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PRE 2010 DOCSMEMO FROM: RICHARD N. SOBIECH Public Works Director SUBJECT: ❑' See attached MEMO NO. TC 151 DATE 7-17-75 REPORT BY: 7-24-75 Fitting in o f Low Axea South o4 M,iAa"aippi Stceet ❑ Review & take appro- priate action ❑'JC Review & comment ❑ Note & discuss with me ❑ Work with f— Rush, immediate action desired REMARKS: There hp been 4U placed an pjiapeniez aj 1340 a 135k Mis.a. 6.6ippi Street; .th" is the area into which the out$a t goer,. Check into the .6 ttuWon and contact the tcu iddents and .indicate to them. any 6itX,i ng wilt have to be OK'd by the City. Make reports, w/background material as complete as poss- ible. oss- COMMENTS: i bl e. Make interim report if c�ra.a D necessary. CD � Action completed, no z further review needed ❑ Further action necessary ❑ See attached letter ❑ Interim report o-����20 a'4�.. DATE: -712: L1;tS— SIGNATURE SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. i �• COMMUNITY DEVELOPMENT DIV. ______ PROTECTIVE INSPECTION SEC , NUMBER REV DATE PAGE OF APPROVED BY /�"1 CITY HALL FRIDLEY 55432 �---- �" ��' 612-571-3450 910-F15 4/4/97 JOB ADDRESS 1340 Mississippi Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 Spring Valley Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Russell Prior 1340 Mississippi Street NE 571-4364 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 ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE x❑ B DESCRIBE WORK Reroof House & Garage (27 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 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 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2 227 1.12 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 Fire SC $2.23 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 8.10 SIGNATURE OF CONTRACCTOORROORAUTHORIZED AGENT IDATEI N P OPE ALID T THIS IS YOU P R T / TNATUREOFpWNERiIFO NE ILDERI (DATEI LDG INSP r)ATE NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATIONf-� . _ _,— ConstructionAddres s : Legal Description: _ Owner Name & Addr Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: ��(J /• 111 �.: ' _Tel. # LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EUPROVEM ENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. ,Ft. Driveway. Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ S� (Fee Schedule on Back) Ft x $ =$ DATE: APPLICANT: Tel. CITY USE ONLY 17499 Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 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 $ C • �%% STIPULATIONS: BUILDING 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 structure, or for any alteration or repair 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 the manner herein provided to -wit: TOTAL VALUE ;: FEES - $1 to $500 $21 (Minimum Fee is $21 _plus surcharge) $501 to $2,000 $21 for fust $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for fust $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1()0,-000 $100,001 to $500,000 $887.25,for;first.$100,000 plus $5-00 for, each additional $1,.0W or fraction: thereof, to and including .$500,000, . {, T 1r,♦ .. 1 `F. i.J4 $500,001 to $1,000,000 $2887 25 forahe fust$500,000rplus. $4 25 for each additional.- $1, 000.or:fractton:thereof to and includuig $1;000;000 $1,000,001 and up $5012.25 for the fust $1,000,000 plus $2:75 for each additional $4000 or fraction thereof DRIVEWAY DEPRESSION :ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install'a 3 foot wide approach with 6 inch depth -. Driveway , width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits 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 foundation once it has it has been constructed will be required before proceeding with the framing. HOUSE -HEATING TEST RECORD ADDRESS %A 7 Cs1 ��1� �ii�ao2 APT. OOR CITY SUBURB ' OCCUPANT AZ OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY Electrical Work- By4 '' Gas Line By TYPE OF HEAT GA FA HW L STEAM SPACE HTR. UNIT HTR. OTHE GAS DESIGNCONVERSIO MAKE MAKE OF BURNER. Model Model Serial Max. BTU Rating % 2 C INPUT MAKE OF FUR ACE Model CONTROLS THERMOSTAT M /4 Heat Plug Valve Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure 3 -6 - Percent CO - 2 Input CFH / F'Percent 02--L�z Stack Temp. Joe Percent�" --- Form 235 Vent Size KIND OF LINER NONE Draft Hood ®r RegulaTor Filters Size dumber Chimney Location Inside Outsi e Chimney Construction - Smoke Bomb Draft Wiring .Test Tag _rte Door Pressure Lighting Inst. Date Tested ' Company Testing Name of Tester WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring County Name WELL AND BORING SEALING RECORD Minnjesota Unique Well No. Minnesota Statutes, Chapter 1031 °�;tepe�s No. ,�nelfa H263598 P; j-OPERTY OWNER'S NAMEICOMPANY NAME CASING(S) Township Name Township No. Range No. Section No. Fraction (sm. Ig.) Date Sealed Date Well or Boring Constructed Frid e ods/Drop Pipe ❑ Check Valve(s) ❑ Debris E] Fill ❑ No Obstruction 10/10/07 Unknown COLOR HARDNESS OR FORMATION FROM GPS Latftude degrees_ minutes_ seconds Depth Before Sealing ft. Original Depth 19 ft. LOCATION: Longitude_ degrees_ m1hutes seconds AO ER(S) Single Aquifer ❑ Multiaquifer/ STATIC WATER LEVEL easured ❑ Estimated Date Measured 'J' 6 15 ft slow ❑ above land surface Numerical Street Address or Fire Number and City of Well or Boring Location 1340 Mississippi St ORING Water -Supply WeII ❑ Monit. Well ❑ Env. Bore Hole ❑ Other Show exact location of well or boring Sketch map of well or boring in section grid with °X" location, showing property N Ifnes, roads, and buildings. CASINGTYPE(S) 1 feel ❑ Plastic ❑ Tile ❑ Other WELLHEAD COMPLETION W E i ` Outside: Well House ❑ At Grade Inside: ❑Basement Onset Mile ' ❑ Pitiess Adapter/Untt ❑ Burled ❑ well Pit r — ❑ Buried 1 WRu Pit .R —1 Mile --I ❑ Other ce P; j-OPERTY OWNER'S NAMEICOMPANY NAME CASING(S) .Marge Prior Diameter Depth Set in oversize hole? Annular space initially grouted? 1,/ in from to� ft. ❑ Yes ,� ❑ Yes Pfvo ❑ Unknown Property o ner's mailing address if different than well location address Indicated above 15523 - 95th Circle NE Otsego, MN 55330 in. from to ft. ❑Yes ❑ No E] Yes ❑ No El Unknown , in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WELL OWNER'S NAME/COMPANY NAME Same Well owner's mailing address if different than property owner's address Indicated above SCREEN/OPEN HOLE Screen from 15 to--19_tt. Open Hole from OBSTR ONS ods/Drop Pipe ❑ Check Valve(s) ❑ Debris E] Fill ❑ No Obstruction Type of Obstructiona (Describe) Suction Pimp - - Obstructions removed? s ❑ No Describe GEOLOGICAL MATERIAL COLOR HARDNESS OR FORMATION FROM TO PUMP Type ❑ Removed of Present ❑ Other If not known, indicate estimated formation log from nearby well or boring. Sand Brown 0 20 C D USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: o Annular Space Exists ❑ Annular Space Grouted with Tremae Pipe ❑ Casing Perforation(Removal Fine Sand Gray 1.90- In. from to ft. ❑ Perforated ❑ Removed -60- Shakopee Doloyrfi-+- 90 2.11-5- In. from to ft. ❑ Perforated ❑ Removed Type of Perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement = 94 lbs., one bag of bentonite - 50 lbs.) / Grouting Material Neat Grout from 0 to 18 ft. yard§ Z bags from to fL yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes ❑ No How many? REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The Information contained in this report is true to the best of my knowledge. Geology From: 1314 Mississippi St Water Level in Above Well: 45' Date Water Level Taken: 03/22/1946 E.H. Renner &Sons, Inc. 1431 Contractor Business Name License orRegistration No. Unique 206665 10/23/07 Certill d e res Slgn Certified Rep. No. Date Kevin Scheiterlein LOCAL COPY H 263598 � � 5 � 8 Name of Person Sealing Well or Boring HE -01434-09 ICH 140.0423 6106R :r MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I (� (�7:�::] [�Sl (� WELL OR BORING LOCATION ng No. �1 V WELL AND BORING SEALING RECORD County Name MinnSealie ota Unique Well No. or W -series No. Anok-a Minnesota Statutes, Chapter 1031 n m i PR OW R'S NAME/COMPANY NAME Farr ` Township Name Township No. Range No. Section No. Fraction (sm. — Ig.) Date Sealed Date Well or Boring Constructed in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Fridley 1 30 23 1 13 , NW, SE 10/23/07 Unknown 15 15 GPS Latitude degrees_ minutes_ seconds Depth Before Sealing ft. Original Depth ft Type of Obstructions (Describe) LOCATION: Longitude_ degrees_ minutes_ seconds AQUIFER(S) STATIC WATER LEVEL COLOR gle Aquifer ❑ Muittaqu'rfer Qrl-asured ❑ Estimated Date Measured U Numerical Street Address or Fire Number and City of Well or Boring Location PUMP 1340 Mississippi St WELLBORING Sand Brow 2 L�MterSupply Well ❑ Monit Well 15 2 Show exact location of well or boring Sketch map of well or boring In section grid with "X." location, showing property F] Env. Bore Hole ❑ Other ft. -slow ❑ above land surface CASING TYPE(S) 6 19 N lines, roads, and buildings. E] Plastic El Tile ❑ Other I I I --i--- -- r-- ---h-- ---f-- ' WELLHEAD COMPLETION F$'O'L .Outside: ❑ Well House ❑ At Grade Inside: E] Basement Offset W EI tIMileess Adapter/Unk ;? uded Well Pit ❑Pik ! ❑ ❑ Buried i—Kwan vn S F 1 Mile I u ❑ Other ❑ Other PR OW R'S NAME/COMPANY NAME Farr ` CASING(S) Marge nor g Diagtqr Depth Set in oversize hole? Annular space initially grouted? 1 �- 4 In. from to 12 ft. ❑ Yes LAORo ❑ Yes eNo ❑ Unknown Property owner's malling address k different than well location address Indicated above 15523-95 Ih Circle NE Otsego, MN 55330 in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown In. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WE OWNER'S NAME/COMPANY NAME ammailing SCREEN/OPEN HOLE Screen from 12 to,15 ft. Open Hole from to ft. Well address it different than property owner's address Indicated above OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill o Obstruction Type of Obstructions (Describe) Obstructions removed? ❑ Yes ❑ No Describe GEOLOGICAL MATERIAL COLOR HARDNESS OR FORMATION I FROM TO PUMP If not (mown, Indicate estimated formation log from nearby well or boring. Sand Brow 2 TWO ❑ Removed Not Presets ❑ Other Clay Brow 2 6 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: Fine Sand Gra 6 19 No Annular Space Exists ❑ Annular Space Grouted with Tremfe Pipe ❑ Casing Perforation/Removal In. from to ft. ❑ Perforated ❑ Removed Shakopee Dolomite 19 21 In. from to ft. ❑Perforated ❑Removed Jordan Sandsto Type of Perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement - 94 lbs., one be of bentonfte - 50 Ibs.) Neat Grout 0 1 ! V2 Grouting Material from to ft yards bags from tc ft_ yards bags from to ftyards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes No How many? REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The Information contained in this report Geology From: 1314 Mississippi St Water Level in Above Well: 45' Is true to the beat of my knowledge. E.H. Renner & Sons, Inc. 1431 Date Water Level Taken: 03/22/1946 Liven Name License or Registration No. Unique 206665 10/23/07 Certified Represen five Signature Certified Rep. No. Date Kevin Scheiterlein LOCAL COPY H 26520 Name of Person Sealing Well or Boring HE -01434-10 IC# 140-0423 5 o7R