The URL can be used to link to this page

PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. No 2 R 7 4 Date ��!!:(f"er.�...�.,..�� ................ Owner �° 4� .....- a.1►\OS:.o...........:...... Builder .... .....1. Y►.0 ............... Address ®...... ��c?r.a1).!`49......... Address .. ®��?.�..�C� 1f"�+!I.............. LOCATION j�OF BUILDING No. ... Q.. .. Street .. ! Y �... r k Y C........... Part of Lot ....................... Lot .. ..I .......... Block ....... t........ Addition or Sub -Division ..56. [ :e-. ...... .v ► .. . � Corner Lot ............ .Inside Lot ....:Y...... Setback Sideyard ... `0 ................... DESCRIPTION OF BUILDING To be Used las: f .i y �/ Front S... Depth . �?.� .. height f Sq. FJ. l �.. Cu. Ft. ........ . �'.�.... Front 20... Depth . P.3:.. Height Sq. Ft......... Cu. Ft........ . Type of Construction . P L lar A Y. Est. Cost .... C ). ......... To be Completed Aa. a . t W.0....... . � Yf 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 th all provisions of ordinances of the village of Fridley. �,..� -1 -Th co ideration of the payment of a fee of permit is hereby granted t0_). . ............ ..4+Y) ............. 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, alter, rep ' and moving of buildings with- in the village limits and this permit may be revoked at 0 n ay of the provisions of said ordinances. / .. ... .. C/ Building Inspector 4 NOTICE: This permit does not cover the construction, installation or alteration for ring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. Origin PERMIT for Power Rants and Heating. Cool. ing, ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of / H_eating Plants to be installed—altered—repaired Make , S. tom'L7;? Oil fired ; Coal fired , Gas fired_; Gas Authorization No. Remarks Approved Final Inspection Date , 19_ Inspector Permit 4609 Fee Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., Owner Location A() Lk) Al Kind of Building How Occupied Work to be Commenced ,19_ To be CompletedA16, ,19619 Estimated Cost, (Ovew, Building Permit N Permission is hereby granted to C, t` YS Q to install--erect—use the material and devices described in the above statement. This permit is granted upon express condition that pdrson to whom it 4 granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devides herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specificatio set �forh the approved application for this permit on file in the office of the Inspector of Buildings. r �-AA-j Inspector of Buildings 42 2M11 -67V 1d11NNEGASC0 City of Fridley 53-84-s-915.51 Appli='j"Lon ftr PP=VA9 =d &M FWNC94 Dept. of Bldgs. Phone 560.3480 DESCRIPTION OF WORT 880 West Moore Lake Drive N. S. Number, Kind and Location of Fixtures I �•' En N zWATER MA. ELM Base 1st Ins4all G s C611 2nd 3rd 44th_ • Future Connection Openings New Fixture. Old Openings Co 33owor D Cesspool D PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ Future Fixture Opening ....... y ... x $1.50 $ -. New Fixture Old Opening.......... x $1.50 $ _ Catch Basin ...........:........ x $3.25 $ Water Heater :Up to 39.000 BTTTt . • • • x $3.00 $ New Ground Run Old Bldg....... , . x $3.25 $ Electric Water Heater .............. z $2.00 $ :;AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures .................—x$.75 $ Gas Range to 199.000 BTU .............. x $5.00 $ City of Fridley: The .undersigned hereby makes application for a permit for the- work herei 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 tact and representations stated in this application are true and correct Fridley, b0nn 7-29-74 I9 Owner Robert L. Prazak Kind of Building Frame Used as Res, To be completed about 8-5-74 Estimated Cost, $ 10.00 Old—Building Permit No. Permit No. l� Signe_6 ---- - . z Business Phone No ROUGH REPAIRS 5r ALTERATIONS—Refer to Code .50 State Surcharge Description ...... Install. Gas. Grill ......... r,00 TOTAL FEE $0 Class ff`A— Surcharge .50¢ CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARIM AIR: RATE, TOTAL Furnace'Snell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTL' $12.00 $ each add. 5i,^,000 BTU Replacement of Furnace 4.00 7.00 $ $ � Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STFAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ / ®. (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONllIT10NING $ FAX HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS$ ALTERATIONS $ REPAIRS- S $ State Surcharge $ .50 TOTAL FEE `.7 ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PE R,IIT REINSPECTION FEE (.$10.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $750 Job Address Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work 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. �i Fridley, Minn. '1927 OWNERj.if KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST 100'Q OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Wate , Warm AiNO. ' Trade Name ,4 s o z" sd Size No. Capacity Sq. Ft. EDR BTU , yHP Total Connected Load �rJ' Kind of Fuel '71 BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By �y (�� / Tel. NO. O` J 633 3 - SUBJECT - P City ®f Fridley � 144 AT THE TOP OF THE TWINS B U I D I G P E R M) � L 1 r RECEIPT-N � COMMUNITY DEVELOPMENT DIV." r PROTECTIVE INSPECTION SEC. 1 i CITY HALL F.RIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j J\ 612-660-3450 910-F15 10/31/77 I �- JOB ADDRESS 880 West Moore Lake Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 l Shorewood 2nd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Robert Prajak 880 West Moore Lake Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lloyd's Home Improvements .4911 --4th Street N.E. 560-4857 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION j] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel kitchen & install aluminum trim 9 CHANGE QF USE FROM TO STIPULATIONS pEEgMITS )REQUIRED FOR WIRING, SEpEFtAIt SIGNS-- HEATING, - PLUMBING AND TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES 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 $ j Os 000 $S. OO 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- $60.