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PRE 2010 DOCSVillage of Maley, Minn. " BUILDING PERMIT No it 9 Office of INSPECTOR OF BUHMINGS owner 'LL + t Architect Fridley, Minn., Builder LOCATION OF BUILDING No._ t,":) Street Part of Lot Lot Bloch Addition or Sub -Division DESCRIPTION OF BUILDING - - To be used as -� ' � ` � "� °'` ' �"'-`��� To be completedManner�of�Cons ct Estimate(' FrontDep h Height , stories d Cost �--- Permit is hereby granted tom ^ . the building described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, 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 limns, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. D Inspector of Buildings. a ,n II AGREEMENT AND SWORN STATEMENT 11 In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permittate I hereby agree to do the proposed work in accordance with the description above set forth ccording to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby and say that the facts stated by me and contained in the above permit are true as therein ted. .. ,r Subscribed and sworn to before me at Fridley, Minnesota, this � F day of,. A.D. 19 r �, Mage of FrldieY9 Hi i U jE { . 5. ` ®fee of INSPECT OF: Owne Architect N'rid'_ey>1i3!n.,�' �"J 1e 1 Ile L��TI�-OF, II aYI�i G hTo.street , ' ot4 66_104e Part ; of Lot _ Lot ]Block i Addition or. Sub -Division DESCRIPTION OF BUn D Front %%oh Dep h j F3eight stories -it- Manner of C©nstr{Iction To be used as I To be completed + ► Estimated Cost 14 - ' Permit_ is hereby ted to e the buildings - described in the above .statement. This permit is granted i upon the express ex naltion t the person.to wheat it, is grafted, and. his agents4 employees and workmen, in all the work :_done in, ound `air' upon said building, or any Bart_ `thereof, shah coni form: in all respects to the ordi- nances of Fridley, Minn., re' ding the construction, alt^ration,' maintenance, repair and moving of buildings within the city 1.1m ordinances. to, and t permit may be revoked at any time upon violation of any of the provisions of said Spector of Buildings. In consideration sr of t! AGREEMENT AND SWORN STATEATENT ie issue and delivery to me by the Twtpeotd� of Buildinof Fridley of the :above,, perms I `.. hog y . agree to do the propoo-ed vrork , 'hj accordance with the description above set fere nd accia ding' to the prow sions of the ofdir�nces, sof, pridley, and.,. being first duly sworn, I hereby state an say, that the facts stated by nqe and. conta,�xled ill the above permit are true as therein ftated. ; Ij I � g Subscribed an sworn be re z3ie atFridleyX ix- mots,, this t► �� t /� it ,j' ��1 [[�� .1i r� ylk8' 44 6 a 1t7 day of --A.D.' -_ ii N 1p4V �r II d I E SUBJECT P MI -City of Fridley 0 18291 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. Z V7 e e CITY HALL FRIDLEY 55432 %.j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/12/85 JOB ADDRESS 6620 Stinson Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Moore Lake Park First Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jan Lind 6620 Stinson Blvd., Mn 571-6713 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. DavKo Home.Improvement 1325 - 42nd Avenue N.E. 788-5850 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE 1, LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 8' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS provide fire alarm in hall.to bedrooms and in basement. See notations on plans. 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 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 $4,950 $2.48 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $50.50 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAN CHECK FEE TOTALFEE ��t S $12.63 $65.61 SIGNATUR OFCO RACTOROR L1IZEDAGENT IDATEI WHEN PROPE VALIDATED THIS IS YOUR PERMIT i BLDG INSP DA SiGNATURE OF OWNER OF OWNER BUILDERI IDATEI E NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address:_ Legal Description: Owner Name & Aress: Contractor: — Address: City of Fridley 1--R-1 AND R-2 I Building Permit Application Effective 4/1/84 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. ,r-! DESCRIPTION OF PROVEMENT / r� LIVING AREA: Length ---T Width Height Sq. Ft. GARAGE AREA: Length 1Width �? Heights Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] In I ide Lot [ ] Ft. Setback Side Yard Setback Type of Construction: GCS Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: APPLICANT: Tel. 72rE Mt CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge fbTAL Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: �� c �L� «Xao�►v1 aC� A O l 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 Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 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 been constructed will be required before proceeding with the framing. SO e 2kD6c,,,— .�� t;lf . / le (le 9-440 F,oLC <<---17- �/r Xe fc -r4,r-- /-�� Aj�,-ef .�x -qz� . 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'� #'3.: a� ,.,�"'„} � � iii t a 3' !'� ,�ti.r.H'.�-, a=a'„k �. - -••' '„t�` . d-.,. < _ ' ��,•-, F�.--,ty��, '..%t -, �,< ,t' _ ¢.�'ri _e•Elyy +,r ar�d..<, , f � l,yya � a; ''r" ✓r - � t ^(+�, _ �-.. � -c a NAFr �rt+F y`i+.a " ^RJ r � ��•.�•-• +�'�' �rtt '� •vi. e- 0'�':3`y ,4 -'" 3i�r ac { � .e: ^ a I1-rcaA•>•aa- AdL"-,j •a �A 'a:....ed ��, t r h•, u�F ��:d � "1 �,+ v' � 4 '9^.rII �t �d { ZI Q ilk 7.,d r` �• 7tTs4t,. jn -3'1 r a tv^. ,d. c IIrs : rr gjE—, >►r-F� S7. "r^ te T6 FYI �� r r � -,n,ct Kw. �� �w.n - . .'RP6'. .. ,, i'•ff', 3£ „' - .t ac tL v""'�-•L � r �F� � " q � _.. I ah 3, � ya.'` ' i,��se. r ._;� C'�`��"'�'-'tea �'' ... y '� s 7+.��r'3�'vy��'�'Ws v'��""a h�"�''�x�r ?"� �• +Y AA a x a � � SUBJECT RMIT NO. City of Fridley " WRECKING ()18875 AT THE TOP OF THE TWINS RU=%* PERM IT ' R ' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 7 �� 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/13/87 JOB ADDRESS 6620 Stinson Bouelvard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 �oore Lake Park First Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jan Lind 6620 Stinson Bouelvard N.E. 571-6713 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Al--Ko House improvement 8090 - 4th Avenue Lino Lakes 788-5850 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residen tia 1 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE REMOVE 8 DESCRIBE WORK Wreck 14' x 22".Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS Clean site of all construction debris. 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 ] 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 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- TRUCTION OR THE PYRFORMANC OF CONSTRUCTION. $15.00 PLAN CHECK FEE TOTAL FEE $15.00 SIGNATURE OF CONT ACTOR OR AVHORIZED AGENT (DATE) HENPROPERL=ATED BLDG INSP IS YOUR PE MIT ATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI Effective Aug. 1, 1981 City of Fridley wxcT Permit No. AT THK Top 0w rK TWW# r WRECKING PERFSIT APPLICATION Receipt No. -------- COMwiftITV O[VtLOPWNT OIV, p1OT[CTrvt NVtCTmm WrT. CM HALL FINDLtV 0001 1....� `.J M'-DDO-34"�a►tD0! wtv OST[ Or rj1E •►rtCv[o 9� Rnp Job Address<� egal' Lot No. Block o. Tract or Addi nJ Desc. /�' -c pi i �2� i-f�i1 pi Prop y Own Add• s P Co ct es - P one Description Front De th H ht q. Ft. Cu. Ft. of Bldg. No. of Dwelling Vnitts Taxes Paid Tax Receipt No. Estimated Cost of Wrecking To Be C let ` Utilities to be Notified and date Services D7i332-4112 Mpls. Gas OD. N.S.P. rthwestern Bell Tel Cha! Engr. Dept. �% Cust. Bus. Ofc.s. Ofc. 372-4850 330-5540 -- Da t4 Da Da Wrecking Feei6Z $1.25 for each 1000 is feet or fraction For structures ch would be impracti to cube, the fee shall be based n the total cost of wrecking such structure at the rate of $6.00 for each $500.00 or fraction. MINIMUM FES: $15.00 No State surcharge on Wrecking Permits. Approved By Water 6 Sewer Department: All Bills Are Paid Services Are Disconnected �./ J/ 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 Ordinances and rulings of the Department of Buildings, and hereby declares that -all facts and representations stated in this application are true and correct. / D.� ?/L. `//v Contractor .� C v d.. '("? Z2 to SUBJECT PER City of Fridley _ I_ g s AT THE TOP OF THE TWINS BUILDING PERMIT i � COMMUNITY DEVELOPMENT DIV. L INSPECTION I! PROTECTIVE SEC. 1 . � NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/13/87 JOB ADDRESS 6620 Stinson Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Moore Lake hark First Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jan Lind 6620 Stinson Boulevard N.E. 571-6713 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Al-Ko House Improvement 8090 - 4th Avenue, Lino Lakes 788-5850 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK �p X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 241 x 241 Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS "Provide a hard surface driveway. 8efor e � ggeq�. cal! Jo TCLEP HONE cal utilities e ELECT REQ J E r SEPARATE PERMITS -REQ�U YtED F r-cis � LA, �'q WIPING, HEATING, PLUMBING A11D Sff,3",q% 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 ISTALLS 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 $8,271 $4.14 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 PERFOR ANCE OF CONSTRUCTION: $74.50 PLAN CHECK FEE TOTAL FEE $ 78.64 SIG AUTHORIZED WHEN PROPE VALIDATED THIS IS YOUR P/MIT BLDG )NSP qAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address:,, Legal Descriptio WC/. Owner Name & Addres : Contractor: Address: _ . TA M� M6/, N i�a�■vtii�vsi��l Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length -- Width Height Sq. Ftp DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback 'N-) Type of Construction: Estimated Cost: $/ i a 3 Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation C ' r DATE: APPLICANT: `► Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $_ 25% of Building Permit Fee State Surcharge $ q,jq $.50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ ! TOTAL $ ,19 Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: TJ_5 Az-"� -- 0 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 Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 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 been constructed will be required before proceeding with the framing. r -� � t O:iz zx n1 �7 CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 June 24, 1987 Mr. Al Kopecky Al -Ko House Improvement 8090 - 4th Avenue Lino Lakes, MN. 55014 Re: Garage Construction at 6620 Stinson Boulevard N.E., Fridley Dear Mr. Kopecky: A final inspection was conducted on June 23, 19.87 of the above construction and it was noted that the following item needs to be completed before the structure can be f inaled: Provide wind bracing from the peak of the gable.ends. We will expect the above item to be completed by July 10, 1987 when a reinspection will again be conducted to determine compliance. If you have any questions on this matter, please feel free to contact me at 571-3450. Sing ely, D CLARK Chief Building Official DGC/mh CC: Ms. Jan Lind 6620 Stinson Boulevard N.E. STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION Of WELL County Name Anoka Township Name Township Number Range Number Section No. Fraction Fridley 30 Sa� r 23 or 13 NEkSENE Numerical Street Address and City of Well Location or Distance from Road Intersection 6620 Stinson Blvd. Fridley Show exact location of well (in section grid with °X°) Sketch map of well location N N W E T 1� 3R S 1-1 an:L- 2. PROPERTY OWNER'S NAME Mailing Address if different than property address indicated above Stephen & Jan Lind HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. . REMARKS. ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. MINNESOTA UNIQUE WELL NO. ABANDONMENT (leave blank if not known) 4. WELL DEPTH (completed) Date sealed 143 ft• 7-11-89 S. DRILLING METHOD (if known) IM Cable tool 4E3 Reverse 70 Driven 103 Dug 20 Hollow Rod 50 Air So Bored 110 3E3 Rotary 60 Jetted 90 Power Auger 6. OBSTRUCTIONS Well obstructed ® Yes [] No Oructions removed Ea Yes 0 No If obstructions cannot be Obstructions 67' 1*" Drop Pipe removed, contact MDH PKR TYP Jet before sealing. 7. USE 10 Domestic 40 Monitoring 80 Heat Loop 20 Irrigation 50 Public 90 Industry 30 Test Well 60 Municipal 100 Commercial 70 Air Conditioning 110 8. CASING(S) 1® $lack 4® Threaded 70 20 Galy. 5[] Welded 30 Plastic 60 Stainiess Steel 3 in. to ft. in. to ft. 9. SCREEN Screened well from _ ft. to _ ft. (If known) Open Hole from _ ft. to _ ft. 10. STATUgATER LEVEL 00 ft. M below ❑ above land surface Date Measured 7-11-89 11. WELLHEAD COMPLETION 1E] Pitless Adapter 4[] Found Buried 20 Basement offset 6[] 3[] Well Pit 12. GROUTING INFORMATION IM Neat Cement 20 Bentonite 31,] Grout material N.C. from 5 to1O9t, Cu. yds 13. NEAREST SOURCES OF CONTAMINATION _ feet direction type Well disinfected before sealing? 0 Yes ® 14. PUMP ® Removed 0 Not Present Type: 10 Submersible 30 L.S. Turbine ED Reciprocating 20 Jet 40 Centrifugal 60 nmm1 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(s) an property? [] Yes ® No Abandoned: M Permanent 0 Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report 1104 is true to the best of my knowledge and belief. MORK WELL COMPANY INC. 02133 E T 1� 3R S 1-1 an:L- 2. PROPERTY OWNER'S NAME Mailing Address if different than property address indicated above Stephen & Jan Lind HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. . REMARKS. ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. MINNESOTA UNIQUE WELL NO. ABANDONMENT (leave blank if not known) 4. WELL DEPTH (completed) Date sealed 143 ft• 7-11-89 S. DRILLING METHOD (if known) IM Cable tool 4E3 Reverse 70 Driven 103 Dug 20 Hollow Rod 50 Air So Bored 110 3E3 Rotary 60 Jetted 90 Power Auger 6. OBSTRUCTIONS Well obstructed ® Yes [] No Oructions removed Ea Yes 0 No If obstructions cannot be Obstructions 67' 1*" Drop Pipe removed, contact MDH PKR TYP Jet before sealing. 7. USE 10 Domestic 40 Monitoring 80 Heat Loop 20 Irrigation 50 Public 90 Industry 30 Test Well 60 Municipal 100 Commercial 70 Air Conditioning 110 8. CASING(S) 1® $lack 4® Threaded 70 20 Galy. 5[] Welded 30 Plastic 60 Stainiess Steel 3 in. to ft. in. to ft. 9. SCREEN Screened well from _ ft. to _ ft. (If known) Open Hole from _ ft. to _ ft. 10. STATUgATER LEVEL 00 ft. M below ❑ above land surface Date Measured 7-11-89 11. WELLHEAD COMPLETION 1E] Pitless Adapter 4[] Found Buried 20 Basement offset 6[] 3[] Well Pit 12. GROUTING INFORMATION IM Neat Cement 20 Bentonite 31,] Grout material N.C. from 5 to1O9t, Cu. yds 13. NEAREST SOURCES OF CONTAMINATION _ feet direction type Well disinfected before sealing? 0 Yes ® 14. PUMP ® Removed 0 Not Present Type: 10 Submersible 30 L.S. Turbine ED Reciprocating 20 Jet 40 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(s) an property? [] Yes ® No Abandoned: M Permanent 0 Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. MORK WELL COMPANY INC. 02133 71censee-@us1 s Name /j License No.. IFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) %ATMTAETs FILE NXTE DEED Signed Date Ron Danielson oate 7 -11 - Name of Driller CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVISES Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $10.00 $ 25.00 State Surcharge TOTAL FEE Effective On March 1, 1996 JOB ADDRESS (, (,.Za �'7$0 &U � �_ it_AiNIMUM FEE FOR ANY HEATINALCOOLIBVG�/ENTILA710N REFRIGERATION/AIR CONDITIONING PERMIT IS $26.00 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 propertyowner. HEATING COMPANY L✓ cl Signed C7. G'C el No. o P'Y� Approved By Rough—In Date Final Date FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE The undersigned hereby makes application for a permit for the work herein TOTAL 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 $3 6. cry representations stated in this application are tru and correct. $ 1996 OWNER? !a +S $.___, — BUILDING USED AS . ESTIMATED COST �� �� d • u PERMIT N0. 12 $ DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units_ .Circle One (Steam) (Hot Wat ) (Warm Trade Namea, Size No, A -If -C _6 �T®C7 /�'i BTU ��; a �u HP EDR $ Fuel �--r c Total Connected Load 50 Burner Trade Name Size No. BTU HP EDR it_AiNIMUM FEE FOR ANY HEATINALCOOLIBVG�/ENTILA710N REFRIGERATION/AIR CONDITIONING PERMIT IS $26.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining propertyowner. HEATING COMPANY L✓ cl Signed C7. G'C el No. o P'Y� Approved By Rough—In Date Final Date FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE Remarks: List ALTERATIONS Being_)Done: HEATING CO: Signed By: Date: CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. . Has been carefully examined Yes (`'No ( ) 2. Is free from rust or deterioration Yes No ( ) -3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes (`,('No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes (—)"'No ( ) 6- Has total heating BTU's of; o All other BTU's TOTAL BTU's '30� 7. Has a liner been provided for water heater Yes O No ( ) 8. Has combustion air been provided for water heater Yes( -No ( ) Remarks: List ALTERATIONS Being_)Done: HEATING CO: Signed By: Date: SUBJECT ollfma NO. City of Fridley 31025 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. ���� r PROTECTIVE 1 NUMBER FIEv GATE PAGE OF APPROVED BY 1 I CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/6/00 JOB ADDRESS 6620 Stinson Boulevard NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Moore Lake Park First Addn SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Rick Crail 6620 Stinson Boulevard NE 763-572-1585 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David Schweich Construction 21716 Kenrick Ave S, Lakeville, MN 55044 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 469-3222 3607 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION J7 ALTERATION O REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Install egress window 9 CHANGE OF USE FROM TO STIPULATIONS Window to meet the State Egress Code requirements. Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Permit inspection Cards Will Be mailed To Homeowner To Post 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 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 ISTALLS 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 $1,575 $.79 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOT EE Licen S $5.00 4.41 SIGNATURE OF CON"RACTOQ OR AUTHORIZED AGENT iDATEiHEN ROPE Y ALID E T IS YIdUR MIT /0'0001" iIS \ S,GNATURE OF OWNER,iF OWNER SUILDERi iDATE, BLOor iNSP F+AtE (•/ NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604Idg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: e) Le x'74 1 Tel. # Contractor: -6'--'V5 1— MN LICENSE # 3 Z C> Address: A116' _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: Estimated Cost: $� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: APPLICANT: A4 V i Tele # �1 Z r Z) i2_Ce CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 49.06'_ Fee Schedule on Reverse Side Fire Surcharge $ 1. _.001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ $1100 per SAC Unit $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: BUILDING PERAM 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,010 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 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 $15.50. 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 $23.25. 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. New Houses Only Building PLUMBIN G Permit No.: 6 Inspections RESIDENTIAL,. APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Reed. 7� 763-502-4977 FAX EFFECTIVE 1-1-08 DATE '?: ® 9' YOUR E-MAIL ADDRESS i�� °�'�e nel SITE ADDRESS �d S �+>mtleP� l E✓ �� %i' i c�l��e %� THIS APPLICANT IS: D-OWNER OCONTRACTOR PROPERTY OWNER/ NAME: CoAA^L_� e)AJ II bit-1 f irAfcr STATE/)'1tVZIPL3LQ_ ADDRESS: K.6_2iO �Itm n CITY_ TENANT PHONE: / ���� CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDS; CITY STATE ZIP INSURANCE . PHONE FAX PERMIT TYPE DINGLE FAMILY ❑ TWO FAMILY D TOWNHOUSE TYPE OF WORK: D NEW MEPLACEMENT DETAILED DESCRIPTION OF WORK r ems- r '� � ' r-, PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINKJLAV DRAINS —SHOWER _ WATER PIPING _FLOOR — BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) WATER CLOSET BACKFLOW PREV. ($15) _ CLOTHES WASHER _ KITCHEN SINK _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER —OTHER .W-011s Permit Fee $ IN I Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ TOTAL DUE $ x J-0 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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�n application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plj in the case orAll worfwhich requires review and approval of plans. / . 0 PRINT NAME CG*li,i [ .o DATE -7,- SIGNATURE OF APPLIC DATE.. APPROVED BY WIEW City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977