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PRE 2010 DOCS®RIERFWELL DRILLING FOR FOUR GENERATIONS D 11i"s 15688 JARVIS STREET N.W. / ELK RIVER, MN 55330 / (612) 427-6100 INCORPORATED Date: JULY 21st, 1989 0/ ( Q) NORTH MINNESOTA DEPARTMENT OF HEALTH .— �I 717 SE DELAWARE STREET 0- 13 DIVISION OF ENVIRONMENTAL HEALTH C- p) 8065 MINNEAPOLIS, MINNESOTA 55440 Ul -'> L '- ATTN : Mr Jim Nye (612) 6?3-5339 SUBJECT: WELL ABANDONMENT Cy - SIT DIRGMADI RE: NOTIFICATION Dear Mr Nye, This letter is to notify you of a water well in'your district that should be sealed according to the Water Well Construction Code MCAR §4725.2500-2900. E.H. RENNER & SONS, INC has been notified by the owner of this property or an interested party and have subsequently submitted to them an estimate for the sealing of this well under our LICENSE #71015. We have also included a copy of the current code with our estimate. In submitting our estimate, the owner may also receive additional estimates and hire any number of Minnesota licensed water well contractors in the area to seal this well. However, there is a possibility that this well may not be properly sealed and thus jeopardize the ground water and Public Health. E.H. RENNER & SONS, INC. wishes to provide you this information for future reference with the abandonment report when submitted. PROPERTY OWNER: RIM WOLD ADDRESS_: 8065 RIVERVIEW TERRACE �° FRIDLEY, MN. 55432 LOCATION: SAME AS ABOVE Sincerely Submitted, Raymond T. Renner, V -President E.H. RENNER & SONS, INCORPORATED STATE LICENSE #71015 PHONE # 785-0577 DATE 7-20-89 WELL DIA. 2" DEPTH: 601+ Cc: CITY OF FRIDLEY 6431 UNIVERSITY AVE. FRIDLEY, MN. 55423 ATTN : DARREL CLARK PHONE # 574-3450 STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD I. LOCATION of WELL P1.1 MINNESOTA UNIQUE WELL N0. County Name ANOKA (leave blank 1f not known) Township Name p Number umber Section No. Fractionot 4. WELL DEPTH (completed) Date sealed FRIDL 30wSr 24 3 h INWNWSW 50 tt. SEPTEMBER 20, 198 W: N 1.1t Street Addres and City of Well Location or istance from Road S. DRILLING METHOD (if known) Inter.tton 10 Cable tool 40 Reverse 7R Driven 100 Dug 806-5 R RV T EW TERRACE 20 Hot l ow Rod 5Q Ai r 6o Bored 110 30 Rotary 60 Jetted g0 Power Auger Show exact 1 anon of well a� (in sect n grid rith •X") N Sketch p of well location 6. OBSTRUCTIONS N ........ _ I Wei l obstructed 0 Yes 75( No Obstructions be i yl removed [] Yes o No If obstructions cannot LL removed. contact MON W - ' - - • -�- - E before sealing. '• 7. USE it we_,� 1 , Domestic 40 Monitoring Bj3 Heat Loop "R a 20 Irrigation 50 Public g0 Industry 3E3 Test Well 60 Municipal loo Commercial S niL-� i 70 Air Conditioning 110 2. PROPERTY OWNER'S NAME Mailing Address if different than B. CASING(S) KIM WALL property address indicated above 10 Black 4AThreaded 70 8065 RIVERVIEW TERRACE 2WGaly. 5[3 Welded FRIDLEY , MN. 55432 30 Plastic C] Stainless Steel 2 in. to 47 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 TAN 0 12 g. SCREEN Screened well from 4 7 ft. to 5 0 ft. (If known) SANDY CLAY TAN 12 40 0 open Hole from _ ft. to _ ft. CLAY BROWN 40 125 to. sTA��t WATER LEVEL Ig lands aces ow ODatteeMeasured 9-20-89 CLAY & STONES BLUE 125 140 BROWN CLAY BROWN 140 1 5 0 11. WELLHEAD COMPLETION 10 Pitless Adapter 40 Found Buried FINE SAND RED 159 160 Basement offset 50 gR JORDON SANDST. GRA 30 well Pit 16. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED. ETC. 12. GROUTING INFORMATION 1 BAGS Neat Cement 20 Bentonite 30 THE GEOLOGY WAS TAKEN FROM THE WELL AT: RIVERVIEW HEIGHTS ADDITION Grout material PORTLANDtras50toSURF�C a ACROSS FROM BANFILL ISLAND NEAT 13. EST SOURCE F CONTAMINATION feet SOURCES direction CITY ' S WATER LEVEL IN THE WELL ABOVE: 211 _ Well disinfected before sealing? WYes AIN DATE WATER LEVEL WAS TAKEN: 10-17-49 14. PUMP XRemoved 0 Not Present Type: 1[1 Submersible 30 L.S. Turbine S0 Reciprocating Jet 40 Centrifugal 60 S E P 2 0 1989 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(s) on property? 