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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° 6706 Date: Owner: Builder a Address Address LOCAT N F UILDING No. Street �____ Part of Lot Lot --- _ Block Addition or Sub -Division . Corner Lot _ Inside Lot !� Setback i""�� _ Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING U / c g Front Depth Height Sq. Ft. /"�L Cu. Ft ! Front Depth ( Height Z16 Sq. Ft.._. Cu. Type of ctio _ Fst. `moo 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of S�-� permit is hereby granted to to construct the building or addition as described above. This permit 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 ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon vi tion of any of the provisions of said ordinances, r' l Building Inspector NOTICE. iib pemb doss not corer the construction, hast ffiWon for wiring, phmnbing, gas hosting, sewer or water. Be sure to no the Building hopector for separate permits for these home. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No. Street2zvPart of Lot Lot Block ' Addition or Subdivision`s Corner Lot Inside Lot Setback 41-0 Side Yard SEWER ELEVATION FOUNDATION ELEVATION F Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front s P Depth 7, Height /,6 q l� Cu . Ft . % S Ft. Front f Depth Height Sq. Ft. 7w Cu. Ft._ Of 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). 4 Appticarion for Power Plants and:. Heating. Cooling, Ventilation, Re%igeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $— each add. 60,000 BTU ... .................. 2.00 $ _ Replacement of Furnace . €§.00 $ Repairs & Alterations—up to $500.00 ... ` ............ 5.00 $ Repairs & Alterations each add. $500.00 .......:....... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 Furnace Shell & Line—to 640 sa. ft. EDR Hot Water Each add. 200 sq. ft. EDR _Steam ...................... teach add. 320 sq. ft. EDR Hot Water .................. 1 = . OIL BURNER—to 3 gal. per hour' ......................... to over 3 gal. per dour=See Fee Schedule GAS BURNER (up to 400,060_BTU) ...................... GAS FITTING FEES: 1st 3 Fixtures ......,................ Additional Fixtures :................. Gas Range to 200,000 BTU ........... AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL 8.00 2.50 2.50 5.00 $ 5.00 $ - , d NO RATE TOTAL _ x $1.50 .$ _ x .50 $ _ x 2.00 . $ See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone SII, 4-7470 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of Building Used as To be completed about Estimated Cost, $ �.� g Qjp�---New. Building Permit No. e�P 7 0 Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS ---Steam, of Water, arm Air—No. Trade Name m ! e ki e No- E (B W Capacity ®® � BTU H.P. Total Connected Load. Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. EM.R BTU H.P. (REMARKS—OVER) Signed al=" " -i 4 By 4::::n ..W 424' 7-59 Business Phone No-�A ®� R®BERTS-HAMILTON COMPANY HEAT LOSS CALCULATIONS Weatherstrips A.S.H.V.E. Construction No. Guide Windows Ijjnt.Wall - Doors Reference Out. Wall I Ceiling I Roof I Floor Yes --No es --No 19 MINNEAPOLIS. MINN. Insulation Kind I How Applied _ Fl Room I Length Zcf_'_Width /.I -%eight F1.1 6SIg Room W' d D s—Crarka a and AreaI a Windows and Doors - m ows an oor Width Height g No. of Lineal ft. Z Area C Width No. of pane LIZ lights of crack sq. ft. 2 t 1 No. of pane do ^ rn- Glass D/ s, -n 2-,,D ...�-7 Exp. wall 2 Z ire I I -a_�_s 1,0 Windows and Doors—Crackage and Area g� ► e a �2 Glass1� WidthHeight No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft 2-Z� / Coef. Btu Infiltration b do ^ rn- Glass . J: s, -n ? ®® Exp. wall L Glass Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Net exp. wall fF ®, 1,0 77 A - Int. wall Net. exp. wall Z®� Required sq. ft. E.D.R. or sq.ins.W.A. Leader area Net exp. wall -I 3 Ian Ceil.or floor Int. wall /In 4 ®fl Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area SI -0 P -71m Windows and Doors—Crackage and Area g� ► e a �2 Glass1� WidthHeight No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft 2-Z� / Exp. wall to 3,4 o Int. wall Net exp. wall Coef. Btu Infiltration Total Btu. 7-3-pC, Required sq.ft. E.D.R. or. sq. ins. W.A. Leader area L Glass Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Total Btu. Exp. wall Reauired sa. ft. E.D.R. or sa.ina: W.A. Leader area Net. exp. wall Z®� Required sq. ft. E.D.R. or sq.ins.W.A. Leader area Net exp. wall -I 3 Ian Int. wall Ceil. or A pmw P -71m rm-fl nr Qcm-v Total Btu. Required sq, ft. E.D.R. or sq. ins. W.A. Leader area FLI Room I Length &f -Width `/ p Height Windows and Doors—Crackage and Area `� 4 - of Width Height No. of Lineal ft. Area No. of pane I of pane I lights of crack sq. ft. a z� .3-� 1 �a 22, Coef.I Btu Infiltration I / E Glass Glass1� Exp. wall Width Height No oC Uneal ft. Area No. of pane of pane lights of crack sq. ft. Exp. wall to 3,4 o Int. wall Net exp. wall . Int. wall 3,1 om Total Btu. 7-3-pC, Required sq.ft. E.D.R. or. sq. ins. W.A. Leader area Fl. Room I Length l LAP—Width !S Ceil. or !fir , Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Total Btu. e2 n Reauired sa. ft. E.D.R. or sa.ina: W.A. Leader area Net. exp. wall Z®� Width Height dr"- ge and Area .S, f Coef.I Btu Infiltration tfG "-J/ 1 1, / E Glass Infiltration Exp. wall Width Height No oC Uneal ft. Area No. of pane of pane lights of crack sq. ft. Net exp. wall� to 3,4 o Int. wall Exp. wall Coef. Ceil. orlam- .�� 3,1 om Total Btu. 7-3-pC, Required sq.ft. E.D.R. or. sq. ins. W.A. Leader area Fl. Room I Length l LAP—Width !S ® Height 6 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft I I I I JCoef. Btu Infiltration Width Height No oC Uneal ft. Area No. of pane of pane lights of crack sq. ft. Glass 0,0 Exp. wall Coef. Net exp. wall Infiltration` o Int. wall .0 Glass �F Ceil. or flffor- e2 n Total Btu. Net. exp. wall Z®� Required sq. ft. E.D.R. or sq.ins.W.A. Leader area ' -I I . ., wr. ,_, i o r ■ , _ a'a.H%/'62' awtaaaa I a..caagtaa , w auaaa ...Y - a aaaguc Windows and Doors—Crackage and Area Width Height No oC Uneal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration` .0 Glass �F Exp. wall Net. exp. wall Z®� Int. wall Ceil. or A pmw P -71m Total Btu. -4 n� L- : � _ I * G_ Reauired so. ft. E.D.R. or so. ins. W.A. Leader are" I��f � I I I I I Coef. Btu Infiltration G K` ROBERTS-HAMILTON COMPANY Exp. wall HEAT LOSS CALCULATIONS Net exp. wall - MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E. Construction No. Ceil.or mer- Glass Insulation Ile Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Guide Reference Out. WallI Int. Wall I Ceiling I Roof 1__Eloor Kind How Applied Windows Doors I n 0, f Yes—No I'Ve-9--No 19 I F1.I On, Room I Length 2 C Width lr, ' Height Windows and Doors--Crackage and Area Width Height No, of I Lineal ft. Area No. of Dane of Dane lights of crack sq. fL ,,,1,' I Fl i -f Room I Length 1:�, Width le- Height .I i12, F1.I Room I Length I � t Width QVHeight Windows and Doors—Crackage and Area lyi' _ Windows and Doors—Crackage and Area � Width Height Nn. of Lineal tt. Area No. of pane of pane lights of crack �. ft. 7 Width Height No of No. of pane of pane lights Lineal ft. Area of crack sq. ft. R X� -5� 1 � 2,2— I I I I I Coef. Btu Infiltration G Glass Width Height No. of Lineal ft. Area No. ofpane of pa/n/e lights of crack sq. ft Exp. wall loft Net exp. wall - Int. wall Coef. Btu Infiltration ILI Ceil.or mer- Glass Total Btu. Ile Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.1 / "oom I Length 12, _ Width j ` Height Windows and Doors—Crackage and Area �O - 1 N �1�t Width Height No. of Lineal ft. Area No. ofpane of pa/n/e lights of crack sq. ft f- I on Glass c Coef. Btu Infiltration ILI 16 L Glass Net exp. wall Ile Exp. wall 14 � - Int. wall Net exp. wall Int. wall t Net. exp. wall rt-;] nr F_%at Geil._m floor Total Btu. n 0, f Total Btu. I -,, I P , Required sq. ft. E.D.R. orsq. ins. W.A. Leader area ,j,F1.I t . Room I Length _41'� Width JZ -"i Height 1e:_ Windows and Doors—Crackage and Area y� r Width Height No. of Lineal ft. Area 2 s! No. of pane VIZlights of crack I sq. ft. 1 Coef.I Btu Infiltration cf-* Glass ®® Exp. wall Net exp. wall 2 �¢ f Int. wall I Geigy: or floors ` IL Total Btu. 13.1.4 eauired sa. ft. E.D.R. or ea. ins. W. A. Leader area I I I I JCoef. Btu Infiltration Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft. f- I on Glass c 11,00 Exp. wall ILI Net exp. wall Glass 00 14 � - Int. wall Exp. wall Net. exp. wall Geil._m floor Total Btu. 15,0 2�P 1z Required sq. ft. E.D.R. or. sq. ins. W.A. Leader area I F1.I On, Room I Length 2 C Width lr, ' Height Windows and Doors--Crackage and Area Width Height No, of I Lineal ft. Area No. of Dane of Dane lights of crack sq. fL ,,,1,' I I I I I JCoef. Btu Infiltration Lf, -o Z. 0 On Glass Exp. wall Net exp. wall 1W /c:� &fo Int. wall Ceil. or floor TJ 31 r Total Btu. Required sq. ft. E.D.R. or sq. ins.W.A. Leader area i� Fl.l � Room I Length ;? ?,--Width , P' -Height ' �n Windows a d Doors —Crack age and Area �' 4 - Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft. I I 10 Coef. Btu Infiltration Glass to 4O f d� Exp. wall Net. exp. wall Int. wall 2�P L, 1S_S7:o Ce Lar -floor SQL 1 0 Total Btu. d 1"<-/ � Reauired sa. ft. E.D.R. or sq. ins. W.A. Leader area I T- R®BERTB-HAMILTON COMPANY HEAT LOSS CALCULATIONS Weatherstrips A.S.H.V.E. Guide Reference Out. Wall 19 Construction No. I Int. Wall I Ceiling I Roof 1__Eloor Kind Insulation How Applied WindowsI Doors Exp. wall I Yes—No Yes --No F1.1 Room I Length 2idth 1 z ®Height Net exp. wall Fl.1 Room I Length Width Height Windows ancVDoors—Crackage and Area Width Height No. of Lineal. Area _ I 1 �' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area wr_ ..c .....,_ ..r ......_e.e..4 ... h No. Coef.I Btu Infiltration I Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 1 2-0 Glass Coef. Btu Exp. wall Glass Net exp. wall Net exp. wall Int. wall �® Ceil_ or floor Ceil or floor Total Btu. �1 s Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area N.. r f -- of Ltl lights of crack so. ft Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceil. or floor Total Btu. Required sq, ft. E.D.R. orsq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane I of pane I lights of crack sq. ft. Coef.I Btu Infiltration I Glass Exp. wall Net exp. wall Int. wall Ceil. or floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area -56 1,5,7-e / = 73; 7 a .f i3, i. c>, Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceil. or floor Total Btu. Required sq. ft. E.D.R. or. sq. ins. W.A. Leader area FIA Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp, wall Net exp. wall Int. wall Ceil_ or floor Total Btu. Required sq. ft. E.D.R. or sq. ins.W.A. Leader area Fl.1 Room I Length Width Height Windows and Doors—Crackage and Area Width I Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net. exp. wall Int. wall Ceil. or floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ;k €- G - r3 60 = 9�, moo f3 r(-) A1..0-:7- Z 13, t City of Fridley Application for Plumbing cmd Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Loc l n �la PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: - RATE TOTAL Number Fixtures ................... /ANO: J x $1.50 $ ®t ®® Future Fixture Opening ................ x �U' �U' aU' eU' F W WATER HTR. GAS ELEC x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ O S < °d $ O GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Base 1st 2nd _ 3rd 4th ' Future Connection Openings Connected with I Sewer New .Fixture, Old Openings Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: - RATE TOTAL Number Fixtures ................... /ANO: J x $1.50 $ ®t ®® Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................... ..... .....$ TOTAL FEE • ® V City of Fridley: The undersigned hereby makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minns —19A3 Owner Kind of Building u Used as To be completed about X6'4 Estimated Cost, $ C, 40—New. Building Permit No. Permit No. ck 4 Signe f G� By a Business Phone No -- ROUG14 FINAL u 560-3450 Gey O/ 7rijley ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55432 CITY OF FRIDLEY AGREEMENT Permission to reslope bank in preparation for fence installation. As per our conversation on September 3, 1974, it was agreed the City of Fridley would be permitted to reslope and seed the westerly portion of your property adjacent to and in preparation for construction of a 4 foot cyclone fence on city park property. RONALD E. HOLDEN Engineering Dept. City of Fridley C RENCE R. OLSON 1660 Mississippi St. PROPERTY OWNER ❑ ED \J ED L�J CM LO t*" co Lo CN CO Mr. Clarence R. Olson 1660 Mississippi Street N.E. 13 Fridley, Minnesota 55432 I'll., W W i [i January 17, 1974 Re: Proposed Screening and Fencing Provided on the West Side of Your Property if Lot 1, Block 1, Harris Lake Estates is Also Taken for Park Purposes Dear Mr. Olson: This is to confirm the telephone conversation we had yesterday in which I indicated that we will be submitting to you a layout out- lining the proposed development of the park, along with the possible fencing and screening the City can do to give protection to your property. As shown on the attached map, we will be providing a four foot metal fence along with some planting and vines. You indicated on the telephone that this seemed to be a reasonable offer by the City, and you are amiable to it. If you find the proposed protection satisfactory to you, would you please sign on the map that the layout is agreed to by you and your wife, and send one of the maps back to us. We will then submit this report to the City Council and get their authorization so we can start this work next spring soon after the storm sewer construction is complete in the area. I certainly appreciate the spirit of cooperation you have shown. Certainly the City wants to provide a playgound area for the neighbor- hood, but we also want to be concerned about adjoining homeowners and provide them as much protection as possible for the safe enjoyment of their properties. Thank you so much for your cooperation. NMQ/ms CC: Councilman Starti,;alt Park and Recreation Director. Planning Assistant Assistant Engineer Enc. map Very truly yours, NASIM M. QURESHI City Manager O. . , t V:0 -41 19 MFv7Q! W�; ,:-P ; I A. MIX Isms, red nt A w ON!, UR - WE* ME "if mf /sma •dTaq anoA ao3 no,& xuegy •ud'TIBTTs4suT aoua3 ORI ao3 uoTIsSTTgo uv anEg saop 6aTPTa3 aouTs 'gsanbaa sTgi 30 uoT4saapTsuoo anoA 94vTo9adds pTnoM I •uoTIaTTBlsuT aoua3 ago 103 aTgvTTvAV aq pTnOA saTuom 3T auTmaa39p o-4 9L61-PTm TT:Iun 3TVA of SuTog aaam aM •9L6T uT a3ua3 9q3 30 uoTIETTE3suT a03 pa3492pnq Baan saTuom alrTadoadds 3T MouN iaupTp Aagl palspTouT ogre 3aagTgsa 3an0 puE 33ng u'ea q:ITn uoT3sngTs sTgi passna -STP ansq I • auTT A:jaadoad alp 2uoTs aoua3 auoToAo ggTq '7 u tTB4suT of sVA ALTO aq3 `VL61 uT quamaaage TEnjnm q$noagy Nava s91'eIs8 93E$Z sTaasg 30 BUTT S aadoad &Taa:lse9 ZIP osTs ST goTgm BUTT Slaadoad ATaalsam sTg SUoTV 80ua3 s 30 uoTIuTTEIsuT 2uTp2E382 am g3TM IORWOo uT uaoq seq 'ULE-LZ8 °uosTO aouaxeTO •a11 uoT:Ismao3uT anoA aol �19 TddTssTssTN 099T `uosTO aauaasTO ao3 SuToua3 uoarans MT `8Z XTnf :31va j204091TU sXaoM aTTgnd `goaTgoS AoTa ll N 401a9aTa uoTIsaaoag I 93iasa lnEaapnog xong0 STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL 1. LOCATION OF CORP WELL NIj1!U0TA UNIQUE WELL N0. cointy a Anoka (fears blank if not known) Townabip Name Township Number ,allege Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed Fridley , — __E 13 SEk StOINE' 55 it- 1-23-92 W ` N cal Street Add*, and City of Well Location or Dist a from Road S. DRILLING METHOD (if known) Intersection 1® Cable tool 40 Reverse 70 Driven 100 Dug 1668 MiztiSsippl St., Fridley 20HollowRod 50Air 110 Bored 110___ ex i location of well 30 Rotary 40 Jetted a Power Auger (1 Section grid with 'X') Sketch ll location N 6. OBSTRUCTIONS W Well obstructed L.4 Yes [] No Obstructions nmavad 93 Yes (3 No If obstructions cannot be 42' 1" d.p. & pkr jet rmvw�a� act E MDN f 7. USE T We. 1® Domestic (3Monitoring so Meat Loop I 213 Irrigation 0 Public 10 Industry _ 1 30 Test Well In Municipal 100 Comas i i ►---1 wild --ted 2. PROPERTY OWNER'S NAME Meiling Address if different then property address indicated above larence Olson 1660 Mississippi St. Fridley, MN 55432 HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known. indicate formation log from new well or nearby well. 16. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS RENGVED. CASINGS PERFORATED, ETC. T IFFICLAL ABANDONED WELL RECORD (May be used for Property Transfer) ZRPCRMWS F= am now rc a 70 Air Conditioning 110 G. CASINOS) Ila Black 4M Threaded 70 20 Gals. • SO Welded 313 Plastic 613 Stainless Steel ?�� In. to50 —ft. in. to _�ft. 9. SCAEEN ® Streeaed well -from '50 ft. to 51 .ft. !' (It known) 0 Open Role fm — ft. to ft. 30. STAT7C.NAM LEVEL 4yy ft. (XJ below C3above land surface Date Measured 1-23-92 11. WELLHEAD COMPLETION 10 Pltless Adapter 40 Found Buried 213 Basement offset d-1 30 Well Pit 12. GR ING INFORMATION 1(3 Neat CemsatBentealto Grout material Nt .M 30 ilt from5 to 55 it. cu. yds i 13. U44W $OURCESAF CONTANiRATION — OO feet JE di,ectino buried sewer type Well disinfected before saltag? [j Tea p i pe in f loo 14. PUMP ® Removed 0 Not present Type: 10 Submersible 30 L.S. Turbine a Reciprocating 2M Jet 40 Catriftgalr 60 15. EXISTING WELLS (Please sketch locations Of abandoned and active we11s•in remarks section or an back.) Other unused wali(a) on property? O Yes ® No Abandoneds IN Permanent 0 Temporary (3 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under cy Jurisdiction and this report is true to the best of my knowledge and belief. Mork Well Co., Inc. 02133 Licensee Business an License No. Add ve no a, 5 S igned pste 1- 4-9.2 Ron Wison ate - - Ramb of Miles, 303 Iwo mum ®®®® Well obstructed L.4 Yes [] No Obstructions nmavad 93 Yes (3 No If obstructions cannot be 42' 1" d.p. & pkr jet rmvw�a� act E MDN f 7. USE T We. 1® Domestic (3Monitoring so Meat Loop I 213 Irrigation 0 Public 10 Industry _ 1 30 Test Well In Municipal 100 Comas i i ►---1 wild --ted 2. PROPERTY OWNER'S NAME Meiling Address if different then property address indicated above larence Olson 1660 Mississippi St. Fridley, MN 55432 HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known. indicate formation log from new well or nearby well. 16. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS RENGVED. CASINGS PERFORATED, ETC. T IFFICLAL ABANDONED WELL RECORD (May be used for Property Transfer) ZRPCRMWS F= am now rc a 70 Air Conditioning 110 G. CASINOS) Ila Black 4M Threaded 70 20 Gals. • SO Welded 313 Plastic 613 Stainless Steel ?�� In. to50 —ft. in. to _�ft. 9. SCAEEN ® Streeaed well -from '50 ft. to 51 .ft. !' (It known) 0 Open Role fm — ft. to ft. 30. STAT7C.NAM LEVEL 4yy ft. (XJ below C3above land surface Date Measured 1-23-92 11. WELLHEAD COMPLETION 10 Pltless Adapter 40 Found Buried 213 Basement offset d-1 30 Well Pit 12. GR ING INFORMATION 1(3 Neat CemsatBentealto Grout material Nt .M 30 ilt from5 to 55 it. cu. yds i 13. U44W $OURCESAF CONTANiRATION — OO feet JE di,ectino buried sewer type Well disinfected before saltag? [j Tea p i pe in f loo 14. PUMP ® Removed 0 Not present Type: 10 Submersible 30 L.S. Turbine a Reciprocating 2M Jet 40 Catriftgalr 60 15. EXISTING WELLS (Please sketch locations Of abandoned and active we11s•in remarks section or an back.) Other unused wali(a) on property? O Yes ® No Abandoneds IN Permanent 0 Temporary (3 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under cy Jurisdiction and this report is true to the best of my knowledge and belief. Mork Well Co., Inc. 02133 Licensee Business an License No. Add ve no a, 5 S igned pste 1- 4-9.2 Ron Wison ate - - Ramb of Miles, 303 CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specked agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner – rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $30.00 S representations stated in this application are true and correct. (Side Vent – Fill Out Back) Gas Piping (Needed with new furnace) S10.00 5 OWNER ZZ14-Ze�'11714,0' 1 / ,44 571 Gas Range $10.00 S z (11 BUILDING USED AS Gas Dryer $10.00 S cv ESTIMATED COST., aC r PERMIT NO. *Air Conditioning – All Sizes $25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EOR 1.25% of Value of Appliance or Work S Fuel Total Connected Load State Surcharge TOTAL FEE S .50 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE S42.00/Hr 'Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Sumer Trade Name BTU HEATING COMP. Signed By Size No. HP EOR Approved By K Lj— Rcugh–In Date FILL OUT HACK SIDE'FOR STACK VERIFICATION ON REPLACEMENT FURNACE Final Date a 1