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $65.00 SIGNATURE bfCONTFrAC ORO Au OR¢EDAG (DATE) �- WHEN PROPS LY VALIDATED THIS IS YOUR PERMIT _.A r. SIGNATURE OF OWNER IIF OWNER BUILDER) )DATE) BLDG INSP - DATE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PER14ITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) ` ✓f7 OWNER: � BUILDER- Address: UILDER•Address: - 60 ,f Address: Tel. No.G—s NO.: C9,90 Street: LAIIL AG 0/1 , � . c� A c1c� LOT: BLOCK: _�_ ADDITION: ,Sf10,eE Ajr CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: l —, �1J lOD et TC eCJ ` A i1c f 1y1► �J ��UUl 1 �s irV Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square/ Feet: —�-- Cubic Feet: IF Type of Construction* -' Estimated Cost: $ 1 To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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*representatioiis stated in this application are true and correct. See reverse side for additional information. DATE: J / SIGNATURE: i' Stipulations: ib r tir 1--:kf i LEY APPLICATION FOR PUMBING AND GAS FITTING PER41T PARTIAL RATE SCHEDULE m NO. RATE TOTAL e 3 x $3.00 $ 61) U x x d New Fixture, Old Opening Water d9 $ m 'a $5.00 $ w C ..4 N a 100,000 BTU to 199,000 BTU � ro $4 fl, w Water Softener x Heater cr M +� 54 N ., C $5.00 m Electric Water Heater F ! a� $, N M U 00 a 4 1st 3 fixtures x $4 $ Additional Fixtures x $1.00 J Gas Range to 199,000 BTU .0 .r. xq .a •.Ca 43 U U to w u M Q? 0 O ;as lec .01 a In3 U)g 1st / f� 2nd 5 3rd 4 t.: (R) = Future Connection Opening Connected with Sewer (°) 3 New Fixture, Old opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures 3 x $3.00 $ 61) 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 $loo.o0 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 p� TOTAL FEE REINSPECTION FEE ($10.00) Job Address Q -g-0 ale's �ooea" 2y� ee- /'-1� Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herea 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 pp Fridley, Mn. OWNER J�8 h9 L •D a Az f3 K KIND OF USED AS TO BE COMPLETED ABOUT ESTIMATED COSTd OV, y O Gj OLD - NEW BUILDING PERMIT NO. PERMIT NO. / Company /y 1 Signed By r Tel. No. 4-9 %- 3 2 7-z ROUGH INSP. Date . FINAL INSP. - % j Date APPROVAL FOR PERMIT C MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE .. RICE CREEK WATERSHED DISTRICT SUITE 177, ARDEN PLAZA 3585 NORTH LEXINGTON AVENUE ARDEN HILLS, MINNESOTA 55112 (For Ottice u PERMIT APPLICATION NO. Rec'd Office MAYO 1985 Notice Sent Agenda S' Administrative Fee d� LK v-Ir-�- �(� 11..^,' a Q_ PERMIT APPLICATION To be completed by the applicant Owner: James Sampson Address: 880 W Moore Lake Drive City: Fridley, 55432 _ (zip code) Permit Application for Approval of: Q Comprehensive Stormwater se Only S -S Rec'd Engr. Date: May 2, 1985 Telephone No.: 571-3027 TSlg anan tu- . Owner _.. .... _.._. Remarks: Management Plan Land Development Plan 94f---�e Final Site Drainage Plan d Use and/or Appropriation p I of Public Waters Bridge and/or Culvert Construction�'� Wetland Alteration $ Shoreland (Riparian) Improvement Private Drainage System Individual Sewage Treatment System Other (explain in remarks) Name of Project: $iprap Shore Protection Purpose of Project: Prevent erosion. Location of Project -Address:- 880 w. Moore Lake Drive Municipality or Township: ftld3n 0 1/4 of Section 14 Township 30 Range 24 Call 483-0634 if assistance in completing this form is required. Please attach drawings, plans and other data as outlined in "Rice Creek Watershed, District Permit Information Brochure, available upon request:' Mail or deliver this form along with a $10.00 administrative fee and appropriate exhibits to the above address. "A field inspection fee on this permit shall be charged to cover actual costs related to a field inspection including the investigation of the area affected by the proposed activity, analysis of the proposed activity, services of a consultant and in addition, a fee will be charged for any required subsequent monitoring of the proposed activity." M.S.A. 112.880 Subd. 2. Applying for this permit to RCWD does not preclude your applying for any necessary permits that may be required from other governmental agencies. AS -78 Revised 2/2/81 PiWI=: Shoreland Improvement Plans for Permit: Application No. 85-52 _ ri'prapping of shoreline along SFR lot riparian Moore Lake at 880 W Moore Lake Drive Date May 24, 1985 Fridley Applicant James Sampson b RICE CREEK WATERSHED DISTRICT NOTICE OP PERMIT APPLICATION STATUS At their meeting on May 22, 1985 the Board of Managers of the Rice Creek Watershed District took the following action on your permit application: []Denied E3Tabled [UTabled with authorization for administrative action ®Pending receipt of revised riprap detail showing the ordinary high water level. 44 If you have any questions, please call 483-0634 cc: City of Fridle E.A. Hickok & Associates�G- RCWD File Bonnie Torpe Administrative Assistant FORM Ell -78 V. VI. VII. Rev. I2/81�_ •d I �� PERMIT APPLICATION PART A OFFICE USE ONLY. DEPARTMENT o TO`.WORK IN PROTECTED` WATERS, Otl WETLANDS. P.A. NO DAM ItHNATURAL, (INCLUDING SAFETY] RESOURCES ISWCD MC/C t�� ?e'�. [�1N•p Qt15C01= '' o,- Po -Please read mstructlons before attempting to complete'this application Applicant's Name (Last, First,,M.l.) Authorized Agent (if applicable) Telephone Number&areac Address (91reet, RFD, Box Number, City, State, Zip Code) Government Lot(s)- Quarter �,Section(s) Sections(s) Township's) Range's) JLot, Block//'' Sub -Division �' Fire No., Box No. or Project' Address County Project will affect Lake, Wetland or Watercourse t' _ AJ .f , l a � $ F +` if known) mbar: ,� Ii. PROPOSED PROJECT ill. PROJECT AREA ❑ fill ❑ excavate ❑ dam O culvert shore -protection ❑ drain construct [ lake ci Wetland ❑ other (specify) remove ❑ other (',Specify) ❑ wharf q shoreline o abandon ❑ bridge = 1 obstruction 11 install ' ❑_ harbor ❑ water -course .— ❑ riprap ❑ sand blanket ❑ channel 0 permanent dock IV ESTIMATED PROJECT COST BRIEF EXPLANATION OF PROJECT FA - JUSTIFICATION (Explain why this project is needed),- '411 ENVIRONMENTAL IMPACT (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects) ALTERNATIVES (Other alternatives to the action,proposed,) ,z. IX. I hereby make application pursuant to Minnesota Statutes Chapter 105.42 and all supporting rules for a permn to worK in or an= me aouve nameu prurecieu water(s) in accordance with all supporting maps, plans, and other information submitted with this application. The information submitted and statements made concerning this application are true and correct to the pest of my knowledge. STATE OF Mi-nnoSl<U COUNTY OFgl Signa�eofwner or Authorized Ag t Date see. Date !J Subscribed and sworn to before met is >< � Distribution: day of jU4 19 GLORIA C. WOJACIf `White: DNR NOTARY PUBLIC - an11111J€SOTA Blue: SWCD My commission expiresHENNEPIN COUNTY Green: Watershed District Jun 1 MY commission ExpiresJUNE06,1991 Goldenrod: City Or County Signature f otary wv+nnov Pink: Army Corps of Engineers Canary: Applicant j7o-v. I �* -- -v - ":W� 1 "Awv�-'7z:;�� "-�' �.,''-' ;_'�'.' !'"'.4��,,��. , .� � � � --'Z!'-"' , , � . �g" OR " " " 1 0, : Or , , " - r " " K . _�. -SA.%- �0&01 _-%Wo . Ir �11 I -'�'��'�" , , " - MOM � — -, '�1"t'i" '��' " I- *t_'*" " ' !_ , _�' '�' ��_ � -. _� �' ',,'�_ �' ;' , '' ; ��:� �� , I 11 , - ' I :' -,',"-.'- , '�_ ' �'�' � �� . , " ' - �'�",- "" "�,>P,, 2 A , - ➢ , U, _;1 AW "j, 1, -� &�'. , ;v-''� I , , - -"-- - , , �, �. I'��"�"'_';' i�'�w ".— ' - - - , -"r'." " ,� ,,,, , '14 ,� Z-�f_"' �'�t� i4 1, - �' " � .... �'.,'�.! �� - ._ I �11_�`� "", _'. 'Yaw. � I - " j - 1 -1 Q - W-", -MW v 5, A, A '� , 11'� � "'.�'-',-�'! �A' 'O�A 1'�- - , - �. , " - , __ 5't. 7� - 11el-1.11- _', __ - , . "� iv, � I 1 V551 �� , ,", 5�4 , ,- - - - . . I * " . , I ^�;""' ��__"'�' - �- _'��' ;' 4-- ; -��' , '�"�"�. �'_ "�'4��i'-�' _ �_' ___ , I - �_�"' a -, �S' '', '_" "I ,1 '. ". �. _;��;_,2_ - "W : - _._'� - " X 11417 � ---"- - -otz4w,: , QW. & , EQ VOW 5 1 "'nn - -, - ' .Y. . '. px , 1 , ja 4 co .- i- - , - � - *l+"'- , � 5.",11-42'A'."j"'. , �� I- "�.%'.�",-��:"��,7;',�--,,, ' 114 fAlly; �'- �"1�11,K' ',� � - 4 , - , 5 �"� I -, I - ��'� -' , ,.- . _. , - `�� T �'� '1, " ".. - - I - ' - ' 1111'"' '-'��".� � �"�;�'�"'' - � ". W I I I ."", 1, -�' , , , , , , � �: , ,1� ',�r" � I , � - '7 , . �ln_&Tk� � M, 1 , -1- _;I �' _1 , . ,.�, I ; 0 , �" �'�, 4 - , � " '.�' " I � � - - 0 16,10jT . AW , ". % �. , ir it - - . �� "� - , I - , I , ' -A., .- `-:1- �� c , � .. � " , - -1 WnMn Y A '-�''. -- '�� , '11' " "'� �:" - � W, � - ., _ _'� , - I '�'�' , � -J 0- �,Y 'c" wo �n I -0-0. -, '" ;'�,� , �"" --a - M -�Qn ; �Atjvo�Wrj, 1 V_&.� .. � AT, WO A � Onn".1- , , " As 0, . � �- ,_4'�� , _111.1� I :" " - -_ ' I - '' " �" _�' -"'_-�, 1 A Q-0. T. � , , 2 '. , , , T' ;' , � �� 'K,_ "_ '. _ - -- - --- - - "'r -.4-, , . , , , -_ " ..- �' ' , -: '' '� � , � -:: - - �;-' � . , - � � , V�W4 ."'�: �1� .- -",�"_ _'�� " --i-, - ""� 11 �il � 11-1 -�, � .. " -'�.� ---, � , , 4 0 : " -',��e' �'"�L 7 _'7_�" .. _� i��'':�, '-- , - , , ,,, , 4' n" 141 -go ". , I - _'"1 V, ?"" - , - : ., - --, �ii 1- , �Yv� 1% 10 _ -, -0,1. - �' _'�'- �' �_ r a �� - vn"-'AQ —, 4, -� �.�15� � A I Y Y_- --- .... ..4091 --','I �' . -��' W=— " , � , - , '� M A F - -- "�' - . I -1, '�._. . �. - ,I- - _X-1, 'c' . - w -�ni," , � I , , _ r 11: �'� , - , - , �ri ; , 11&'; " � �" , _ '�' ' i'� ,� -': I 11 i " '�� - '�"��',�O, - " , " N -_ " k44 - I - - '' � .1 ILI ,rr,- , , 'r . � -, I:r"',��".. �W_u 1 q � �4 1�11"',", , �.."'_' r - '' ,- �.7�" � �� *' �7t; 2-�5'--two _1 SAO " '4_" ` !'-!� �' -�-'!�"� '�' T', ,_�'�,_': _ , , 11 - 1 -� � 1t;1' - , , � ""�' , - . .'�7�� "M I I too 1 � p 11X-4� ,- I ��' %p , "go Mon, , V'�M' _; 1- I - 'k .._' - ;.' , - " _.Z�Io"� "" - �'_" ' - .'-'� "_'';O'' - ��'_:,�'�� '-f1 __"' - , "�-"'-' I ', '' ',"'_"" - ,�L- - "�?. . ", ". 1, �'- � , '- `7 ";�,:'��' - I _.". , vvvw�" 'T , '', -, ,''-,_"� ��;�"',�' i -, � ''�' � - ." �� _ -1 - � "Now 1_� 11'1� �" '� �'�_," , .�4 .� -, � . 5 1 " _.'�'-_t - � .' , "A"; - --- mw � -1 .*M 4�"�,_ �.'7"��"' � -_ 7, �.;; � ___ _ � 41'.11.1' - " - � ��' 3, �' ��""�'.'! -, -, , - - - "-owl 0 02,-:7 ��'.- �_' - --- " "'� � AMUS"! , 10- 11 _�__'+'� -, 4, 4, 4 4, ' - - � , . . 6 - , _"'�` 1, �- , - o '""'�---"'" -� . ' - ' -'� , - ��O � � - , _�',�,'�'�'�!_:'"qg Wod -, - - - __ %_ , � , ,". . ` :9 _11- 4 . - I - I - - I'll -_ I , X � V. Now. ,,-'��', � �'- , I , " �_ '�--�i��'�'-, "- "'- Q TQ-� --l'',-l" , A �'. . -, i" _j I I " , , ........... .. � , ' ''�"' � - - , , .,�;."" - .� - , , I— .,-.--, --'_-_!, , jyj" mp - V MM 4", �14' - - I ��]_' _11F., T � '4 '� " , ', � -�- -'Ii, - z . � :1,11 -I " ', -,- ., ',N' , ..; '�" -, '' ", %_ � 1 1. " - _ '�1 r'.0 ,`- " I _ Z� �' "�"'� � " " � _' -, , I'I . - .; . --- � - - , '' , , - .- � " � A I � 1 ,Si , _ � , . 7 "�--i!�� " �� 1, � ., _ , . "�:_.�, �� ';l �;� I 1. 11-11-1. - . �" �'�' ", f, �' , - A --no 1 , "".o''I , , , " "AxWW__-_ajRQv,�, i " Z��"4"P44-1 j '�'�-'�'" '4'� ,�'; 17", , - - �-, , , 4. �' _ �'. ' �n' �: .. _ _ I , � -'�"_ "'."je I �"'K v , , K"..':':,", -, r.1." '�"AV�4;�"'-'_:�",� ---- -- _�_ I : , _ - ., �' �, _ _ - �11 , �_' , - , - . "a" _". - - - � - ',� :� - ,.. � " I �r '' e" , " . .. - -_. - - , . , , ' : Ph - - , - - � � , I - .- -� ", �� '; '� - . - - al a 11 , � � _'�". - ';��_' -'� _. �'� " - � A - - - �' -'�'- , , , - � ' - �. - 'O";i, " . -, . , . �. - " , ", ` -",- , , _ . 3; � �i . v , I � j I , 5 0 - 115-4-20— I r', '"� - - I ---------- -_ - I 11 I I _�� "' _'��' . - �.' � ,, .1 z� '-, A I I -- - - , - . - A �=Du �Wgnn I , - 1. - , �. '' ,��. - , �;' myu, n� n , _.� ,��',� �' ' " - �, -, :''�57'j' �'i '', vm-sf Y j6ny -P��_-'j�"'��-' "I IL-_0" I— , - , ,. - � W- a �?r,�'� "��;: �' _- , , , ' �'- �. 0 _� _ , - - , - , - , ,- - ' '. _ � ��"' ,"'.1 A ,�'.. .11 .. , .- � ' . " � V7 - , , - , .�- - I , ,! 111 I ,_- , ,� -,.'-'-. - - - ��O. �. .1-7, -.-� " ,� � .. _-t " - , 1, " ".- W - _;�'.' I , ", - , - __L' - -�.' - , `X - �' �. -- - -�--!�� - � � � I _'� �' , _ _� I -1 - . _ I 7' ;_ 177; zi � -, - i.. _�,'� - , � ., - , __.�'Zm� - I a , . - - � 1` -- �- - - �,� - __ -, �. -, ___ '' . - I—- �. � -_ - 1- � , � , - I � , i'�, 7 � �. �� ,' , ''... '� , �5 - - �' ,: �' '� K"A- 117 0 " ,-"--,, � -- 11 '�.;� I __ ''i., .".- ";�_ I ..i_ I .- ,- - , --, ��;��'.r " � " - � t_�y__: , I ' - 11 -if 11�' '.". �. . 11 '!4, , I , t - -, ,� � T '. " , _n'. _ � _ -' �� , , , , - qy� ". � - , - . ,4 - 14440 A �-_"_''�,' �. - � , . I'll " , . 1 , - ' r7lf 6 � -�`��: 41' � A * '&�','j�1'___ - '?� -:� � -� �'� � �-'� , . "e�:�'-'' � -' -, , � � 1: ."�' , _ .. '' � , M-E _ '- '-.�.' I I � �� - - '� � �"-"'-'_ - A=,, Vol �r''�."� �_ - A � " _j ,,, � � , _ f, ""%.�'�' , . W. � �"� '� I - - " ' ,-- - - Q,Tj , I , I � -;"�!�_'� � -, , -, - , c . � , - - I � - , 1; '; , , -�� ., " � �?,��-� � ... . .. ;_ � � " -' �' �' ,� �- --'T--" _!.- - I _.''� - �,,'O 177010if, jh";"'� � .' ''-"C�_ � _, - 1�?,i� : I".,:. ;' - I - " � = ,us !-- 114 . " - � �:�' , - , '.� * �'pg 1, � - � I MION lr'l - " % �"'��i""'� -- Q _ W-1 - 4 � I ". . � - F_ . ,'� I ':' _� "'-;0_" .�_ ,. , 4�4_-, '_ " r; , , - , - - -,�,,�,-,.�EK".",.�,11�,,,,-,�, - - -, , my _�:r �'�'S � � 9.1 "? 'i jj��t';�'� '�..'4_ . -, 11 WXY, WAVOW . � - �. � " � -- �';--!"; ".," _ - - �-- _� - "-]� -,-,,- �--,, W"MI _ �""", I . � - _ 11 � �' � , � `,."' �.,.,:�,-v,� '.' 1 _% , - -� � - - - �e4 , , � '�%�'z'�"�'S�' 11 -A" Ap " A_W&") A I .11 . " �' t�' " i" ,�' 1: . '��*-':� 4 _"�O Z ' � 6__'�_ "._ - I - 1, 111 , _" , ' �'. "I" -W �-�-Qq*-'K%Qho h__ QQOM,� , "," 4,"'�" - ,'' ' ' ' Ii - - -"� � -', - - , _�.',�� , ", I ."�N'_ _.' ' ".- - ', ' -4,- ' ft, ','j-"'. 4;�_ -'_�" '�','��'--' - �' '-'�� , , , -��k"'�"'j '�jvq, ' of TIP . �' 1. I.i _ 7'.,_�� , -1 . - ��, W70 a n, 1 j �� ' 4 ny z . I -, '_ � - �-�A'n,� wm_n� _ V - , _41-6,0611 �4" - �;",.,:��__..-�-. t, , -'g;�-,t�'.� �2 .... .. - _ 41- ;�--!'�� 1 � � - ,"�'i ,' T,__ - __ �"` 1; - , " - ,R__ -,4_- � _: -� -, 'QANY YoMn�7�gl"x___ — - -,-�p�,"""�-,.,��, " Z� 7'', �"-"`U�14�'i _" _ I - " �'4 - , !_ z ,'r' , �, , , , -,-i�.1,��,, , -. - � , ' - - --�7��-_ - --.-, — �` �4'QAR'� �,�' "'J"i'_�,"MR-9-0 War& p so do " -:' � 1 _11--l" " . , " " 4"�"'��, - 1`4� ''. , .1 _�� _. I � - �:' , -, '�';_-�'__ " j '�-' , -, �;'%�' I I � .1. _1'_ 11 - -11 I - �' h, :�'- ,.,,�_,'�� _" I I , ;'�'_ � 11 11� _ �' , S;� �,i _ - r �-I''� - _ _", _'.' '' � ._��' " . , I - I- ` " '_� I -.:, - ,::-----��-',','�".,'S',�,., _� ___� .'e",":' i'-, - . , - , - , - - z�� v - I � � _��- _. ` -, '7'_:1 ,- �-'_�, - - ' ' � att .. �- "! � - - ".._-',�'�� j.�� __ �'-�" . - .1 �:`-.�' U-_�"Z, t.-_��t - _- � , " I -� - .' -" - , -, '* � � % - - �k '. - . - took -_ 0 Q 011..�, � v �v . ;-, - -'-'� ,�' - -, - , " "'. -11 , i - - - , -_ -, ,- - .-, - . _' � -, _'. , � - ,.,----, 117 -_ J'4_) Is r- .1 MEN&-0245051. '�' , - .;"I - I , , _�" , ,--,-. ,0411 T - ' - � , ,� �:',' ' ..� %- '-'��' � -L . , ',;:.':', " �---' � , - ,j , , " :_ _ 11 , '�,z",;�;,,��",,!,;,,'��,�,�, ��' -�: '!'�.'.'��r-'i _'� -"'�-_-' �4' " � :_ . 71,_1Fv__' '$,"" ,-, 1.-"�"'� 1. ,:- '� , .'', � - '�'e: . ,�" i I __ .�_ "'' , - 7 , �__ ' - - . '_ �,�;,��l!,,,'��,�",-,7�-�-,-,-��,�" � , ' �'�._ ,: .� " _. , " , ` �' - lj"'�" 11 ,".. 11 �- " i_.' P'�' - � , � -: it;�'� � �' j , , -11_P';e�'� I , I � _:'-,�' - , e ".-": a � " - I � - - - - " � I-, �, i� - - -, Z'' �'.' ',-'i -'-' "Ovy '_ " VIVE �t� 1 _K"Q5Qp�Q - ' - l.i_�,___ �'_ - � � A Ponta ISM , . - _; .", �. _��_ A" ' V, � "OY ,, - Anm_-OnswM1�4 . �S 1 � - �- - . � - A U..-- " '�' �' -'� '-�''!.'_�--�"" - . - , _. -1, � 1, . 11 - _1" , 1. r '��. - _ . � - _ - �_ �� - -,"_ _ ��l '�� , �_ '-, " . � - -- - - � - �. - -_' __" '� � - �" "T 01,00100; � ,' , - 'I 7 '5 W,Z& __ ,I � , - N W-g - . " ._ ,"��' �___' v��" � ' '--- 0 _ _. 'n. ','�" _.'�.*'_ —, _ ... , - w- -a, -OW-10- A-- - " 10 " 1 nv� , . � -J� ' Amm"M�Y�--" -Q'Q` '��'. _'�� .. , -,101 "no 1 1 A '��-- -_'�' ". 11__' _4MR&A `�- .1, ; yv-eo jKQ ;-�A�4"p ",YMA Y-'�_' , '', �1111�1; --�,-i-.�*i.�,-:--*�,--7"�,K,.�',-��,-",7�,,-,." _� ": _- "'k, - z� -1�."�"r� ' �'�".�W�''.'__ �' M -��o�-y�2,-�--,i-;-��,-�,.�,,,,- , - , - " , " - `T' - .. 4� - , 'j, 'oZ" ,4- - - - -4 , , ,,, , I I - ' �' 1� � W14 - --,,�:��'i":�.,��- _- � -'_'��, �,-�,�-,�-�.'�,--,�-,� '-"-J�""':�_�-'� 11-'-IF 11� �' � *''� , � ,W4 ". -" �'* a, - � - ,""' - ,_' "".. __ - � - � T'�, I _ , " "', _ .,, - " Q �3 - , . �"Ms" " ,01"Yj, " , , � I _��i -�; -, , yn�-� - ,. _"' Qjv-&"�=Q�j - -- -, "R MA - ""� �4". .i'._A=v? 4m oz. �xv- , .'� "&Q, "Y yj4Yn ,AM ." 7w,c' -- ", 0-0- - - " nnqo T JOUVA-My WAN -', W A WWWO V-0-Ina-Aw"j" 1 � ''�r'�,':��'-.�'.',' . jAWMxW__'j_ TAQA�MOVWAQTQAW '_ A ... , . . WS-OnK, a a ��"� � , -,, � - - Ory , SMAKTX""%�- at ., , , ; - - � "'.'.' I "'�--`�� Mem 1, � '�' L '- � ', , , _ " �_ . , , ,� -..2----- W41' QQAT - �' ' � � .,' W! �Y_" , I - � " *1 -J"��d�'- �'.'Z____ �"' ;,��" �'-z;-�'fp is g- " � "' -'�'t ..... ..... " � ""'�'. " � ,1 1 � � �' -��";� �':! � " _ -- , we GlAns vp A 0 vm Q- Q _ _ - , , - ' � ;_ � � . FAMEWWW"Ry -y" q� ", " 00"AaKa" A It— --- any .10411± .11MATOOMI,g-l-'so�-az---,-"--�N�l- E, - - __. " , ' - '_ ' -- ___ � "';-n�' ,'_ -"' -�";_ - -��'t �,�.�.'.'..',� 01 '7� �,'. _;�' , " , - 2001001 W " -�"'�7 " � Tz' t', ., I " . "_--'_' ';��.,_ . 1, - 11 .. _.�'.�", -T. ��.' � �' ,'_�'�', ...._.._"�:"' . � -_,, � - -'�--_''%;' - - ol .1 , I � , , - � I- 1 1. - 1'1 *_ - - I _ ".' " - - --,),- -, ;?-.'�_-i'%'��',- " 1 , " , � _�;". , , , . __', , �, ,I _1" _� " _", � � a51��" -I I I ; , � , � - � �7� �__ I _� . I t.'�'�. " , � , � 'i ""I' -- --, ; '4, - -"��! -'-P- � �� ... ... , _:�-'� lt''��i-'- --,5 ." .'�� 1� � , '�' � - - " , , . � _-1=.__W0?_ _W_ , �� '. � - ,", P_ -- QQ MQQQ -501 0 "a' Y�Ne" � � ."co"p", & " -, 11 "On""nsk".3 I " ""A, -: ,-, ,_�..'�'_'_ -�"'-?�"', 41 � .41C " - -, "I - 12y".u1ni- , Awfa '101wr"I'SMAS =,I:'�-,�-L--;*-- -'��'��3��`�= 412 " �� "��.---:'-- ,-- ._XWWX _. -0". , � . _ . a� _ 7'� ."_ 'q- . __- - -, t '.�"- .- 'a" Ky"201M � -, ��_ �'_'-� � '_ j, . __ � '�4- " ,,, ,. � �� - ' "s "&"�YQ,Mo, - _- - ;�'S_ ".'F-t� -4E�,��"'�'�" = 47 U -_, , " , r . ",A"OT.un"a A'-'�" � :�`_lr',`�' � W" "'' -;ns ��'.'r"�.' . A -"K Wo oz A�w<�t4a,"-6,0-.��.,I� 7" �_"c I �njl�nAjjwh Qqw, A Tva"R"OYY AQN�vv.n nvo"Nwn , -Oj� _Q � f-"" _M�_ __ � � Scm I_ ,",- - , y""Q, TQ,im - 'a '"", M SAW.. c yop So"Q - �� , 1, Sr �-L�"-"�""' N , .. MRO MMUK WWFM� '�t��,-,.-,�' "'i �"Nyo- K , . � - `� _ , * 4 ,� " gymaw i ��_"�L:��,: '"' �r'.� ... �' - `�L � � '-�-,";'A"I"- , k_ _Wn� W - -,,--A �:- -'1�-.' %�:"'-V"" 1 , .'_;�'"� � _�10 1�1' ,,, , , " i4' . �i "" , �' - � 1�1 I , �' ' - ngg I— Q- q, � ,�'�4�' � �*�;.�� ,�� W-A j � �i !'I' -1-'-'M , '�'. �" t 1-4- " � r�' �'1111 s . - ,,, . .'' I -, , � .',� , -�" � 0- " '�'- � �' , '7 �_ I _ 7�Qjv. .. I , _-, ",". .-M-A-A - �, _ K -9- A A %_ -, - --- '._'__'' , � ,_ �, . . , 6 � ,v "_� , , ' _.� - .;_ - , * ' ';�� -.��' - - , , - � _ _� " , , '.'� 'Z:�_ .- � '; -, - ., - _' - - - .- __ , � -, , , : -, , ,. - - - -1- - � z - - , :' , " - �1�1. .- - _;.� 1 . lt� --� -.Aw - � , " - -. � .'':� _�. , %.. , _ ... - . , : I � , - � _ -, , _*_; - - -, �"�-- �"' ,,,, , '� - '��--_,��"--- `'� ' Fz: '-�"�..':_;'7__�,�""' I . '.... - " -'--,r ,� - . �' . . � _- An� �'- , _ '�' 1a 01 1 0,01 I �;'S� ,,'I, �. 1;,"' �-' , , ; '__11� "-'I. , "Z' 7'�" " , " � �� - � ., ,% — - . , � '�-:��"j�_-.�""-�-_':..' �-�':Jk - -, " I 1e__.�. �- - , , 1'_ � I " W ,IF d1jip..DEPARTMENT OF NATURAL RESOURCES Section I (To be completed by applicant] I Name- of Applicant ----l—n(s) ion(s) Township(s) Range(s) County(ies) Sect PROJECT LOCATIONouarter Sectio I Project will affect: (name and number of lake, Wetland, or watercourse) I hereby submit this application for permit to: Sign of Applicant (mark proper box) appropriate water 4-woek in protected waters .�,Section 11 (To be completed by local unit of government) The following local unit of government comments and/or recommendations are submitted for consideration by the -Department of Natural Resources, in the disposition of the referenced permit application. (YOUR RESPONSE MUST BE SUBMITTEUT-O"THE DNR WITHIN 30 DAYS.) Water Appropriation Permit Applications are to be sent to the Central Of- fice St. Paul, and Protected Waters Permit Applications to the DNR Regional Office. SEE REVERSE SIDE FOR CORRECT MAILING ADDRESSES). 4' 4_ j ,4A A� Was the proposed project field inspected by this local unit of government? [:]NO OYES (if Yes, give viewer's name) lViewer's Name ITitle Authorized Signature Title to Name of responding Soil and Water Conservation District, Watershed District, ,Clty,or, County Address (of the above named local unit of government) blephone No. (Ai (DNR — Division of Wilers addresses on back) REGION 1 (& BEMIDJI AREA) Regional Hydrologist DNR - Division of Waters 2115 Birchmont Beach Road N.E. Bemidji, MN 56601 (218)755-3973 Detroit Lakes Area Area Hydrologist DNR - Division of Waters P.O. Box 823 Detroit Lakes, MN 56501 (218) 847-1579 Fergus Fails Area Area Hydrologist DNR - Division of Waters 1221 Fir Avenue East Fergus Falls, MN 56537 (218)739-7576 NW Area Area Hydrologist DNR - Division of Waters P.O. Box 502 Thief River Falls, MN 56701 (218) 681-7789 REGION 2 Regional Hydrologist DNR - Division of Waters 1201 East Highway 2 Grand Rapids, MN 55744 (218) 327-1716 Grand Rapids Area Area Hydrologist DNR - Division of Waters (Served out of Region 2 headquarters) Duluth Area Area Hydrologist DNR - Division of Waters French River Hatchery 10029 North Shore Drive Duluth, MN 58804 (218) 723-4786 REGION 3 Regional Hydrologist DNR - Division of Waters 424 Front St., Box 648 Brainerd, MN 56401 `(216) 828=2605 Brainerd Area Area Hydrologist DNR — Division of Waters (Served out of Region 3 headquarters) Cambridge Area Area Hydrologist DNR - Division of Waters 915 South Highway 65 Cambridge, MN 55008 (612) 689-2832 DIVISION OF WATERS ADMINISTRATIVE REGIONS AND AREAS la�rmni m Iws wa of ua—oft River Fa IIs . r wa 1 • BE iDJ 2 h bbNd — *GRAN I RAPIDS REGION 3 (Con't.) Little Falls Area Area Hydrologist DNR — Division of Waters (Served out of Region 3 headquarters) St. Cloud Area Area Hydrologist DNR - Division of Waters 3725 12th St. North St. Cloud, MN 56302 (612) 255-4278 • Regional Office .•` Regional Boundary a ■ Area Office Ca ridge .-- Area Boundary � a- �L • RC Detroit Lakes ■ .raem,a Area Hydrologist —Wax DNR - Division of Waters ami tw 1400 East Lyon REGION 4 P� `w3 Regional Hydrologist Fergus Falls DNR - Division of Waters (507) 537-7258 maw ■ New Ulm, MN 56073 • BF (5 07) 354-2196 Area Hydrologist DNR - Division of Waters St. (Served out of Region 4 Cloud Area Hydrologist Spi er ■ Qa A-.* ,rte me u pro„ .W&- Regional Hydrologist & Areas moom N- DNR - Division of Waters (612) 796-2161 P.O. Box 6247 ar hall • EW dma, a�esm�a naney .ao an Mwl.. oo ato ma mum REGION 3 (Con't.) Little Falls Area Area Hydrologist DNR — Division of Waters (Served out of Region 3 headquarters) St. Cloud Area Area Hydrologist DNR - Division of Waters 3725 12th St. North St. Cloud, MN 56302 (612) 255-4278 • Regional Office .•` Regional Boundary a ■ Area Office Ca ridge .-- Area Boundary � a- �L • RC REGION 6 Regional Hydrologist DNR - Division of Waters 1200 Warner Road St. Paul, MN 55106 (612) 296-7523. (No Areas) e34 Y 11 J-11KOTI I`g� DNR - Division of Waters 500 Lafayette Road St. Paul, MN 55146 (612) 296-4800 REGION 4 (Con't.) Marshall Area Area Hydrologist DNR - Division of Waters 1400 East Lyon REGION 4 Box 111 Regional Hydrologist Marshall, MN 56258 DNR - Division of Waters (507) 537-7258 Box 756, Highway 15 South New Ulm, MN 56073 New Ulm Area (5 07) 354-2196 Area Hydrologist DNR - Division of Waters Spicer Area (Served out of Region 4 headquarters) Area Hydrologist DNR - Division of Waters REGION 5 P.O. Box 457 232 Lake Ave. South Regional Hydrologist & Areas Spicer, MN 56488 DNR - Division of Waters (612) 796-2161 P.O. Box 6247 Rochester, MN 55901 (507) 285-7430 REGION 6 Regional Hydrologist DNR - Division of Waters 1200 Warner Road St. Paul, MN 55106 (612) 296-7523. (No Areas) e34 Y 11 J-11KOTI I`g� DNR - Division of Waters 500 Lafayette Road St. Paul, MN 55146 (612) 296-4800 RICE CREEK WATERSHED DISTRICT RCWD permit, No. 85-52 SUITE 177, ARDEN PLAZA 3585 NORTH LEXINGTON AVENUE cc: City of Fridley t__11 ARDEN HILLS, MINNESOTA 55126 E.A. Hickok & Associates'. PEP-MITRCWDFile . N k Permit Application No. 85-52 Issued t o : James Sampson, 880 West Moore Lake Drive, Fridley, MN 55432 -x Location: 880 West Moore Lake Drive (north shoreline of Moore Lake),. Fridley. x Y Purpose: Approval of Shoreland Improvenmt. Applicant proposes to rept afi existing 2 -foot high wooden railroad tie retaining wall along tl F shoreline of a single-family lot riparian to Moore Lake. -; At their meeting on Septarber 25, 1985 the Board of Managers of the Rice Creek Watershed District re\tiewed your Dermit application and the recce` ommendation of the District Engineer together with the following exhibits: 1. Permit Application dated May 2, 1985. 2. DNR Permit Application 86-6021 received August 8, 1985. 3. Tie Wall Construction Plan and Profile received frnan James Sampson, S%Ytefber. and September 11, 1985, respectively.. They found the project as planned to be in accordance with the RUl,es-and Regulations, and Guidelines of the District and therefore approved the Ky permit as requested, with the following stipulations: NONE A followup inspection will be conducted at the project site to asare.',oitty' pliance with all agreements, terms and/or stipulations to this Permit; Fai. ure to comply with the foregoing may result in rescission of the Peretit, ori is in violation of Chanter. 112.89 MSA, a misdemeanor. This document is not transferable, and is valid for one (1). year ,after the.`"s date of issuance. No construction is authorized'beyond expiratign..date� If Permittee requires more time to complete construction, a renew�il 4� the; Permit will be necessary. L. -- - Please contact -us at 483-0634 when the project is about to Commence -0 1, inspector may view the work in progress. The enclosed Owner',s Certificttti' must be forwarded within 10 days of project completion. } Date of Issue: October 9. 1985 i rest ent, Ku arip o Managers Form C11-82 4 A k*EF ..; NA -02734-01 PROTECTED WATERS PERMIT P.A. Number INNESOTA TO E RECORDED WITH Department of Natural Resources 86-6021 Division of, aters THE COUNTY RECORDER Pursuant to Minnesota Statutes, Chapter 105, and on the basis of statements and information contained in th permit application, letters, maps, and plans submitted by the applicant and others supporting data, all of whir are made a part hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant named below to change the course current. or cross section of the followina: Protected Mater County Moore Lake 2-75 Anoka Name of Applicant Telephone Number (include Area Code) James A Sampson 612 571--3027 Address (No. B Street, RFD, Box No., City, State, Zip Code) 880 W. Moore Lake Drive., Fridley, MN. 55432 Authorized to: Construct Treated Timber retaining wall 2 feet high along 33 feet of existing shoreline of Moore Lake with tie backs every 8 feet; all as described on application plans and supporting materials. Purpose of Permit: Date of Permit Expiration Shore protection and erosion control 11/30/86 Property Described as: County Lot l Block l Shorewood 2nd Addition, Sec 14 T30 R24W Anoka As Indicated (6): (if applicable) As Indicated (9): (if applicable) I Does Not Apply Does Not Apply This permit is granted subject to the following GENERAL and SPECIAL PROVISIONS: GENERAL PROVISIONS 1. This permit is permissive only and shall not release the permittee from any liability or obligation impose by Minnesota Statutes, Federal Law or local ordinances relating thereto and shall remain in force subject tr all conditions and limitations now or hereafter imposed by law. 2. No change shall be made, without written permission previously obtained from the Commissioner of Natural Resources, in the dimensions, capacity or location of any items of work authorized hereunder. 3. The permittee shall grant access to the site at all reasonable times during and after construction to authorize, representatives of the Commissioner of Natural Resources for inspection of the work authorized hereunder. 4. This permit may be terminated by the Commissioner of Natural Resources at any time he deems it necessary fol the conservation of the water resources of the state, or in the interest of public health and welfare, or for violation of any of the provisions of this permit, unless otherwise provided in the Special Provisions. 5. Construction work authorized under this permit shall be completed on or before the date specified above unles. terminated as hereinafter provided. Upon written request to the Commissioner by the Permittee, stating thf reason therefore, an extension of time may be obtained. 6. The excavation of soil authorized herein shall not be construed to include the removal of organic matter(a-. indicated above) unless the area from which such organic matter is removed, is impervious, or is sealed by the application of bentonite after excavation. 7. In all cases where the doing by the permittee of anything authorized by this permit shall involve the taking, using, or damaging of any property rights or interests of any other person or persons, or of any publicly owner lands or improvements thereon or interests therein, the permittee, before proceeding therewith, shall obtain the written consent of all persons, agencies, or authorities concerned, and shall acquire all property, right and interests necessary therefore. 8. This permit is permissive only. No liability shall be imposed upon or "incurred by the State of Minnesota or any of its officers, agents or employees, officially or personally, on account of the granting hereof or or account of any damage to any person or property resulting from any act or omission of the permittee or an;; of its agents, employees, or contractors relating to any matter hereunder. This permit shall not be construes. as estopping or limiting any legal .claims or.-right'of action of airy person other than the state against the permittee, its agents, employees, or contrac'torsi for, any.;damage,or injury resulting from any such act or, omission, or as estopping or limiting any legal claim or right of action of the state against the permittee, its agents, employees, or contractors for violation of or failure to comply with the permit or applicable provisions of law. No material excavated by authority of this permit nor material from other source, except- as, specified herein, shall be placed on any portion of' the bed of said waters which 'lies below(as indicated above) if applicable. Any extension of the surface of said waters resulting from work authorized by this permit shall become protected: waters and left open and unobstructed for use by the public. This permit shall become effective on the date it is recorded in your County in the Office of the Recorder.": Provided, the work affecting protected waters authorized herein shall not be commenced until a Notice of Permit'; has been conspicuously posted at the construction site and a copy of the recorded permit is posted on or near the premises upon which such work is conducted. A Notice of Permit will be issued by the Commissioner upon' his receipt of a Certified copy of the recorded permit. All general and special provisions of this permit shall bind the permittee, his heirs and assigns' and shall run with the land. After the completion of the project authorized, permittee shall supply the Department of Natural Resources with photographs of the project area. Permittee shall maintain the authorized project in a stable and safe condition. At any time the Commissioner; finds that the project is subject to instability, creates a navigation hazard, has become a public nuisance,' or has fallen into a state of disrepair, he shall order the owner to repair the project within a specified;. time. Any Commissioner's Order terminating this permit may also require the permittee, at his own expense, to remove within the time specified in said Order, any authorized project constructed under this permit and, if applicable, any unauthorized project in violations of this permit. Said Order shall also require the permittee to. restore, if necessary, the protected waters or beds thereof to the condition existing before the unauthorized activity.: . This permit does not obviate any requirement for federal assent from the U.S.Corps of Engineers, 1135 U.S. Post Office and Custom House, St. Paul, Minnesota 55101. SPECIAL PROVISIONS The permittee shall comply with all rules, regulations, requirements or standards .of the Minnesota Pollution Control Agency and other applicable federal, state or local agencies. Erosion control measures shall be adequately designed for 'the site characteristics. They may include staked haybales, diversion channels, sediment ponds, or sediment fences. They shall be installed prior to commencement and maintaining throughout project. All exposed soil shall be restored (by seeding and mulching or sodding and staking) within 72 hours of completion of project. uscoe Anoka County SWCD Rice Creek WSD City of Fridley t/ ATE OF IVIA/NE507A 'INTY OF HeAWE P/A/ ;scribed and sworn to before me this '& day of 66CEM8Lk 19�J commission expires: V _/5 otary ubic Signature 9.OI,l A. n1l eta a Q• � ,:�: °F NOTARY PUBLIC • i Executed at St. Paul, Minnesota this e9'day of / Eco 19c5� COMMISSIONER 0 MINNESOTA DEPARTMENT OF NATURAL RESOURCES � ", Aly Commission r%! I,;$ Apr, 1401gg4a Authorized Signature Xent Lokkesmoe, ional Hydrologist SUBJECT PER City ®f Fridley 2-.-959 AT THE TOP OF THE TWINS PERMIT BUILDING r 1 9 1 _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 0/70 d 1 1 i NUMBER REY DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/8/93 JOB ADDRESS 880 West Moore Lake Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Shorewood 2nd Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE James/Beverly Sampson 880 West Moore Latae Drive NE 571-3027 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Patio Enclosures Inc, 5120 Cedar Lake Rd, St. Louis Park M(J 55416 525-1494 1676 4 ARCHITECTOR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 16' x 12' Three Season 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plane WARNRIG " Before digging call for all utility locations 454-0002 REQUIRED BY LAI TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4f476 $ 2e24 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $72.00 Fire SC $4.48 RUCTION OR THE PERFORMANy OF CONSTRUCTION. PLAN CHECK FEE License SC $5,00 TOTAL FEE $83,72 SIGNATURE OF CONTRACTOR OR 0RIZED AGENT TEI WHE �PZERLYINATED THIS IS YOUR PERMIT r L G 4 DATE SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ;] ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application 880 West Moore Lake Drive Effecti 1111 9 Owner Name & Address: James & Beverly Sampson (same address) Tel. # 571-3027 Contractor: Patio Enclosures, Inc. MN LICENSE # 0001676 Address: 5120 Cedar Lake Road, St Louis Parte, MN 554 6 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 1b' Width 12' Height GARAGE AREA: Length Width Height DECK AREA: Length same Width Hgt/Ground OTHER: 525-1494 Sq. Ft. 192 sq ft Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot Pq Ft. Yd Setback r,1' Side Yard Setbacks 1-11 & 73' Type of Construction: Resiaenri.al Addition/Enclosure Estimated Cost: $ Approx. Completion Date: approx. a/5 weather permitting ,(Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6/17/93 APPLICANT: ` Tel. # 525-1494 uraiq Affcfcxrson, Installation Supervisor Permit Fee $ CIO a Fire Surcharge $ ' State Surcharge $ a SAC Charge $ License Surcharge $ 00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ 63. t7,, -)- STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ 0 JUN 22 '93 oe:is PEIiMNPLS P•2%2 �. Patin, Rttcloaures, Inc. "All -View" and "Comfort -View" Roons 3" and 6" "Soper -Foam" Roof Systems Material Data Sheet I -.Beans: 3": 6063-T6 Aluminum extrusions containing an industry -standard thermal break matt ial. 6": 6063-T6 Aluminuffi "T" extrusions joined by an extrudes} vinyl connector. Panel Facings: .024" 3105-H174 aluminum, as manufactured by Nichols Homeshield, Datvenport, TA, or approved equal. Topcoat is a textured, two -cant finish known as "Krystal Kote" manufactured by Lilly. Panes Core: 1.5 lbs. per cubic foot BPS Board Foam manufactured by Falcon Mfg., Inc., Byron Center, SII or approved equal. Foam beads are Grade 66 or Grade 54 as manufactured by Huntsman Chemical Corp., Salt Lake City, UT (NER-384), or Type 1Dylite 33M as manufactured by Arco Chemical Co., Newtown Square, PA Facings -to -Core Adhesive: One part, moisture cured adhesive (MOR -AD 336 or 366), manufactured by Morton Thiokol, Inc., Chicago, IL (ICBG deport #3462) Foam Plastic Compliance with Model Codes Applic!16 •,tions: Code.- rvuo Code Title Pub. Date section Section Title CABO One and Two Family Dwelling Code 1992 R-216.3 Specific Approval BOCA National Building Code 1991 Supp. 2002.9 Diversified Tests, ICBO Uniform Building Code 1991 1713(f) Specific Approval SBCC1 Standard Building Cade 1991 717.6 special Approval Test Conducted: Enclosed Room. Corner Test Steiner Tunnel. Test Standard 'fest Meth,_- _'aed: UL1715 (also known, as UBC 17-5) ASTM -E84 Test Laboratory: Omega Point Laboratories, Inc. Commercial Testing Co. San Antonio, T% (NER-TL337) Dalton, GA (NER-TL154) Test Results: Passed Passed CERTIFICATION: 14ereby certify the following: g I am in responsible charge concerning the data contained herein. The data contained herein is true and correct, to the best of my knowledge and abil.,Ly. I am quplified to prepare the data contained herein, based on my education and experit _ice. 4. I am an actively registered professional engineer in the state(s) having jurisdiction over the application of the data contained herein, to which I affix ms aeal(s) below. -ire r a --' Date �egis�ratRan MN 150 IS lboreby certify that this plait, slreoi-- or under day 41 root anpa:rvislor. and that I am a duly Registered Prcf'esnional. Fr,gtneasr under the 2;iwa of the State of mirmeacta. 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 9gq w m m o ice L %G 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 $ 3o" representations stated in this application are true and correct, (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10,00 $ `_ Jl^� ,1996 OWNER 54 e. 'Ps 0 ki 571-30.2 Gas Range $ 10,00 $ / BUILDING USED As Aot Gas Dryer $ 10,00 $� ESTIMATED COST %DO9 , d Q PERMIT *Air Gonditionin g — All Sizes $ 25,00 $� All Others/Repairs & Alterations (LIST ON BACK) DESCRIPTION OF FURNACE AND OR BURNER I% of Value of Appliance or Work $ No. of Pleating Units Circle One (Steam) (Hot Water)rm i ) Trade Name 7:- -4-q, Size No, Commercial/Industrial BTU_ 7 ytq HP 2_ EDR 1.25% of Value of Appliance or Work $ Fuel n44- Total Connected—Load State Surcharge 50 Burner Trade Name Size No. TOTAL FEE$ BTU_ HP %Z EDP', .16 HEATING COMPA Y + est. �� 4 K /c L Mi•N1tAQMJEEE FOR ANY HEFTING/gQgLIl JG,LVENTILATI(?N REFRIGERATION/AIR COHDITIONIIVG PERMIT 1:3 25.00Signed By. 'JI J� �—/ ��Tel No, tI PLUS THE $,50 STATE SURCHARGE REINSPECTION FEE $42,00/Hr Approved By&k--- Rough—In Date Final Date 'Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner, REPLACEMENT FURNACE Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: z ��- 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 Yes IC) No ( ) 8. Has combustion air been provided for water heater Yes (� No Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: z ��- CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On March 1, 1996 APPLICATION FOR POWER PLANTS, AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS u Eo (, F 6mii'(,� - 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 cleclares 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 $_1 (� - ,1 996 c Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10,00 $+ _ ESTIMATED COST PERMIT NO. *Air Conditioning - All Sizes $ 25.00 $___ , DESCRIPTION OF FURNACE ANL) OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units 1 Circle One (Steam) (Hot Wat6r) (Warm Air) Trade Name % /� I N 6-1- a Size No. Commercial/Industrial BTU_ - ® , HP EQR 1.25% of Value of Appliance or Work $ Fuel d--) A 't" Total Connected Load State Surcharge 5o Burner'frade Name Size No, TOTAL FEE��, BTU _ HP EDR' , HEATING COMP NY_ f (10ty MINIMUM FEE FOR ANY HEATING/CnOLIP[QNIENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By Tel No. `f0 PLUS THE $.50 STATE SURCHARGE _ REINSPECTION FEE $42.00/Hr Approved By _ Rough -in Date Final Date ,Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDFOR STACK VERIFICATION ON written permission from adjoining property owner, REPLACEMENT FURNACE Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIMNEY AND STACK YERIFICATION 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 Yes () No ( ) 8. Has combustion air been provided for water heater Yes( No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: SUBJECT PER City of Fridley 7 1 9 % AT THE TOP OF THE TWINS BUILDING PERMIT • z. _-----COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC ^- r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �'j 612-571-3450 910-F15 5/27/97 JOB ADDRESS 880 West Moore Lake Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 1 Shorewood 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Sampson 880 West Moore Lake Drive 571-3027 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Thurs Roofing 5717 113 Ave N. Cham lin MN 55316 424-5624 9346 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reroof House 18 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 $1,485 $•75 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 FEETO AL FEE � 7 Lice e S .00 'SIGNAT TRACTOR OR AUTHORIZED AGENT (DATE) N P OP VALID T D THIS IS YOUR PERMIT v BLQF INSP DATE _ SIGNATURE OF OWNERUF OWNER BUILDERi IDATEI NEW [ ] Effective 1 / 1 /97 ADDN [ ] CITY OF FRIDLEY ALTER [ ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION��1 ConstructionAddress: Legal Description: Owner Name & Address: J ; „,� 5�q 114 OQ S 0 X/ Tel. # �S- 7 Contractor: " MN LICENSE # Address: 3��A � A2r Tel. #�� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: / �4.,9 Construction Type: ��✓o®u s cow Estimated Cost: $ (Fee Schedule on Back Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. #�4� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $ -$450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-12S"/ ADDRESS 880 W MOORE LAKE DR NE PIN 143024440041 LEGAL DESC SHOREWOOD 2ND ADD LOT 1 BLOCK I PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIREPLACE VALUATION NOTE: INSTALL A GAS FIREPLACE INSERT. APPLICANT FIRESIDE HEARTH & HOME 2700 N FAIRVIEW AVE ROSEVILLE, MN 55113 OWNER SAMPSON JAMES A & BEVERLY M 880 W MOORE LAKE DR 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 worl 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 performance of construction. Applicant Date Bldg Insp Date PE N0.:2004-00735 DATE ISSUED: 05/19/2004 HEATING PERMIT MINIMUM FEE 15.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 607416 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $1.5.00 far Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTE D ES JOB ADDRESS O SWv ®P� �� i9ti� D 4 Fee Total Ownerr—e-5 $35.00 $ Building Used As $10.00 $ ESTIMATED COST 4--"0 PERMIT NO 0�� $10.00 $ DESCRIPTION OF FURNACE AND BURNER Flre_plea,ce �^Seri- &e,5, $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name 64&e_�- n &l ® Size No. $25.00 $ BTU '30. G cst--) HP EDR Fuel 114 l� Total Connected Load Commercial/industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Burner Trade Name BTU HP Size No. EDR The undersigned hereby makes application for a permit for the work herein 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 $" *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City and representations stated in this application are true and correct. AMed ROW0 dba FYt9Ee Heard & How HEATING CO uanseranosss1� FAX # 2=K FabVIMAve. ,e,MNW„3 eMM33-E + Tel # Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by 0,1 Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existina combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) M HEATING CO: Signed By: Date '--/ 4,-e, IF ZOO l4-;� - 00 / Fr9 NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: 98c) Nees+ Aour ele Le- O y-- lye Legal Description: Owner Name & Address:_ Mes+6eterlU SanV3u-,-) (0,bo e) Tel. #7 (o 3 -57 / - 30d i Contractor: NJ coy-tl �- '-h � MN LICENSE # oZ D'� 33 9 70 Address:_ 9 M) oci nc ey-s W ,-�Y- 1ci 2 L4 , M /U Tel. #`7(o3 - 787 -YS 5/ 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: res)L Estimated Cost: $ 10 _� 10, 00 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 21- jQ& APPLICANT: dj�Tel. Call (763) 572-3604 for Permit Fees if mail g in application. Fax to 763-5714287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ a/ 4;,, 3 / CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ]