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PRE 2010 DOCSSUBJECT P City of Fridley ®14440 AT THE TOP OF THE TWINS BUILDING P E I T r RECEIPT COMMUNITY DEVELOPMENT DIV. L INSPECTION foB p; r PROTECTIVE SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 I 10 24/77 JOB ADDRESS 4633 - 2-1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23, 24 10 Plymouth Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Chuck Swanson 4633 2-1/2 Street NE Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. ABC Siding & Roofing 4591 2-1/2 Street 560-3173 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION CX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Siding 9 CHANGE OF USE FROM TO STIPULATIONS 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 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. $1,800.00 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- $0 g STRUCT OR THE PERFORMANCE OF CONSTRUCTION. x 3iif� QQ PLAN CHECK FEE TOTAL FEE $11.70 SIGNATURE OFC TRA"OR 967-0911ZDA T (DATE) 711 WHE PROPER[Y AID T IS YOUR PERMIT SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) BLDG INSP ATE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS,. ADDITIONS, OR REPAIRS) o OWNER: �. BUILDER: e Address: .� %%� Address: Tel. No. b No.: Street: 4 LOTc-715 K _ BLOCK: ADDITION: CORNER LO INSIDE IAT: 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: �i Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: �Estimated Cost: $ 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 representations stated in this application are true and correct. See reverse side for additional information. DATE: SIGNATURE• Stipulations: ( I %J 1 (0 .- I L) 01 SUBJECT P City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r *EeT NO. • COMMUNITY DEVELOPMENT DIV. ______ f' 1 ti PROTECTIVE INSPECTION SEC. /� I � L NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910 -Fl 5 5/8/95 / / JOB ADDRESS 4633 2 1/2 Street NE 1 LEGAL LOT NO. BLOCKTRACTOR ADDITION SEE ATTACHED DESCR. 23,24 10 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Margaret Swanson 4633 2 1/2 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 497-2775 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 Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide engineer trusses. Provide header for garage door opening. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $4.86 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,711 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- $117.00 Fire SC $9.71 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $131.57 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI /WHEN�PPR�OPER • SLO19 INSP VALI ATED THIS IS YOUR PERMIT 4AT SIGNATURE OF OWNER pF OWNER BUILDER) IDATEI 01 NEW [ ] ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: J Z 22--�- Effective 1 / 1 /95 Legal Description: Flo l . #.. . Owner Name &Address:.. �'� �r �L�� � ���� P) . Tel .< �.. _ :.. Contractor:. MN LICENSE Address' :^l 3�1 &&lace AZI,Vii', -ems. Tela# Attach to 'this appiication; aCertificate 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. ✓ �6 DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks. Type of Construction: ,- }t Y ft,A !-e 4e— Estimated Cost: Approx. Completion Date: cTa L_ 1, ( o! ?? S l (Cosi on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ e .001 of Permit Valuation (1/10th%) State Surcharge $'p $.50/$1,00 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary j ] Not Necessary [ ] 1 � TOTAL $ l STIPULATIONS: t IX �.t r� �-nOH. r- WELL OR 90FUNG =ON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL AND BORING SEALING RECORD sealing 114700 County Name MinnesotaUnique No. AMMAMinnesota Statutes, Chapter 1031 or W -series No. (Leave blank tf not known) To Name Township No. Range No. Section No.. Fraction (sm. -D. lg.) Date Sealed Date Well or Boring Constructed Aship Numerical Street Addressor Fire Number and City of Well or Boring Location 2% ST HE Depth Before Sealing 45 ft. Original Depth ft• Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL In section grid with 'X'.location, showing property Single Aquifer ElMultlaquifer WELUBORING lines, roads, and buildings. N f Measured ❑ Estimated �F i ater Supply Well Monit. Well [3nv. -,t - - 4- --+- 4 EBore Hole ❑ Other 20 ft. low ` ❑'above land surface 1 W -T- -i-- ..... EJ.