Licensed Capacity 1 O Phone No. -7 66 a- o This is to inform you that we are in receipt of an application for licensure under Minnesota Rules, parts 9502.0300 to 9502.0445 (formerly Rule 2), Family Day Care and Group Family Day Care Standards. Issuance of this license is subject to compliance with the provisions of Minnesota Statutes, Sections 245.781 to 245.812 and 252.28, subdivision 2, known as the Public Welfare Licensing Act and the rules of the Department of Human Services. You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing o ker IJ 30 days after receipt of this letter, we day care home to be in compliance with COMMUNITY HEALTH a SOCIAL SERVICES DEPARTMENT COUNTY OF ANOKA :.*UM%OU9E. FOURTH FLOOR ANOKA.MINNSSOTA 5590s Name of Agency/Organization Street Address City State Zip Code AN EQUAL OPPORTUNITY EMPLOYER STATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD I ST. PAUL. MINNESOTA 55101 Date q 3t onilg Authority treet Address .1J F. tie �l M k. _ 5- 6- 4 3;-, y el State Zip Code DHS -2722 (9-85). PZ -02722-02 RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject: "a-., (�)�Type of License: Name of Day Care Home Applicant �D O o s-AJW S reet Address �l N City State Zip Code Family Day Care A Group Family Day Care Licensed Capacity ( a Phone No. -7-9 1 -3 S This is to inform you that we are in receipt licensure under Minnesota Rules, parts 9502.0300 Rule 2), Family Day Care and Group Family Day Care this license is subject to compliance with the Statutes, Sections 245.781 to 245.812 and 252.28, the Public Welfare Licensing Act and the rules of Services. of an application for to 9502.0445 (formerly Standards. Issuance of provisions of Minnesota subdivision 2, known as the Department of Human You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall -be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing Wokkerq Vi I MW Street Address 30 days after receipt of this letter, we day care home to be in compliance with COMMUNrlry "CAITN 6'800,4L SERVICES C)EPARTMEUT COUNTY OF ANOKA COYRTHOUBC. FOURTH FLOOR ANor'k ElIIVN"07A nvaoa Name of Agency/Organization City State Zip Code AN EQUAL OPPORTUNITY EMPLOYER STATE OF MINNESOTA DEPARTMENT OF HEALTH �. aL� ABdj ABANDONED WELL RECORD * 41 1. LOCATION OF HELL MINNESOTA UNIQUE WELL NO. (leave blank if not known) County Name ANOKAI Township Name FRIDLEY r Township Number I "0� 'S` Range Number E , 24 wr Section No. 134 Fraction h 4of k ENESE 4. WELL DEPTH (completed) 3G ft' Date sealed J 3L.Y 2., 199 Nu cal Street Address and City of ell Location or Distance from Road Intersection e 4000 MAIN STREET N.i. Y 5. DRILLING METHOD (if known) 9 Cable tool 40 Reverse 70 Driven 100 Dug 20 Hollow Rod So Air 80 Bored 110 30 Rotary 60 Jetted 90 Power Auger haw exact location of well :. `(in.jection grid with `14"_ Sketch map of well location N-=-= - _ t _ _ _ • _ _� _ i 1 140 3 E IV� r H . , 0 25' (� ' 1. , • S� _ 4 ~CU. 6. OBSTRUCTIONS Well obstructed [3 Yes No Obstructions removed [3� 0 No If obstructions cannot be removed. contact MDH before sealing. 7. U...SS.....EIIIII Domestic 40 Monitoring - e0 Heat Loop 20 Irrigation 50 Public g0 Industry 30 Test Well 60 Municipal • 100 Commercial 70 Air Conditioning 110 2. PROPERTY OWNER'S NAME STEVEN & DEBBIE LOWS Mailing Address if different than property address indicated above 4000 MAIN STREET FRIDLEY, -MN. 55421 8. RNG(S) Black 40 Threaded 70 20 Galv. Welded 30 Plastic 6QStainless Steel 6 in. to 30 ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. in. to ft. SAND ROWN 0 11 9. SCREEN 0 Screened well from ft, to ft. (If known) Open Hole from 30 ft. to 36 ft. GRAVEL ROWN 11 14 CLAY RAY 14 6 0 10. STATIC WATER LEVEL DRY ft.3(below 0 above 9/02/91 land u ace Date Measured GRAVEL DARK 60 70 SAND BROWN 70 95 11. WELLHEAD COMPLETION 10 Pitless Adapter 40 Found Buried GKA ZL 95 105 20 Basement offset PUMP_ _HOUSE ST.PETER ELLOr 30 Well Pit 16. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. GEOLOGY WAS TAKEN FROM THE WELL AT: 12. GROUTING INFORMATION Neat Cement Bentonite 3010 BAGS 4849 UNIVERSITY AVE. N . , FRI DLEY, MN . OK 20 Grout materiaPRTLAND 1`46gJR ft, cu. yds NEAT GROUT WATER LEVEL IN THE ABOVE WELL: 34' — ATE WATER LEVEL WAS TAKEN: 5-12-46 13.170 NgUST SOURCES OF CONTAMINATION feet E direction CITY 88"R 101111 type Well disinfected before sealing? XYes 14. PUMP 0 Removed ANot Present Type: ILI Submersible 30 L.S. Turbine 50 Reciprocating 20 Jet 40 Centrifugal 60 JULd U L 1J3� -• SEALED,17. 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or an back.) Other unused wells) on property? 0 YesNo Abandoned: 0 Permanent 0 Temporary 0 of sealed WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. According to -MN State Regulations 11-H. RENNER & SO INC. 71015 159ttleQJ'A"Ble ST. N.T+b'i:e.s. No. AddrIVE .55330 427-6100 ��� Signed to 7-2-91 STEVE L D Date 7-2-91 Mame of Qtiller FFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) XJ PCRrAMr: FZZJ WXrli DMW GREG/KEVIN HOPPE CI7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 February 28, 1992 Mr. Kendy Parker 4000 Main Street NE Fridley, MN 55421 Re: Wood Burning Boiler in Accessory Building Dear Mr. Parker: This is in reply to our telephone conversation of February 24, 1992. You asked if it would be possible to build an accessory building in the rear yard and install a wood burning boiler in this building and pipe the heat into the home for supplemental heat. It appears that this would meet the City Zoning Code as buildings of less than 240 square feet can be constructed but the total area of all the buildings can not exceed 25 percent of the area of the lot. We would need a rough sketch of the building, with a list of materials, and also a plot plan showing where all of the buildings, including sizes, are located on the lot. Please feel free to contact me at 571-3450 if you require more information. Sincerely, r Z�4* - CLYA WILEY Building/Mechanic 1 Inspector CW/mh COUNTY OF ANOKA Public Services Division HIGHWAY DEPARTMENT 1440 BUNKER LAKE BLVD. N.W., ANDOVER, MINNESOTA 55304-4005 (763) 862-4200 FAX (763) 862-4201 1.� 3 X Kendy Parker May, 16 2001 4000 Main St. NE f ! ^�. Fridley, Mn. 55421 .L r V� Re: Driveway Re est ! endo. We have reviewed your request for a residential entrance and offer the following comments. A driveway where you requested as per your drawing will be allowed for the purpose of a residential access, providing that you have approval from the City of Fridley and meet all of their requirements. The Anoka County Driveway Policy allows for one access per parcel. The maximum width of a residential driveway on the Anoka County Highway System is 22 feet. Typically a residential access is 12 to 14 feet in width. An Anoka County Highway Department Residential Access Permit must be obtained prior to construction. There is a $60.00 processing fee for this permit, which is to be paid at time of issuance. Contact Roger Butler, Traffic Engineering Coordinator for this permit and for any further information regarding the permit process. We also require you to notify us upon commencement of your project. This will enable us to put up a temporary `Double Arrow' sign until a permanent one can be installed. Anoka County is currently developing a policy on the installation of mailboxes adjacent to County Highways. Any mailbox installed for this parcel should meet the attached specifications. Anoka County has a policy forbidding any obstructions within the County Right of Way, such as retaining walls, head rocks, post, or anything that creates a hazard within the County R/W. Feel free to contact Roger Butler or me if you have any questions. Sincere Dick Martin Traffic Engineering Technician Xc: City of Fridley, Planning Dept. Josie Scott, Permit Tech. ACHD Driveway file, CSAH 2 Affirmative Action / Equal Opportunity Employer ' 1�2v�� ^���� � �r l� � V' —7(n -!''"07!o y `Jr eve �/a V►Gtn t/0 9M a �vl l� o� MN��I y°� T �.�N r �'�0 �vmM Pry! 1 rvt� so,,fil TO � , DATA V�'j Cove ccf n" Lrf LL F--�, , l &t,5 �w Move- '13rt souk r Cw;11 st;11 F2crq�f'ik �aQ'lfd� Pro foier) New l0� w;d 110 (lain -P .-TA • r . 1�O�� �1 —o GREIF R OS. CONTA ERS MAIL BOX SUPPORT STEEL PIPE WITH FITTINGS AND STEEL FENCE POST ROADWAY VIEW 1 /4' x 1-1 4' x 5' PIPE/POST CONNECTION „�„,L�,,-- 1 VN` DRILL 5/16" DIA. HOLES FOR l/4" DIA. CARRIAGE BOLTS ALL MA MRIALS SHALL 13E GALVANZED PER 5PEC. 3392 THE MAILBOX TO BE 8 TO 12 INCHES OUTSIDE THE EDGE OF SHOULDER OR 6 TO 12 INCHES FROM FACE OF CURB. NEW [ ] ADDN [ ] ALTER [ ] ConstructionAddress: 9 i Effective 1/1/98 CITY OF FRIDLEY N�1� ,r� N SINGLE FAMILY AND DUPLEXES R-1 AND R -k � (N BUILDING PERMIT APPLICATION Legal Description: -5o . asrt r i1 I of L& -1- " to s 5 Owner Name & Address: k,Q,yl; 'To U C�� 4� em ; 4C (i1c� Tel. # - 3 �7 6 ContractonGrz rrc�aq C LQ. y - MN LICENSE #a'of _ 0 (p O C5 (':! Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT Length Length_ Length Width Width Width Driveway Curb Cut Width Needed: Ft. + 6 Ft = Height Height Hgt/Ground Tel. # It Sq. Ft. Sq. Ft. Sq. Ft. = 019 YX Estimated Cost: $ 0 a l b (Fee Schedule on Back) Ft x $ = $ DATE: 0 - 9 - cl APPLICANT: �P �4 u— CG- r Tel. # Permit Fee $ 7� Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ ;Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 1 /. �c STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] SUBJECT City of Fridley 2 8572 572� = THE TWINS BUILDING PERMIT RECEIPT NO. � fr .......COMMUNITY DEVELOPMENT DIV. i PROTECTIVE INSPECTION SEC. E 1 NUMBER REV OTE PAGE OF APPROVED By E _ o"'1 CITY HALL FRIDLEY 55432 612-571-3450 910415 11 /13/98 JOB ADDRESS 4000 Main Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. t,1,Par.6 I Auditor's Subdivision #39 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kendy & Joyce Parker 788-3678 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW [Rx ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 24' x 24' garage 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. 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 CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,944 $5.47 DOES NOT PRESUME TO GIVE 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 $174.75 Fi a SC $10.94 PLAN CHECK FEE AL FEE X191.16 Si AE OF CON'aACTO110 R AUTMOTaiZED AGENT i0ATE0� HE IP VA A D THIS ISIYFIP IT SQGN�O�OwNE A, NEp Bu4DEAi i TEi BE -NSP PATE SUBJECT P T O. N3 City of Fridley 1 8 3 0 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. 16 � • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��® 3�4 NUMBER REV DATE PAGE OF APPROVED BY i ��"'f;'� CITY HALL FRIDLEY '55432 -__•� L 612-571-3450 910-F15 5/17/01 JOB ADDRESS 4000 Main Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 1 arcel 60 Auditor's Sub. #39 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kendy Parker 4000 Main Street NE 763-706-9526 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW Q ADDITION ❑ ALTERATION O REPAIR X ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (20 Sq House) Tear -off, 8 Sq Garage, 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Roofing can be the 2nd layer but not the 3rd. TYPE OFCONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12Q DAYS AT ANY TIME AFTER WORK IS COMMENCED. ` NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 9E COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,660 $1.33 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $2.66 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $8.3.25 PLAN CHECK FEE TOTALFEE $87.24 SiGNA UPE OF CO "RAC G R AUT ZED AGENT JDATEi H N PR CY VALIDAT THIS IS YOUR PERMIT / SYNATURE OF OW E i6 OWNER BU4DERi tDATEi G iN gAtE NEW [] ADDN [] ALTER [ ] Construction Address: Legal Description: _M. Owner Name & Address: Effective 1/1/2001 CITY OF FRIDLEY (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION lvalo G Ol� -�_L Tel. # Contractor: -e-"r MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length— Width Hgt/Ground Sq. Ft. OTHER: 0 ;,f r��f � ���fs✓� �- G G!V Gaye v 1W) lawJPir' Construction Type: Estimated Cost: $ 1-i 4 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 41,14 17 0/ APPLICANT: �. G� c,�, G > Tel. # V7Ce CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ V5.2Fee Schedule on Reverse Side Fire Surcharge $ (-o .001 of Permit Valuation (1/10th%) State Surcharge $ 1 t �2 5 $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 7 t Z;� STIPULATIONS: G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 May 17, 2001 PWO1-023 Ms. Jane Pemble, PE Anoka County Traffic Engineer Anoka County Highway Department 1440 Bunker Lake Blvd NW Andover, MN 55304 Subject: 4000 Main Street Driveway Opening Relocation Dear Ms. Pemble: The City of Fridley has reviewed the site of the proposed driveway relocation. The City does not object to the work as long as City utilities are not impacted and the driveway location complies with City ordinances. If you have any questions or concerns, please call me at 763-572-3551. Sincerely, Layne Otteson Assistant Public Works Director LO:cz CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Fee Total l Owner u� $35.00 $ Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater ESTIMATED COST PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNE $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) Warm Air) Trade Name Size No. $25.00 $ l BTU 'ILI HP EDR Fuel Total Connected Load $ Burner Trade Name BTU Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge $ REINSPECTION FEE $50.00/HOUR HP Size No. EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. - � 1►111 TOTAL.W--=11 1 - FAX #i i1 i Vii.. .. *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETED' FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes ( No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer Length ft to meet the current codes and manufacturer's specifications. Yes` specifications including sizing, length, number of elbows and termination. Yes () No� The undersigned also verifies that the replacement unit is a listed assembly Type specifications. This does include AGA-GAMA Category I Central Furnace and meets the current codes and manufacturer's specifications. This does Venting Tables for fan assisted and natural draft appliances. Yes ( ) N� include AGA-GAMA Category I Central Furnace Venting Tables for fan an appliance has been removed from the common vent and vented assisted and natural draft appliances. Ye No No ( ) The existina combustion air is sized and installed to meet the current codes ��'r" '7b llh and manufacturer's specifications. Yes( N&k When required to install a new combustion air, it will be sized and installed Length ft to meet the current codes and manufacturer's specifications. Yes` No ( ) When installing a new venting system, the undersigned hereby verifies that Length t ft it is a listed assembly and meets the current codes and manufacturer's Type specifications. This does include AGA-GAMA Category I Central Furnace Length ft Venting Tables for fan assisted and natural draft appliances. Yes ( ) N� Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes ( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information ��'r" '7b llh Appliance #1 Type BTU Input Fan Assisted or Nat 1 Appliance #2 Type l, -14l BTU Input 's Fan Assisted or Nat A/4+, Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Taal Btu Input Common Vent Type 3 Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter n Type Appliance #2 Vent Connector Height ft Length t ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Cc, I i Date CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE V FRIDLEY, MN 55432 571-36U4 YAX: ADDRESS : 4000 MAIN ST NE PIN : 343024410029 LEGAL DESC : UNAVAILABLE : LOT BLOCK. PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 1,000.00 APPLICANT PARKER KENDY & JOYCE 4000 MAIN ST NE FRIDLEY, MN 55421 OWNER PARKER KENDY & JOYCE 4000 MAIN ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or g16tha Vri sof any other state or local law regulating , Wperf9finance of cogsguctlp?W Bldg 571-1287 PERMIT NO.: 2004-02233 DATE ISSUED: 12/02/2004 BUILDING PERMIT FEE 38.75 FIRE SURCHARGE 1.00 STATE SURCHARGE, VALUE 0.50 TOTAL 40.25 PAID WITH CHECK # MASTER SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [J ADDN [] ALTER Construction Address:yo Legal Description: CITY OF FRIULL-Y tHecuve 4r uzuu4 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Owner Name & Address: eff1/lao r',PI^�R4pr Tel. #_A:;- 3 --®!0 7 7'nt Contractor. ® W V__ MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale.. DESCRIPTION OF IMPROVEMENT ' LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: fie ao&� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: C a ® APPLICANT: Tel. # -,;?63 2 Q `_� 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 TOTAL i $ Fee Schedule on Reverse Side $ 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1350 per SAC Unit .$ $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 [ ] $ D J� STIPULATIONS: .c9.11,t�lRxo NW II Mev 55303 LOW NEW [ ] CITY OF FRIDLEY ADDN 6431 University Ave NE, Fridley, MN 55432 (763) 5#'2-360 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: Y%i®D Aa i vi S Al Legal Description: Owner Name & Address: �il� �` /da�r�Gt .,�/� re s-ah Tel. # YSiR - EYE • 97r30" Contractor: T MN LICENSE # Aririrpcc % 9.�� — .�%® • .fcPl/�'�l�✓t/ ��� �7 Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Lengthy Width js- Height/� Sq. Ft d DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: Me, a c1 1�Grol �` t I.P A Estimated Cost: $ c�� 35^y /_ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: q - l 9, ®S APPLICANT: _T A S er v i't- es / A-Oql1 lS Tel. # egg `,740 ff3g' 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 TOTAL 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. " W Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: �.. �-0 � raj\ Q ��° � �