0 Yes No = ��f..4• Abandoned: 0 Permanent 0 Temporary 0t seaN led 17. WATER WELL CONTRACTORS CERTIFICATION � .._ .. This well was sealed under report my jurisdiction and this re rt is true to the best of my knowledge and belief. r; q� 6V p�}p� f According to N State Regulations E.H. RENNER & SONS, icINC.7101 1419 '3011% ST. NW . nff1N RI Address 5533 612-427-6100 R..I Signede Ll:I STEVE L NDoats — Name of riller OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) ZADPC6RfWfft FZEB WZ2W DMW CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1. 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water Stories Closet Urinal Bath Tub Shower Wash Drink. Sink Tray Fount. Floor Catch Auto. Drain Basin Washer Gas Gas Misc. A pl. Range Fixt. Water Heater Gas Elec Basemen Floor 1 Floor 2 Floor 3 Flnr�r t} PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas Gas Range NO. RATE TOTAL $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes ( ) No Type $5.00 Reinspection Fee $30.00 C ® Q. ' TV�5 ' ALL OTHERS AND/OR REPAIRS AND ALTERATIONSo200 1 % of Value of Fixture or Appliance State Surcharge $ .50 JOB ADD The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work ir4 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. 4—SQ '19W .. Owner Building Used Ash .�e :E�, ( 8 Estimated Cost -32Q," PERMIT NO. 106c)O II , PLUMBING COMPANY e� \ 1� Ludy r 700 W. Lin 326 N BY l TEL NO. E? 1165 Minneapolis, tv, 5 54An_1157 - MIWEGas Approved By�-tet-- Rough- n Date Final Date� MINIMUM FEE FOR ANY PLUFIBING/GAS PERMIT IS $15.00 TOTAL FEE PLUS THE $.50 STATE SURCHARGE olce�o CITY OF FRIDLEY INSPECTION DIVISION 1� Effective On January 1, 1999 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 9 % 65 2�:,, / 6 (?_ V I c- L, ) ) C?- R- ftC-E N - C- ' RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified 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 $ Din stated in this application are true and correct. (Side Vent - FII Out Back) 3-111 ,1 999 Gas Piping (Needed with new fumace, $10.00 $ but not replacement) OWNER J ®H 1 c N S® ol Gas Range $10.00 $ BUILDING USED AS U M C. Gas Dryer $10.00 $ ® Q ESTIMATED COST 1 1 C PERMIT N0. L2S'ca *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (UST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units_Circle One (Steam) (Hot Water) (Warm Air Trade Name E.m S TA Size No. Commercial/lndustrial BTU i e�, r� HP EDR 1.25% of Value of Appliance or Work $ Fuel GV A T _ Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. ` �� BTU HP EDR TOTAL FEE $30 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING CO MPANY —?,4 Sk L>e&3 , N & s P ems® -*Avr_ Signed By Approved By pJi(N� Tel No. —7 Rough -In Date Final Dat FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: Yes No Yes No HEATING CO: -�Stz- Signed By: Date: CHMMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1: Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: Yes No Yes No HEATING CO: -�Stz- Signed By: Date: ITY OF FKIDLEY INSI't(,:IJUN UIV. r31 University Ave NE idley, MN 55432 631572-3Rft- FAX (7631671-1287 Floor 1 Floor2 Floor 3 Floor 4 Urinal a.ucvnr� 0 AtJ1 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON Heater 3inspection Fee $50.00/Hr -L OTHERS ANDIOR REPAIRS AND ALTERATIONS 126% of Value of Fixture or Appliance State Surcharge $ . 50 TOTAL FEE 05 SIGNED TEL N0. Approved By Rough -In Date Final Date MINIMUM FEE FOR A114Y PLUMBINGIPAS PERMIT IS $15.00 or 6% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATERON WORK LESS THAN $300 OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 544(A) AND TABLE 8-A. --PROVIDE COMMON VENT INFO ON MC—K SIDE SLL6 .UMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS $10.00 The undersigned hereby makes application for a permit for the work herein 3w Fixtures d Opening, New Fixture $10.00 specified agreeing to do all work in strict accordanos with the city codes ter Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts ow Off Basin $10.00 and representations stated in this application are true and correct. itch Basin $10.00 20 iin Water Leader $10.00 DATE: imp/Receiving Tank $10.00 Ct-)VYY--% ater Treating Appliance $35.00 OWNER titer Heater -Electric $35.00 35 00 Ater Neater - Gas"* $35.00 BUILDING USED AS ss Range" $10.00 0 PERMIT NO. as Dryer' $10.00 ESTIMATED COST L-0® ick Flow Preventer Required { )Yes () N© ` Pr��L1� Type $15.00 PLUMRINGVPAJ-4 3inspection Fee $50.00/Hr -L OTHERS ANDIOR REPAIRS AND ALTERATIONS 126% of Value of Fixture or Appliance State Surcharge $ . 