­_"'.�',] CASING TYPE(S) _.r_ _ - __�__ TSteel ❑ Plastic ❑ Tile ❑ Other 14 mile CASING --'-- -4-- -�-- -- I Diameter Depth Set in oversize hole? Annuaiar space initially grouted? S 11 �h— t mite + in. from .to 42 ft ❑ Yes No ❑ Yes ❑ No E] Unknown In. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME RICHARD SNAMSCA In. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address if different than well location address Indicated above. 539 HMSACK AVE' KE SCREEN/OPEN HOLE ST MIS EL 55376 Screen from 42 to 4 5 ft. Open Hole from to ft. s OBSTRUCTION/DEBRIS/FILL ❑ Obstruction ❑ Debris ❑ Fill 0 No Obstruction WELL OWNER'S NAME SAM Type of Obstruction/Debris/FIII Well owner's mailing address If different than property owner's address indicated above. Obstruction/DebrielFlll removed? ❑ Yes ❑ No PUMP TyperUP `s.-" .TI Removed ❑ Not Present ❑ Other GEOLOGICAL MATERIAL COLOR HARDNESS OF FORMATION FROM TO If not known, Indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: No Annular Space Exits SA BROWN Annular space grouted with tremie pipe jBROM❑ Casing Perforation/Removal In. from to it. ❑ Perforated ❑ Removed In. from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) Grouting Material JEORTLAM from 45 to 9UMft. yards bags from to ft. yards bags from to ft. yards bags from to ft. yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well of boring on property? ❑ Yes :.. No GEOLOGY FROM: 4849 IV 'MMD OR REGISTERED CONTRACTOR CERTIFICATION LEVELWATM IN ABOVE WELL: 34" This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The Information contained in this report is `E i T . TA ' "w —1 ® ,true to the best of my knowledge. 71015 Contr or Business Name_ License or Registration No.. ccording tQ N State Re ilationS) -;.-A f 4 f Autho Re nleTiv gniaWre Date Iii RUF LOCAL COPY FI 4 70 0 Name of P n Sealing Well oiKEV�dng � HE -01434-02 10/95R SUBJECT City ®f Fridley 31322 AT THE TOP OF THE TWINS BUILDING PERMI T r � T NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE E �v--- I" CITY HALL FRIDLEY 55432 NUMPERREv DATE PAGE of AVPgOVED 8r 1 612-571-3450 91®-F15 8/18/00 JOB ADDRESS 4633 22 St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23,24 10 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brad Trane 4633 22 St NE (612) 572-8841 3 CONTRACTORMAIL ADDRESS ZIP ����� PHONE LICENSE NO -&fB Hume 4633 22 St NE Fridley, PIT 55421 (612)919-1960 20150069 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 IN REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (12 sq,) Tear -Off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,049.00 $.52 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHAR E PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. Fir SC $1.05 CTION OR THE PERFORMANCE OF CONSTRUCTION $41.80 PLAN CHECK TOTA FEE .37 SIGN4TUREOF 'RAC OR AUTMORI Dom_ T �� '°a N Pq E LIDA THIS ISj 11R /iSV�/� ..� SGi ATURE Of OWNE N RBUILDERi iE�KBL9&-NSP D�tE NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION /b \ Construction Address: /vim �� 1� /`d li► �` �� J Legal Description: Owner Name & Address: y' -17;�- tv-L Tel. # 41,12-1-7,24,90 Contractor.�/� MN LICENSE # Address: 31 P,6Z 151 /1/ 1 � / Tel. # 6,aR 12 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 DECK AREA: OTHER: Width Height_ Width gt/Grou LSA7 /�s Sq. Ft Sq. Ft _ 177 Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ r DATE: APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ,�//, e0 Fee Schedule on Reverse Side Fire Surcharge $ �- C �� .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ °,-12 - STIPULATIONS: