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PRE 2010 DOCSV 0 age of nab ey' Minn. BUELDING PERHff ® l ® 4 9 Office of INSPECTOR OF BUILDINGS j .. ` owner . Architect�4 � °.. Fridley, Minn., ,'�, 19 Builder rid T'LCA�ION OF BUILDING hTo. Street 7, _���. �.����,E4:4 Part of -Lot Lot Block Addition or Sub -Division DESCRIPTION OF BUILDING Front Depth Height Stories Manner of To be used To be Permit is hereby granted to ? !_ILL V Estimated Cost +i the building ',44L4L44L4 4 -. .dcl crit e %n he a$ ove Itement. This permit is granted ^�y r upon the express condition that the person t6 whom it is canted, and his agents;,'employees and workmen, in all the work done in, around and ,upon said building, or any part thereof, shall conform in all respects to the ordi- nances .of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. y Y�" ,inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inzpector' of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein sated. Subscribed and sworn to before me at Fridley, day of A.D. 19 -- Ouit claim newtFOrlri NO. 27-M Miller -Davi. Co.. Minneapolis Individual to Wividual . Minnesota Uniform Conveyancing Blanks (1931) I' F -3n Thio 3lnbenture, Made this-----------------Z-----------day of ---------ft------------------------.., 19 --- 74 between.................................................................... •--•---•.............................•----...._. DaIdel Glenn Klingensmith and Carol A. Klingensmith, husband and wife of the County of ............ Anoka and State of 1!�nwoOU---------------------------------------------- part4e8of the first part, and .............................. ------------------•-•---------•---------•------------------.......-•---------•-----•---•--.:.._-•------.... JTot I. tc> ear�dRobe.K,t..Met�alf�,..huahaadaad..srLfa----------------------------------------------- of the County of--------------An�----------------------------------------and State of ---------- Minnesota, ........................................ partie 8. of the second part, Mitnefgeth, That the said partial._. of the first part, in consideration of the, sura of Le--Do138T..$►1d__at!21@�'..$Q9d_._a__1xl_Y41um .A ... acAsIderat4 6 .............................. ........... ......... DOLL.i1RS, to ........... t1ieF►_______________in hand paid by the said pardf).8_ of the second part, the receipt whereof is hereby j acknowledged, do ---------- hereby Grant, Bargain, Quitclaim, and Convey unto the said part..188.._ of the second part, ....their----------- heirs and assigns, Forever, all the tract.___ or parcel____ of land lying and being in the County of ................ . i44!ft......................... and State of Minnesota, described as follows, to -wit: An easement for ingress and egress over the North 8 feet of the South 13 feet to the- ` Mississippi River of the following described tract: That part of Lot 16, Au*Ltore Subdivision No. 23 Reviseds Anoka County, Minnesota, lying Southwesterly of a line drawn from a point on the Northwesterly lithe of said Lot 16 distant 130 feet Southwesterly from its intersection with the Westerly right of way line of Riverview Terrace to a point on the Southeasterly line of said Lot 16 distant 80.0 fett Southwesterly from the Westerly right of way line of said Riverview Terrace, except the Southeasterly 5.0 feet thereof. STATE OF DEPT. OF o DEED _ sTAA9P, 02. 2 0 = o TAX To J04be dnb to JI)o[b the frame, Together with all the hereditaments and appurtenances I thereunto belonging or in anywise appertaining, to the said partie8_ of the second part......._tteix' ........... heirs and assigns, Forever. 31n Teotitnonp Mbereof, The said partied. of the first part have.._ heretinto set.....their.............. hand s, the day and year first above written. i' ` In Presence of � Daniel Glenn ngensmith f! w...............................................................................'__........ ...... •�___ __ ,_. - ....... ........... .......... .................... Carol A. Klingensmith j-- •-............................... ............................ ----------- . ............. ................. ............................................................ 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L..1..5-- .................................... within ctn%dJ for said C anti/, Personall7l appeare(I /�� to nae known to be the person .... s..................................descri.bed in, and who execrated the fore_.6oin_s instrtimcitt, _............................ -..:............................................................................................................ and acicnozvledfed tk.Rt 1S 6.4- execrated the. L (See Note) sranr•e us free act and. deed ................... (See Note) N ,11'*ota7•y Public..............�°,o� �4....),. .....................-...County, .11"Inn. Jly conanzission ex ires.........�...MQc Ra vo . ` Note: The blankllines marked "See Note" are for use when the instrument is executed by an attortl�y 4�ijc z 1g)� A :E Quit Claim Deed. ladividual to Corporation. Form No. 28-M. Miller -Davis Co., Minneapolis, Minn. Minnesota Uniform Conveyancing Blanks (1931). 26th November Tcz ubenture. .1ylade this. ...........................................day of..............................................................., 19..72..... between .......HP. ... GIRM.... .................V ..KUM.".,th.... TWe..................................... of the County of....fA€P .4.1 .............................................................and State of.. .. HUMMOU .......................................................... partAPPof the Pat part, and...............W—V...Qf ..Fruley......................................................................................................................... eorpora n r�ncZer the I&= of the State of ....... Minnesota ............................................... party of the second part, (trit-00b, That the said part. ®P.. of the first part, in consideration of the sum of .... ... ...0.9/1..00....' ...00)....Wd..�tkter...TAI ez..receive......... _xr4,:P..-.mPOLL✓1BS, to ...... par rlea,!� ..............................in hand paid by the said party of the second part, the receipt whereof is hereby acknowledged, do............ hereby Grant, Bargain, Quitclaim, and Convey unto the said party of the second part, its successors and assigns, Forever, all the tract...... or parcel...... of land lying and being County f e of .Minnesota, described as follows, to -wit: in the Coun o..........................�1!?�,Rel............................................and Stat A fort/ toot (401) easement for the purpose of construction and maintenance of street'surfacring and public utilities described as follows: That part of Lot 16. Auditorls Subdivision No. 23 Revised, Anoka County, Minnesota, lying within the following described 40 foot strip of land to telt: A strip of land 40 feet wide, the centerline described as follows: Beginning at the intersection of the North line of Nva Erickson Manor and the centerline of Riverview Terrace, according to the plat; thence North. westerly along the extension of said centerline 28.57 feet; thence Northeasterly on a tangential curve to the right with a radius of 127.08 feet, delta angle 39 degrees a distance of 66.50 feet; thence Northeasterly on tangent to said curve 11.15 feet; thence North an tangential curve to the left with a radius of 97,77 feet, a delta angle of 44 degrees, 30 minutes a distance of 75.91# feet; thence Northeasterly on a tangential curve to the right with a radius of 108.56 feet to the Borth line of said Lot 16, Auditors Subdivision No. 23, Revised and there terminating. No State Deed Tax Required. To 3babe anb to 3boib the dame, Together with all the hereditaments and appurtenances there- unto belonging or in anywise appertaining, to the sahl party of the second part, its successors and assigns, Forever. In Tegtintonp Ubereof, The said part .... iesof the first part ha..9e..... hereunto set......... ...... hand .... sthe day and year first above zuritten. 0 In ence of ....................................... --................................................ ... . ...... r i[Z L. C e C. .,`Y OF FR.IDLEY 412 Application for Installation of Water and Sewer Service This form to be completed before a tap is made to any existing water or sewer line. e�� Lot -- ---- /-��------------- Bloc --- ••••1;jA.1Addition Address ......la �a / ..... __.... ..... Owner ... _• . .._ _ .... - - -•-- Plumber.._----__.------- ._.._.... _-.-,-----_ __ (thi rtion o orm to be comgle by person requesting tap) CHARGES TO BE PAID BEFORE TAP IS MADE — WHERE ASSESSMENT HAS NOT BEEN LEVIED AGAINST PROPERTY Sewer Connection fee529 Wreet 6.00 $26.00 Water Connection fee Meter deposit Materials used -Street patch _._ ..... _................... _................ .... $10.00 25.00 _ ___..._ :_..__....._-... 55.00 6.00 $96.00 Where applicable The above applies for all regular residential size services IF LATERAL ASSESSMENTS HAVE BEEN LEVIED AGAINST THE PROPERTY, THERE WILL BE NO CHARGES OTHER THAN CONNECTION PERMITS AND METER DEPOSIT The City will furnish materials for water service and the plumber will bill the City for sewer, not to exceed $3.00 a foot or a maximum of $60.00. ASSESSMENTS TO BE LEVIED Water Lateral $.... Credit for material Total assessment $•--•-- ............._--....._.._.._---. Credit for material 60.00 Total assessment 6 Clerk's signature-�=7 -LZ ..:.� I hereby authorize the above tap 1st copy—Public Works Director of Public Works 4 G .L'Y OF IRMLEY Tj42 Application for Installation of Water and Sewer Service This form to be completed before a tap is made to any existing water or sewer line. Lot x_'.40 .... ....--- Bl----�------- ------ Addition -..4Z-4- �. _. / Owner _. _.C1..1-.: /L ......... Plumbe (this portion o orm to be completer) by person requesting tap) CHARGES TO BE PAID BEFORE TAP IS MADE — WHERE ASSESSMENT HAS NOT BEEN LEVIED AGAINST PROPERTY Sewer Connection fee *Street patch -_ Water Connection fee Meter deposit Materials used *Street patch __ * Where applicable The above applies for all regular residential size IF LATERAL ASSESSMENTS HAVE BEEN LEVIED AGAINST THE PROPERTY, THERE WILL BE NO CHARGES OTHER THAN CONNECTION PERMITS AND METER DEPOSIT The City will furnish materials for water service and the plumber will bill the City for sewer, not to exceed $3.00 a foot or a maximum of $60.00. ASSESSMENTS TO BE LEVIED Water Lateral Credit for material Total assessment Sewer Lateral Credit for material $------------------------ $----..-..-_...._ - - $------------- _..... — ._... 60.00 Total assessment Clerk's signature .__. _.. _ - ---- --- 5) I hereby authorize the above tap Ist copy—Public Works Director of Public Works APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND ,.AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE •t� GRAVITY WARM AIR: R0.TE TOTAL Job Address Furnace Shell & Duct Work ' $12.00 $ Replacement of Furnace 7.00 S Repairs & Alterations -up to $500.00 7.00 S Department of Buildings Repairs 6 Alterations each add. $500.00 4.00 $ City of Fridley dle y Tel. #571-i450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 STU $12.00 S specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 S 7- B� facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 $ dp® ;y Repairs & Alterations each add. $500.00 4.00 $ Fridley nn. 19 /✓ STE,4M OR HOT WATER SYSTEM: . OWNER Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING each addn. 50,000 BTU 4.00 $ a Bailer only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT 20 ® 7 OIL BURNER- to 3 gal, per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199.999 BTU $10.00 $�rd• OLD; NEW BUILDING PERMIT NO. PERMIT NO. (over 199,999 BTU see Fee Schedule) S GAS FITTING FEES: 1st 3 Fixtures X $ 3.00 $ -ey. DESCRIPTION OF FURNACE/BURNER Additional Fixtures X $ 1.00 $ Gas Range to 199,000 BTU X $10.00 $ HEATING or POWER PLANTS, Steam, Hot Wate Waren A Yi lNo. AIR CONDITIONING` $ FAX HEATING SYSTEMS Trade Name VENTILATING SYSTEMS See Fee Schedule $ Capacity Sq. Ft. EDR BTU HP ALTERATIONS $ REPAIRS $ State Surcharge $ .50 Total Connected Load 7f® Kind of Fuel TOTAL FEE $ � BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. Date APPROVAL FOR PER%STT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.SO STATE SURCHARGE Capacity Sq. Ft. EDR STU HP Company �. Signed By / Tel. No. ��•� 97-8b-879001 CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PMT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening x m tr' $ Water x $2.00 $ a n x $5.00 $ Si p, W $ 100,000 BTU to 199,000 BTU Heater w r o ' Water Softener x $7.00 $ New Ground Run Old Building a $5.00 8 n By a y GAS FITTING FEES: aui 1st 3 fixtures x '$3.00 $ s�7 ai $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 y u 0 0 $ (4 3 A w° fn w $ 8®oo 1st nn t -ir A a a h at .r 2nd 3rd 4 th (P.) - Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ ' Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8®oo REINSPECTION FEE ($10.00) Job Address 6L18 Riverview Terre Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the vork herein specified agreeing to do all work in strict accordance with the City Codes 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, Mn. 9-U-78 , 19 OWNER B?M,LOST KIND OF BUILDING frame USED AS res, TO BE COMPLETED ABOUT 9-21-78 ESTIMATED COST _ 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS M50 PLUS $.50 STATS SURCHARGE ` r 44 tic 4-6 m o w W X X X X X F- W W oflu CL O W C ... _.-.- __.. _. -.... N O[ Q CL CL •�Z Z •� a R 0 0 0 _ OL Z W } W o S LIL - Z .. -.. W Z x X X X X X x06 uj • t _ _-- _ _ _-_.___. 0 N i s � CL- W UCn w ,a uj 11 c m O 4 o V Q (� \ • X X X X x X X X J nn O a ® 01r _� O ea J O e V I 0 O � d s W Q K OC O _V Q •� P \ • V L• o 0uk Y7 = W W W OC z •� W W 06 Z W S71 W a< Z J W mJIN Z a o C I.... > W OL - oa � LL N L°i � C ti. • 2 [7 D $ m V v O •P Z CD OCD , �� — o V �- LU m w A., W W W d{ D - V O $ • zo L-- a oL Z tl[ J O T► � d K � D p .� 6 � ¢ � LL ,- � Z � � z ry` W O 0 r } 4 us Q v • o ¢ V • x 15-. uj }z.. '� v t • p¢� S mC ore + OWL m N W Y C N ..J O u�i u. z z ee ec a i Z d z 3 3 x o o oL = a d s o Z o 0 N N V N V F OO C9 S OIC p p SUBJECT PERMIT City of Fridley ® 19254 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. r ~ PROTECTIVE INSPECTION SEC 1 � ` CITY HALL FRIDLEY 55432 L � NUMBER REV. DATE 1T PAGE OF APPROVED BY 612-571-3450 910-F15 10/27/87 JOB ADDRESS 6418 Riverview Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16, Parc 1 A, Auditor's Subdivision #23 Revised SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Evelyn Bruflodt 6418 Riverview Terrace N.E. 574-9728 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Rod Day Company 2957 - 108th. Lane N.V., Coon Rapids 427-4274 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 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 221.x 141 Detached Garage 9 CHANGEOFUSEFROM TO STIPULATIONS Variance approved for side yard setback of 2 feet on October 13, 1987. The South and North walls must be 1 hour fire rated. Provide a hard surface driveway. WARNING Before digging call local utilities SEPARATE PERMITS REQUIRED FOR TELEPHONE - ELECTRIC' GAS Etc.Ian',°tiI NIG, PL°JIMEING REQUIRED BY LAS! A NFD S, 17 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 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 . .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 BE COMPLIED $47422 $2.21 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE NY OTHER STATE OR LOCAL LAW REGULATING CON- PROVASIGNATURE $50.50 TRUPERFORMANCE OF CONSTRUCTION. PJAN CHECK FEE TOTAL FEE $52.71 N' CTO ZED AGENT ID EI i WHEN PROPERLY VA ` TED THIS IS YOUR PERMIT SiGNATUREOF OWNERIIF OWNERBUILDER) tDATE) BLDG INSP n E NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: 41 9 T< !y6w Vrcrt) %c, Legal Description: Owner Name & Address: �N ��yTel. ,# Contractor: 1 Tel. # Address: ��� � log; LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale., Length Length Length DESCRIPTION OF IMPROVEMENT Width Height Width ri Height /D Width Hgt/Ground Sq. Ft. Sq. Ft.®$ Sq. Ft. Corner Lot [ ] Inside Lot [�1C Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ Approx. Completion Date: / Mt'J'jre- , Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 'o g% g APPLICANT: Tel. CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: �C_ c,)), b L �4 FAC E u_t, 9 k F-- o 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 ADDRESSZo 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 $ representations stated In this application are true and correct. _ (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ ,�- 4�oxD®,,j S72 — Z /Y6 - OWNER Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST �,�®,� PERMIT NO. *Air Conditioning - All Sizes $ 25.00 $ I?g§CRIPTION 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 -5-Oc 0 HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge TOTAL FEE 50 $ MINIMUM FEE FOR ANY HEATING COOLINGNENTILATiON REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Burner Trade Na BTU HEATING Signed By Size No. HP EDR Approved By V` -I Rough -in Date _ (SCI?.572 •^^-�9 Tel No. *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE MR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Final Date WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Baring o. H 132903 County Name WELL AND BORING SEALING RECORD Sealing Minnesota Unique No. AAOXA Minnesota Statutes, Chapter 1031 or W -series No. (Leave blank if not known) Township No. Range No. Section No. I Fraction (sm. � Ig.) Date Sealed Date Well or Boring Constructed 30 24 22 IMMA ME >a WY, JAN 07, 1998 950"S Numerical Street Address or Fire Number and City of Well or Boring Location 6418 RIVERVIEW TERRACE NE Depth Before Sealing 40 ft. Original Depth ?—ft. Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL in section grid with °X°.location, showing property Single Aquifer [IMuttiaquffer Ines, roads, and buildings. N WELL/BORING 19Measured ❑Estimated W EE� NEON E FT in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to ft. Q Yes ❑ No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME WRMN 04GLUM Property owner's mailing address if different than well location address indicated above. El SCREEWOPEN HOLE t ? Water Supply Well ❑ Monft. Well ❑ Env. Bore Hole ❑ Other tt. P below ❑ above land surface E CASING TYPE(S) �8) Steel ❑ Plastic ❑Tile E] Other % mile I CASING Diameter Depth Set in oversize hole? Annualar space initially grouted? ll S 11'' gt~— f Moe II` 2 in. from 0 to 37 ft. ❑Yes No El Yes E]No El Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to ft. Q Yes ❑ No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME WRMN 04GLUM Property owner's mailing address if different than well location address indicated above. 6418 RI V TERRACE SCREEWOPEN HOLE FRIDLEY, M 55432 Screen from 37 to 0 ft. Open Hole from to ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill No Obstruction Type of Obstructions (Describe) WELL OWNER'S NAME SAM Well owner's mailing address If different than property owner's address indicated above. Obstructions removed? ❑ Yes ❑ No Describe PUMP Type JET 10 Removed El Not Present El Other HARDNESS OF GEOLOGICAL MATERIAL COLOR FROM TO FORMATION If not known, indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: No Annular Space Exits ❑ Annular space grouted with tremie pipe SAM BROW 12 SAMY CLAY BLUE 12 23 ❑ Casing Perforation/Removal In. from to _ tL ❑ Perforated ❑ Removed from to - fL ❑ Perforated ❑ Removed WATER AM oymin. Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Materiel from 40 tS ft. yards bags from to ft. yards bags from to ft. yards bags from to ft. yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS GEOLOGY FROM: 82ND AND HUNWLDT WATER LEVEL = AWVE WELL: 301 Other unsealed and unused well or boring on property? ❑ Yes [A. How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION DATE E WATER, L E TAKEN.- 12 —01 " 6' st of my knowledge.accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true t the beboring was sealed In E.H. REMMM SONS, INC.710151 Contractor Business Name License or Registration No. Tom„ K 5Klm A r c� q n I N yaa a y ons g to Autho&-ed Represent , dve S/gnature Date KEVIN SCHEITERLEMMVIN HOPPE LOCAL COPY JH 132903 Name of Person Sealing weftor Boring HE -0143403 2/97 R NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 BUILDING PERMIT APPLICATION -Construction Address: I Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 571-1287 Fax Legal Description: Owner Name & Address: 6Q,2QQAJ Tel. # Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: &Ft. + �Ft x $ _ $ DATE: APPLICANT: S�)Tel. #577,� 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 $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation % SAC Charge $ $1275 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ STIPULATIONS- la„1l v , r r i ° a a q� / Pt 1 CITY OF FRIDLEY PERMIT &0.: 2004-018 6431 UNIVERSITY AVENUE NE -� FRIDLEY, MN 55432 DATE ISSUED: 10/14/2004 ' (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6418 RIVERVIEW TERRACE NE PIN : 153024420016 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL AN AIR CONDITIONER. # A/C UNITS I # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALL) 2100 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 0.00 SUPERIOR CONTRACTORS INC 612142 AVE N GAS RANGE FEE 0.00 CRYSTAL, MN 55422 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL PAID WITH CHECK # 16849 25.50 OWNER ENGLUND GORDON 6418 RIVERVIEW TER NE FRIDLEY, MN 55432 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 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the p ormance of construction. Applicant Date Bldg Insp D:e,n SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. *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 CITY_ OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 6431 University Ave NE Ftidley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 63-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 140% qqtt` JOBADDRESS 6-VIT 10 RATE SCHEDULE Fee Total ,tesi� Owner 66;'40o") Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $ Building Used As $10.00 $ ,+�p� ) ESTIMATED COST a o PERMIT NO C?OL! " 0/6-Y)6 Gas Piping (New Furnace, Fireplace, Insert) Gas Range $10.00 $ . DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. *Air Conditioning -All Sizes $25.00 $ v© BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ -4 HEATING CO TOTAL FEE $ Signed Tel REINSPECTION FEE $50.00/HOUR FAX # Date *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 CITY OF FRIDLEY PERMIT NO:: 2004-00527 6431 UNIVERSITY AVENUE NE --- --_.__-W FRIDLEY, MN 55432 DATE ISSUED: 04/19/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6418 RIVERVIEW TERRACE NE PIN : 153024420016 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,547.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (22 SQ) TEAR-OFF STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 83.25 2.55 WESTPHAL TODD ROOFING (20244759) 1060 118 IN STATE SURCHARGE, VALUE 1.27 BLAINE, MN 55434 LICENSE SURCHARGE 5.00 TOTAL 92.07 PAID WITH CHECK # 8180 OWNER ,ENGLUND GORDON 6418 RIVERVIEW TER NE FRIDLEY, MN 55432 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 veing t ' e of work provisions of laws and ordinancesgorn will be complied with whether speci erein or not. The granting of a permit does not o give authority to violate or cancel th ons y others or local law regula ' ft rm construction. Ap icant Date Bldg Date -141111 Zk - SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. APR -19-2004 08:34 FROM CITY OF FRIDLEY To NEW [ ] 011Y OF FRIDL.EY ADDN [ ] 6431 U6versity Ave NE, Fridley. MN W 32 ALTER (] SINCLEFAWLY AND I3UILDlN4 PERMIT AP�CATION� R-2 Construction Address: Legal Dewipbon: 77B31385 P. 04/02 Effecffve 4J112004 (763) 572,604 Bidg hmp (763) $Ti -1287 F8x Owner Nram'e-r&-Address: Tat.* Contractor: t -ODO ( �1 MN LICENSE % Address_ „Z6�6l%G� I'� /l0 di% 't/ el. # %� ✓`� / �c'"�' Attach to this application, a CenM=te of Survey of the lot, with the proposed construction drawn on it to ale. DESCRUVnON OF IMFROVENENT Width r LdVIN©.AREA: LertgLll — Height 4K Sq. F#. GARAGE AREA: Length H"'9ht -- Sq' Ft �, TrAaJ_ DECK ARM Width - _ HgWoound Sq. Ft. OTHER: J Construction Type: &e mated Cost DMwdy Ctub Cut Width !Needed: Ft + B Ft = F $Z = $ — Call (762) 5724004 for Permit Fee$ if mmTog in apppcat%n. Fax to 763.6714 287 N using are" c" and we will call you for card numbar. CITY USE ONLY - Permit Fee S � Fee Sctledule on Raverse Skie Plan Review $ - = - =- --� 65% of Permit Fee Oth%) Fire Surcharge $ .001 of Permit Valuation (111 State Surcharge $ / ? �_ $.501$1,000 Valuation SAC Charge Surcharge $ $ 5 o6 $1350 per SAC Unit $5.00 (State LicanSed RaSiden#iai Contrdotors) License , Curb Cut Escrow $ Alt 09 or Alt aW Above Erosion Control $ $450.00 Gon$enrat on Pian Review Park Fee $ -- Fee Determined by Engineering Sewer Main Charge 5 Ag=ment Necessary C I Not Necessary I ] TOTAL $ T� STIPULATIQNB: .07 Z0 39Vd NId008 1VHdiS3M caoi GSETEBL69L 09:06 0006/BZ/00 Minnesota Department of Commerce Licensing Division tib - Ith Place East Suite 600 St. Paul, IVIN 55101-3165 TODD WESTPHAL ROOFING 1060 118TH LANE BLAINE, MN 55434 State of Minnesota Department oiCommerce Licensing Division Department of Commerce Telephone- (651) 296-6319 4-A - 0 7th Place Cast, 3u;la 600 E-mail address: licensing. commeroe(d_Dstate. mn,us A St Paul, MN 55101-3166 Website address: commerce.state.mn.us Roofer License Legal Name: WESTPHAL TODD DSA: TODD WESTPHAL ROOFING Address- 106011 .8TH LANE BLAINE, MN 65434 License Identification Number: BC- 20244759 LiCo6nSe EApitatiois Date. 3/31/2005 ....... . ..... ...... . Business Strijouret INDIVIDUAL PROPRIETOR Qualifying Person: TODD WESTPHAL Continuing Eoucation: 7 His CE due by 5/31/2005 ZO 39Vd NIJ006 7VHd1S3M 0001 GGETEBLESL 179:0z t00Z/81/170