50 TOTAL FEE 05 SIGNED TEL N0. Approved By Rough -In Date Final Date MINIMUM FEE FOR A114Y PLUMBINGIPAS PERMIT IS $15.00 or 6% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATERON WORK LESS THAN $300 OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 544(A) AND TABLE 8-A. --PROVIDE COMMON VENT INFO ON MC—K SIDE Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY D' E P 2 3 2000 DATE YOUR E-MAIL ADDRESS SITE ADDRESS f �; THIS APPLICANT IS: ❑ OWNER CONTRACTOR ru PROPERTY OWNER/ NAME: TENANT ADDRESS: i/O PHONE" 3 -- --CONTRACTOR STATE IP�� CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # E DATE YOUR STATE LICENSE ADDRESS �%� CIT& K �,0 5 ea 04 sTATE ZIP 5� WITH APPLICATION PHONE YJW- ' � � FAX 6 :?? PROPERTY TYPE SINGLE FAMILYiNEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH PROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONEQg6 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES aHOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ DETACHED GARAGE 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS OYes []No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING=3. B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ iq 4a OCCUPANCY TYPE [Permit Fee $ �(„ a �j See Back Page for Fee Schedule lan Review $ 65% of Building Permit Fee Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev Attach 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 fo a permit d work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whic req • fires w and approval of plans. Q SIGNATURE OF APPLICANT PRINT NAME i DATE ak Building 1 MECHANICAL ICAL Permit No.: Inspections C14- RESIDENTIAL APPLICATION Received By - 763 -572-3604 Date Rec'd: CITY OF F DLE,Y 763-502-4977 FAX EFFECTIVE 2-19-09 DATE q a�; , a G lv YOUR E-MAIL ADDRESS SITE ADD 10 Ce `S THIS APPLICANT IS: 0 OWNER AICONTRACTOR PROPERTY NAME: o�\ Y1 0" Y1 ASO yl OWNER/ n I ADDRESS: ` 01,o S ­(�erY- CITY V -o d�-e­w STATErAw ZIPScSgSP, TENANT PHONE: —1(e3 -'"l � Ce • i � (,a: CONTRACTOR- - -COMPANY NAME:--- CENTERPOINT-ENERGY—- ---- - - - - --- - - --- - -- - - -- -- - CONTACT PERSON: JOANN ZINKEN SUBMIT A COPY OF STATE LICENSE # BOND 22013346 EXP DATE 08/19/2009 YOUR STATE LICENSE WITH ADDRESS:9320 EVERGREEN BLVD NW SUITE B cITYCOON RAPIDS STATE MN ZIP 55433 APPLICATION PHONE 763-757-6202 FAX 763-757-6701 PERMIT TYPE XSINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW ALREPLACEMENT 0 ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK - 1 i FEES ARE BASED ON $10.00 PER FIXTURE E,�'CEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) ili U YA- -Q Equipment Installed MFG: ky_ ea MODEL: 9 m - O;LL( SIZE/BTU A A L m se- MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU ® A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 _FURNACE $35.00 _AS UNIT HTR $10.00 G _CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00 _POOL DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR$15.00 �„?' i ads. X `fa�*'s��j' y J.+ 33JF _-5'dSC'�', y .� .'M„` �& �'•� >v l��i. � F3' P'-. S �.Vr�' '�_ i Jt. .�Y-,'�, L�.F� � 3Y „.. +. �`� ;`X fs��3.e4'. M3 'o�3`Trw ��u'.Ym....:s� ,ya. £'«�"=Aaf � �J-. � �� Z S �}�. ="'x y 9,.. r^F'-Pi 14�D: x - :;.xta�.e"�' .`' h :�"Jx•L` 3�= < :g u" . `n;>9 ha?xT . <� 3 sY �T �rvg'v '�M1 �i,,. ^« y .§ . y'��' :� � p. a'l..i. 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'�" #��a � � - `� � iy�,y: �''' �g� '����, ,_. •..�'� -'�. �,5;,�� .i, a `tr• � a",� �u� r� '+'�'s"� r'�"..u�fi.�dk3 �%1� <,x 3 y: R�*c��K � �` z"'ti.r �''A�i�'y `� s Y� �kh �r� 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 all work which r Quire review and approval of plans. ROGER HOFFHEIN I SIGNATURE OF APPLICA PRINT NAME DATE $ o'ZS 1 b B63''t.�. ^�-`�L§-!A.:., ,, ... City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ZEXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2: Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations.