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PRE 2010 DOCSOwner Architect Builder Village of Fridley, Minn. BUILDING PERMW 728 Office of INSPECTOR OF BUMIMINGS 0--'t — as j Fridley, Minn.- 19 LOCATION OF BUILDING No. Street —Part of Lot LotBlock Addition or Sub-Division.,e-T DESCRIPTION OF BUILDING L/I -L-C- Front Depth—�f' --' I-Ieight— Stories Manner of Construction," To be used as To be completed Estimated Cost Permit Is hereby granted to 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 limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. —inspector of Buildings. 11 .� -V AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duty sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Menne t this 7 Z" 4 day of---- D. 19 - J 0 • Village of Fridley, Minn. BUILDING PERMIT Offiee of INSPECTOR OF BULDINGS Owner, ;y Architect— Fridley, Builder, LOCATION O BUILDING No. 62' ' street - �. Part of Lot Lot Block Addition or sub -Division DESCRIPTION OF BUILDING Front , 4, Depth—LL-- Height Stories-f---c—Manner of Constructio -- ' To be used as �,:: y'f, Y �' To be completes "" f"� Estimated Cost Permit is hereby granted to to the building"" described is the above statement. This permit is grant upon the express condition that the person to whom it is, granted, and his agents, employees and workmen, in the work done in, around and upon said building, or any part thereof, shall conform in all respects to the o nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildin within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of ordinances. !=nspector of Buildin AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley the above permit, I hereby agree to do the proposed work in accordance with the descripti above set forth'' and according to the provisions of the ordinances of Fridley, and, being first d sworn, I hereby state and say that the facts stated by me and contained in the above permit true as therein stated. , d. f Subscribed and sworn to before me at Fridley, Minnesota, tlli�s day 0 ~ZA.D. 1 1•_ �;-t+' _ ;.,J_.::-"` r..z:."I` e BUILDIN( PERMIT Village of Fridley, Minn. N° 2503' � Y Date .. i ......... II III Builder ,' . . .. ................. Owner ......... ...... ........ a dress... Address .... ............................ 310 Street TION OF BUILDING No ............... i. Street .. .. C ....... P ,;of Lot ...... P .:......... . ................. Lot B1 Addition o r Sub -Division ` Y .... UM1 Corner Lot .. .... � . .. ...... Setback .3S ...... - Sideyard I�:'.... .: ................. Inside .Lot DESCRIPTION !'!OF BUILDING To be U ed as: De ..... ........ nt .... pth ....._.. �Height .:....... Sq.' Ft......... Qu. Ft. . ... , Front ......, Depth . ...''Height ......... Sq.l Ft......... Cu. Ft........ . .....: To be:, .. Type of Constructio ....:.....:...:.Fast. Cost .... °r� �'� .:..:,. Completed ........ . I iP ii it fi In consideratior of the issuance to me of a permit to construct the building' described above, I agree to do the proposed work n accordance with. the description above set forth and in compliance with all provisions of ordinances of the v. lage of Fridley. ..tea •.. .. In consideratio of the payment of a fee of$. �« "permit is h reby granlpd to ... .:.. .................... .. to construct the building, dr �ad!dition as described abovo. This permWgranted upon`' the express conditic n. that the person to whom it is je ted and his agents, employees and workmen, in all work, 'done in, around an , upon said building, or any part eof, shall conform in al�j respects to the ordinances of Fridley, Minnesota egarding location, construction, jation, maintenance, repair and moving of buildings with in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 1 ,, NOTICE:, This permit sewer or Water. v'i"1.. Building Inspector a not cover the construction, Installation or alteration for Wiring, plumbing, gas heating, sure to see the Building .jnspector for separate permits for!, these items. L • • 0 City of Fridley, Minn.. BUILDING PERMIT N® 6545 5-6Date: �,F —.� 13 ----- i Owner: Builder Address - Address L�I��BUILDING No. Street �_ - s —.. Part -op Lot Lot _ Block _�y�Addition or Sub - comer Lot , Inside Lot abackSideyard �- Sewer Elevation — ro tion Elevation DESCRIPTION OF BUILDING To Front Depth --��= Height Sq. Ft. Ca. Ft. Fro t Depth Height Sq. Ft. Cu. Ft. Type of Construction i _... Fist. 1^� __ _ To be Completed In consideration of the issuance to me of a permit to construct the building described above agree to do the proposed work in accordance with the description above set forth in compliance with ,�roviaio ordinances of the city of Fridley. 7 In consideration of the payment of a fee of $ ,permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the esditionatthe personaddnsaid buildFdIF Mlocatiothtyandpermiinance. Building Inspector NOTICE: 'Ills perm* does not corer the eondruction, hutallation for whine, phaabing, gas boding, sewer or wrier. Be sero to see the Building laspomr for separate permhs for these hams. r APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 01 mul. f S NAM_ & R j J BUILDER ADDP.ESS !U, /O y�y 7T V a • ADDRESS � � ®� �i/� � n} J L� it, LOCATION OF BUILDING NoC) Street q £ys r /j E' Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot 1--' Setback Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING Front I I Depth OLD, Height / Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction tfLA_AqVn Estimated Cost 1,90 To be Completed V— / L.2 The undersigned her,.eby 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. G-10- 4`3 (Schedule of Fee Costs can be found on the'gev-swe Side). s PUBLIC WORKS DEPARTMENT CITY OF FRIDLEY May 28, 1971 RE: PROBLEM WITH SEWER SERVICE - 5310 - 4TH STREET N.E. This is in regard to the sewer service at 5310 - 4th Street N.E. Mr. Flentie of this address claims the sewer service was installed by a plumber who has since died. This, I know nothing about; but the City Crew did daylight the service for said home. We found the four inch service out in the street in good, sound condition, with no faults. I believe the problems he has been having must be in his own line, or from the property line to his home. He claims a four inch line was put in in- stead of a six inch line. This, we found to be true; but I believe he had his contractor lay all the line from the City sewer main to his house ac- cording -to our As-builts. We had no service available for his home off 4th Street, so a complete new service had to be put in. The policy was to issue a contract for his connection to our sewer line, to be put in by his own contractor. •It was to be inspected by a City man. This, I believe, was done. I do think the line was properly connected to the City line, even though it was a four inch line. If the homeowner did not have the line from the home to the street laid properly, I don't believe we can take the responsi- bility of reconnecting to his home. The pipe that should be relaid is on his own land, from house to connection at the property line. �LESTER E. CHESNEY Director of Public Works LEC:ik cc: Marvin Brunsell., Acting City Manager Nasim Qureshi, City Engineer ✓ Darrel Clark, Engineering Assistant City of Fridley ApplUcalion for Phi and Gas Rnbig Dept. Of BldqL Phone 560-3450 DESCRIPTION Or WORE - e s7 Number. Kind and Locs ioe of Whorl•" r'•••�•"• 39MnE MMMMMI Base 1st 2nd 3rd 4th I I I 1 1 1 1 • Fie Cannecdon Openinp c »®w 71aivan.Old Opoulaw *AM em. City of Fridley: C, p GAS FLIC. The undersigned hereby makes application for a permit for the work hemi, speciffled, agreeing to do all work in strict accordance with the Qty Ordinance and riding of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct Fridley. Minn d �' �•� , . IS w OwnerP$ At e� Kind of Buildi� ��d c Sewer p Cesspool 0 PARTIAL RATE SCHEDULE PLUMIDIRG, FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening .... a ...... x $1.50 E New 7ixture Old Opening .......... x $1.50 $ Catch Basin . . m .. . . . . . . . . .. m .... x $3.25 $ Water Beater 'Up to 99,000 BTU) .... x $3.00 i , 0 v New Ground Rune Old Bldg......... x $3.25 $ Electric Water Mor .............. a $100 $ GAS FITTING FEES; NO. RATE TOTAL lot 3 Fixtures . • • • • .......... 232.00 $ � o � Adtlltlonal FIxtuime ............... : $ .75 $ Lias Range to 199.000 BTU ............ s MOO $ State Surcharge $ .50 81E;PAMS�ft AL`TERAT1ONS-1tefer to Cbde _ TOTAL Used as Y V / /10 M e -- To be completed about , �®� ® 7 Estimated cost, $ r-® - Old—New. Building Permit No. Permit No. 5 A Signed / gy •% L L� �O/r Business Phone No ROUGH City of Fridley SUBJECT o - 16356 AT THE TOP OF THE TWINS BUILDING PERMIT r I L RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE i---- A----,CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J\ 612-571-3450 910-F15 8/25/81 JOB ADDRESS 5310 - 4th Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 12,13 13 Hamilton's Addn. to Mech. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Hansen 5310 - 4th Street N.E. 572-9335 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Backlund Contrac Inc. 15710 X lite Street N.E. Anoka 434-5348 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Replace 24' of basement wall: Add two basement windows: Restucco dwelling: Replace two kitchen windows: Replace garage doors. 9 CHANGE OF USE FROM TO STIPULATIONS Provide fire alar if not already existing. SE�ERI TE PERMITS REQUIRED FOR WtRCt#G, WAl WC2# PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO 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 o $12000 $C.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- STRUCT R E PERFORMANC OF CONSTRUCTION. $92.50 PLAN CHECK FEE TOTALFEE 8 9. 50 Y SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE, N, WHEN PROPERLY LIDATED THIS IS YOUR PERMIT as BLDG INSP I)AT SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIOJ FOR RESIDENTIAL BUILDING PER4ITS (New, Alterations, Additions, or Repairs) OWNER: 44(4"� -t ti ADDRESS:) TEL NO: 7vZ ' c?5 -3 ,S- BUILDER : ADDRESS: "04eA SS3c)3 TEL 1.40: -3 17(,F j Construction Location • STRI•MT NO: / STREET: Lj�� LOT: , �3 BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. u�Aa_.(_, - 4,6,6 Tina Y LAJ,AAb0 _S_ - 1q6 %. _E ea DESCRIPTIO14 OF CONSTRUCTION ,eEl7wo ,�•z ! rv,.,ioau/s - Q�� Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: 00 Type of Construction: Estimated Cost: $ 4)O®® Zb Be Cbmpleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the uork'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 applicaT=-'_ and correct. DATE: � - �` L/ -9r SIGNATURE: Stipulations: t a 97 c Ty SUBJECT City of Fridley 2654!4 9 AT THE TOP OF THE TWINS BUILDING PERMIT 1 , COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. / / r 1 NUMBER REV DATE PAGE OF APPROVED BY ; 1 CITY HALL FRIDLEY 55432 �'' 612-571-3450 910-F15 7-10-98 JOB ADDRESS 5310 4th St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12-13 13 Hamilton's Add. to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 5310 4th St NE 586-0690 Steven I 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 1] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-roof house & garage (21 Sq) - tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 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 I I 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 $1,751.00 $.88 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. $56.75 Fire SC $1.75 PLAN CHECK FEE TO L FEE $59.38 SIGNATURE F CO TRACTOR OR AUTWOR17AD AGENT IDATEI NO VALID T D THIS I UR _A&C .BL'D INSP /PEERREMIT w I�V DATE SIGNATURE OF OWNER I IF OWNERBUILDERI (DATE, NEW [ ] ADDN [ ] ALTER ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 . BUILDING PERMIT APPLICATION Effective 1/1/98 Owner Name &Address: �, n� 1 r�eX D � ui� �T,�c� a� ��i+e�� v� Tel. # 6 / �) Contractor: WA'� MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF RUPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: A( P P Q U' Ino t �' Gccatcr�a P Construction Type: Driveway Curb Cut Width Needed: Tel. # Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost: $ Q` /7�� (Fee Schedule. on Back) Ft. + 6 Ft = Ft x $ _ $ qr DATE: i - I — y APPLICANT: �Ieve/� �� , % �, .� Q r' Tel. # 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 $1000 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 [ ] NEW [ l ADDN [ ] ALTER [ ] Construction Address: Legal Description: Owner Name & Address: CITY OF FRIDLEY Effective 1/1/2003 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION V VI KZ) CS �-i k -c- -r 1)6- Contractor. khkca"-1 W ide ks ®� MN LICENSE # Address• q & 6-"7 Ails- f7,.J IQaeks r4� 5�q®J Tel. # J a7 - D83-- /6 ?a, 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: 3 APPLICANT: :` MZ V -596L../ Tel. # 3/l r) Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge 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 [ ] TOTAL $ STIPULATIONS* ®�� y N If full navrnant Is not received an 19% Finance Marna will he accessed- AV,WM03/M j American Waterworks i �.�,A*Orlzed Dealer of. 1244 60th Ave. NW Suite B, -Aw Rochester, MN 55901 .507-285-1672 •* FaX: 507-285-6512 1,.� flijoij&W waterpr-fifflir 1-800-795-1204 DATE BID A PROPOSAL SUMMED TO PHONE (HOME) 112 SrIC3 PHONE (WORK) STREET )` .25--1 PHONE (CELL) FAX ZOIDE, AM, A NE Job Description: 00n , M4 ffV.71 Wall Opening to cut: (3 Wood Wall 0 Other— Type of Wall Finish:' C3 Plain over - C3 Paneling 0 studs Type of Wall: gBIock 0 Sheetrock 0 firring 0 Other Type of Floor Finish: A0'_ Pour ad Concrete 0 Stone 0 Concrete 0 Other 0 Tile Fula, jf1*Aft di 0 SuperSump-New System to drain Into: 0 Carpeting 0 Other Obstacles to go around: C3 Floor Drain C3 Existing Sump 0 Pilaster 0 Oil Tank 0 Behind -1 7 0 Other C] Other Quantity System Features: Quantity System Features: WaterGuard® WaterGuard Port® FloodRina FloodChe V SuperSumpP Wataffietch Alarm® IceGuard® 1.11178SUM& -7 A, ReinChute® [CleanPump Stand" t _ - (e"j Thermal[Drj"Floor BriahlWalP Panels BriahtPost' EverLast'Windows 1 r ire;//� D Trak® WellDuct' LawnScepeS TrenchDraln' Dehumidifier all Infection 4va pf 11/20 Pipe Pipe In action Extended 3"or 4" Pipe Y Well Anchor 47 Pterina SanlDry- Icactu a Board' (31f "K�,iLS S177T& L4,Lf 2/2 U_ We Propose, - here to furnish material and labor—co I ith above specifications, for the sum of: by m plate In gcco�a e w a ove oe r A. t7 dollars $ Deposit Required Deposit A.,ld,$ Balance Due Upon Installation $ Additional charge for moving objects out of the work area: $ Unforseen objects ,ftaylesult In additional charges. Accepbance, of Proposal --rhe above prices, specifications and Date of Acceptance: conditions are satisfactory and are hereby accepted. You are authorized - to do Payment be Signature X the work as specified. will made as outlined above. If full navrnant Is not received an 19% Finance Marna will he accessed- AV,WM03/M iii x.6/2003 07: 49 4023y34Ubt I HKHoHt-H =A;:) Il kN I HAUr- UL1 1:3 IMATERIALS: Angle Bracket: Bruckel Plate: Bracket Tube: Bracket Supports: Weld - Bracket Cap: Threaded Rod: Pier'lhihe: Coupicr: Hydraulic lift: undafivion Pier Sysfem 8" x 8" x 112" ASTM A•36 Hut Rolled Ungth: 10 inches Tensile Strength: 58,U0t,) psi Yield Sirength: 36,000 psi 5 1/2" x 9 I12" x 3/4" AS'1M A-36 Hat Rolled Tensile Strength: 58.000 psi Y}Cld Stwngth. 30.000 psi 3 7/8" DD x 3 118" M Length: 10" Will Thickrms; 318" 'Cattsile Strength; 80,000 psl Yield Strength. 70,000 psi 2" x 8" .c 318" ASTM A-36 Hot RL)JW F.7171 • Tcnsilc S:rcngih. 71,000 psi 4" x 8 1/2" x I" ASTM ra •36 Hot Ruitcd Tensile Strength: 58,t?t)0 psi Yield SErength: 36,000 psi 3/4" x 12" Long - Gradc 7 Tensile Strangth: 133,000 psi min. Yield Strength: 115,000 psi min. 3" DD x .120 Walt - ffOt R011Cd E1c:tric Weld High Strength - Law Alloy TetWila Strength: 80,000 psi Yield Sixength: 70,100 psi 2.75" OD x .144 Wall x 6" Long Hot Roliod Tensile Strength: 80.000 psi Yield Strength: 70,WU psi 22" Stroke Hydraulic Cyliruier Wodcing Presort raring of 3,500 psi Ultimste cylinder lift capttcity: 29,050 11/25/2003 07:49 4023934M THHAbHtk bAbL(YLNT HAut udi LJ Q11jD"Ti-te Manufacturing Co., Inc. Dealer Development Group 3455 South 6e Street, Omaha, NE 68106 Tel 800-827-0702 Fax (402) 393-4002 I Lift Cylinder.Asseinbly r, 11/25/2003 07:49 4023934002 IHRHSHtR W4bLfvLNI IjAuc u4iiJ GRIP-TITE'FOUNDATION PIER SYSTEM BRACKET ASSEMBLY fart No. FP3B.A TGBE: 3 71$" OD ,, 3 118" ID PnM. ►ti1inimum 'tensile Strength 80,000 psi / Minimum Yield St ength 70,000 psi ��.5tL ,ICGT; ASTM A-36 Hot Ro11cd Steel. Minimum Tensile Strength %000 psi A4iairnum Yield Strength 36,000 psi RIALKF ._S_UPP0 STRAITS LR_LCKET PLATE Bi�A� CT T0� ASTM A -3G k[ot Rolled Steel, minim= Tensile Strength 58,000 psi I Minimturt Yield Strength 36,000 psi «�D E71T1 Minimurn Tensile Strength 71,000 psi TI�EADEL} RQ1:) Gr>tde 7 zinc Plated. Mittirnum Tensile Strength. 133,000 psi / Minimum Yield Strength 115,000 psi 5T0191 -1V Twln City Testing Corporation PROJECT NUMBER: 3618 200-8742,1 PAGE: i or 2 DATE: July 20, 2000 Patzig Testing Laboratories 3922 Delaware Avenue Des Wines, Iowa 50313-2597 REPORT OF WAO.`FESTING Prepared for: Grip -Tice Co., Inc, Attn: Mike Johnson 115 W. Jefferson Street P.U. Box .1, 11 Wi((tcrset, TA'.50273-0111 Client Purchnse Order Number: :dike ,JolinsQn Prepared by: Reviewed bv: V /VJC%/ I.�r4.citi��"1+._ 1 .r'�•,';'q..Vi�.r�r / 1�,..^, �� Brian S. Escherich Timothy 13. Cox, p.L, Jab :tanager Product Ser►,ice Afan�tget• Alechanical/hIelallurgical sept. �1ccltltnicallilletaltlErgicll Uclit. Phone: (515) 266-311}1 The tcst results contained in this report pertain only to (lie samples Submitted for luting wid nn( nermsarily to all similar product. AS A ML -I AL MOTEcr1ou % CLIEWS, Mr. PuOL(r AND qI)+ EI VF;;, ALL NAMIM rCCIINOLOGIFS. INC RETORTS AnE gVWITTF(.i AS n -t I::MFI:+LN (IAI WFORMa-1014 OF CLIENrS, AND AVrMORI;ATION Foh ru1)1.(:ArIGro OF STATF,MENT9. CdN'C.LUSIONS OR EKTAACrIONS r'nora ?�:r :�Fr,p.tippll�ry �,oql RFPORr.r.$ RESE`IvrD PENDINS AUR PP.ion WRIrT'EN APPHnVAL 11/25/2003 07:49 4023934002 THRASHER W45ENENT GRIP -TITS® FOUNDATION PIER SYSTEM HAut u i i l:i 36.00 3.00 PIER TUBE WITH COUPLER Part No. FP3T FRICTION COLLA., Part No. FP3FC T1�E.: 3" OD x .120 Wall High Strength /Low ow Alloy Hat Rolled Electric Weld. Minimum Tensile Strength 80,000 psi I Minimum Yield Strength 70,000 psi C-Q1MI.EEL, 2.75" OD x .134 Wall DOM Mechanical Steel Tubing. Minimum Tensile Strength 80,000 psi I Minimum Yield Strength 70,000 psi EUICTION COLLAR• 3.25" CSD x .438 Wall DOM Mechanical Steel Tubing x 3.125" long. Nfinimurn, Tenstle StrcngtPj 50,000 psi / Minimum Yield Strength 70,000 psi 6 R air ib/:XUJ W. WS 4W.,!y.4uu& IViI%".,rC_K ri-I...,ti'LHI Ni,le� uvr13 PR0.TECT NUMBER: 3618 200.8742.1 PAGE: 2 of 2 DATE: July 20, 2000 )<lVTROI�CT10H: This report presents the results of load tests performed on house support piers. This work was requested by Mike Johnson of Grip -Tice Manufacturing Co.. inc. The samples were received on June 22, 2000 with the work conducted on July 19, 2000. SAMPLE DESCRIPTION: A total of I sample was received. The sample was described as an all -steel pier bracket for 3" tube (new design-robotically welded). Major design details :ansist of C.5-1nc4 X 8 X 8 -inch flat plate bent 9o° as the bracket and 0.75 -inch thick top plate with a 1.0 -inch thick cap plate. Threaded rod to hold cap to top plate was ?.-10 grade 7 with 314 inch grade 8 nuts. The sample was attached to a fixture inverted from its normal position. A three inch diametdr solid round bar was used to apply the load directly to the cap at a rate of approximately 12,000 to 24,000 Ihs.Iminute with inspections and data recorded at 20,000, 30.000, and finally at the point when tha samples would no longer accept additional loads. Deflection readings were taken from a dial indicator measuring the relative travel between the ram and thZ crosshead, (Some t)f the deflection may have been movement of the fxtttre rather than the sample) TF..$T RF', LIS,.: [.0--U) OF CAP AT 411 MAIMS UNCI -LIES OF DEFLF;(.:7'i(),,N UFSCitIPTI 0N OF FAII.,URIi _ FEAK ,l.Ca �l1 Las) 7- 0.1.30 ..__._.. _ _ .... None �__....1. 20.000 0.155 Nuns 30.000 Not recorded Bolt stretch M 7(in NOTE — The bolt stretch (or sample = 0.24" RIGHT and 0.24" LEFT. .1)t5P�1SIT14N OF SA�Ir(�; Samnl`s were returned to 1IMike. 1c)!;n;;crr, at c(jmPlct:t)n of testing. (i;1HPpAT:11Al,'?QtYI)I:tl[�I�k.L'k7.^Ix1.p7s: ;i.:,: 11I't5i 2aa � o7:49 HAa= uv .LJ PROJECT MAIBER: 3618 199-8240 PAGE: 2 of t I DATE: December 23, 1999 11 INTRODUCT This report presents die results of load tests performed on three inch outside diameter tube. This work was requested by Mike Johnson of Grip -Tits Manufacturing Co., Inc. Tho samples were received and tested on December 21, 1999. SAII'fPLE DESCRIPTION. F A total of 3 specin=s were received, Each specitnfin was described as a Grip — Tire 3 inch O.D. tube with a p nominal wall dik:kncss of 0.120 inches by 3 feet long. Each 3 foot long section of tube hada coupler welded to the inside to fit to die inside of the adjoining pipe. TING PROCEUTIRE: Eacli Specimen was placed vertically between (tivo loading Tates and loaded in compression a .� p p t a rate of approximately 24,000 lbsdiiiinute until die specimens would no longer accept additionai loads, 7MT IR S: i '.'R.'-". '..T1 '•rtTYJi'1♦a"ili •QQ,Y�;.m��"-''R�'P�'•^ :ffil:pel LQG-d�l•.. lL�.+ :31 '.YPLS39t�iJ••....SVfLC� �LYOO.f•4•.T• . -, •,f�T•i• -rNIE.N _„_,,,-.,,., , __.•—,._.tea. PI:hE: LORI) (1hs.) SP ��.salL L''ifL2•••:f.Y.:::.-TI'i43S'9' T•• #Z -Two se MY+ aYr®_eL-'u saga• �.. ..__ ty 3' sections to_I,cdter 31,700 #3 -One 3' section .... -- i ' � —� -NOTE — The columns would no longer accept additional load when buckling started. Tlie tests w11re rerfornied with a friction collar over die coupler at the base, I D SPOSITION nF SAMPLES: !� samples were returned to Mike Johuison at completion of testing. WPDATA%AUTQpq%l99 xxxXH99•l2a0bu I I J 1 1 L STORE-- ` Twin City Testing Corporation PROJECT IYtI1+wJIBER: 3618 199-8240 PAGE: I of 2 DATE: December 23, 1999 Patzig Testing Laboratories 3932 Delaware Avenue Dcs 11(oines, Iowa 5031.3.2597 REPORT OF LOAD TESTING 3 inch O.D. GRLP TITS TUBE Prepared for: Gsip-Fite Co., Inc. Attn: Mike -Johnson. -......r .',1+/'Vr�, 115 W. Jefferson Street P.O. Dox 111 Winte:rset, IA 50273-0111 Client Purchase Order Nurnl.)er: Mike Jolulson 1:'reparetl by: Brian S. Escherich Job Manager `Techattical/Metallurgical Dept. Phone: (515) 266-5101 Reviewed by: ('L--zt- Timothy B. Cox, P,E, Product Service Manager 11 �echanical/Metallurgieal rept. The test resttlts Contained in this report pertain only to the samples submitted for tcsling and not neccssarJy to all similar products. AS A &!L:' -:AL PROTECTION to CLIENTS, THE PUBLIC AND OUM5ELVES, ALL MAXIM rECHNOLOGIES, INC REPORTS ARE SUBMITTED AS THE CONPIOENTIAL 1`.=OAILIA-•)N OF CLIENTS, ANO AUTHORIZATION FOR PUBLICATION OF STATEM6vTS. CONCLUSIONS OR EXTRACTIONS FROM Olt RECiAAC)INi OUR R` -OATS 5 AESEMVEO KNOING OUR r'RI0A wnlrTEN APPROVAL An Allirtna ivo ,4 oil .' tcual C)rrnrrrurvw rm:elnvr+. a,# 6/a6 07 SUBJECTII -� City of Fridley 34039- AT THE TOP OF THE TWINS BUILDING PERM11C T,. � COMMUNITY DEVELOPMENT DIV. M!IPTN(Oj ; � __��_ i PROTECTIVE INSPECTION SEC. I 1 . i NUMBER pEV DATE PAGE OF APPROVED BY ItA '�'�CITY HALL FRIDLEY 55432 L ---. J ` 763-571-3450 910415 11/26/03 JOB ADDRESS 5310 4 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. 12,13 13 I Hamilton's Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Josh Chi 3 CONTRACTOR MAIL ADDRESS ZIP , PHONE LICENSE NO Breland Enter rises/Americ Waterworks d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 507-285-1672 20387395 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Repair 50 feet of foundation wall 9 CHANGE OF USE FROM TO STIPULATIONS Corefill as needed. Corrections per approved pier system. 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 E.0 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 1 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 $11,500 $5.75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW STRUCTION $209.25 Fire SC $11.50 OR THE ORMAN E OF CONSTRUCTION /// PLAN CHECK FEE TOTAL E Licens $5 $2 .50 NATURE F ON'RACTORORAUTHORIZED AGENT IOATEI NOOMYALIDATIE.DfiAIS IS Y �U77M�1 S,GNATURE OF OWNER,Io OWNER BUILDER, IDATEI BlD INS T TE 07 CITY OF FRMLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 kAX: (763)571-1287 PERMIT NTO.: 2004-00190 DATE ISSUED: 02/10/2004 ADDRESS : 5310 4TH ST NE PIN : 233024340034 LEGAL DESC : HAMILTONS ADD TO MECHANICS : LOT 12 BLOCK 13 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 2,800.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. 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 WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. BASEMENT REMODELING APPLICANT BUILDING PERMIT FEE 83.25 CHIO, JOHN FIRE SURCHARGE 2.80 5310 4TH ST NE STATE SURCHARGE, VALUE 1.40 FRIDLEY, MN 55421 TOTAL 87.45 PAID WITH CHECK # 1496 OWNER CHIO, JOHN 5310 4TH ST NE FRIDLEY, MN 55421 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 atter 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 wor: will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or canceltt Drovisions of auv other state or local In n QRDA117 ATR DRRMTTQ T?PnTTTRRTI RC1R WnPW r)TTJFR THAN TIERC'RTREn ABOVE NEW [ ] CITY OF FRIDLEY Effective 1/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: y�1 Owner Name & Address: J o,4,, L" 7 fl o `t"j �f Tel. # Contractor: MN LICENSE # Address: 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: omt --Y�Pit' Q0, X Z?' , Z r3R, Lie , k,.UIQ,,IF Construction Type: 1"22 Estimated Cost: $ 0900 99 - Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: A3 oq APPLICANT: �� l�u%- Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $__ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1350 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 [ ] $ 817 -295 — STIPULATIONS: - � _LL t GYPSUM WALLBOARD, RESILIENT CHANNELS, WOOD JOISTS ar 1/z° proprietary type X gypsum wallboard or gypsum veneer base applied at right is to resilient furring channels 24" o.c. with 1" Type S drywall screws 12' o.c. ,um board end joints located midway between continuous channels and attached to lonal pieces of channel 60" long with screws at 12" o.c. Resilient channels applied lht angles to 2 x 10 wood joists 16° o.c: with 6d common nails. Wood joists orting 18/32" plywood and 1" proprietary sanded gypsum underlayment ed with 31/2" glass fiber insulation in joist spaces and with carpet and pad. Second of gypsum wallboard required to achieve 1 hour fire resistance rating when glass Insulation is used. PROPRIETARY GYPSUM BOARD in Gypsum Company - 1/2" TYPE X PLUS Corporation 1/2' FI -ROK PLUSTm ntal Gypsum - 1/2" MoreRocke FireBaro Type C psum Hardie Gypsum Gypsum - 3ypsum - -Inland Forest Products Corporation .7 (CGTC-C) 1/2" GyProce Fireguard° C 1/2' Hardirocke Brand Max "C"M Gypsum Panels 1/2" Firechecke Type C 1/2" FLAME CURB@ Super'C' 1/2" FIRE -RATED "r UILE NO, FC 51,07 GYPSUM WALLBOARD, RESILIENT CHANNELS, WOOD JOISTS, GYPSUM FLOOR UNDERLAYMENT rer 5/e° proprietary type X gypsum wallboard or gypsum veneer base applied at right as to resilient furring channels 24" o.c. with 1" Type S drywall screws 12" o.c. sum board end joints located midway between continuous channels and attached to tional pieces of channel 54" long with screws at 12" o.c. Resilient furring channels lied at right angles to 2 x 10 wood joists 16' o.c. with 11/4' Type W screws. Wood s supporting 19/32" plywood subfioor and 3!a° ps san erlayment. PROPRIETARY c Corporation antal Gypsum rpsum Hardie Gypsum a Gypsum Gypsum States Gypsum Company iYP UM BOARD 5/e' FI -ROK PLUSTM e/e" MoreRock@ FireBar@ Type C (CGTC-C) - 5/e" GyProco Fireguards C 5/e" Hardirock@ Brand Max "C"T"" Gypsum Panels 5/e" Firecheck@ Type C 5/e" FLAME CURB@ Super'C' 5/8" SHEETROCKe Brand Gypsum \ Panels, FIRECODEe C Core WOOD JOISTS, GYPSUM LATH, GYPSUM PLASTER, NNEL S 1 Approx. Ceiling Weight: 2 psf Fire Test: UL R6352, 4-21-71, UL Design L502 Sound Test: G&H BWA 0 MT, 10-13-70 IIC & Test: (73 C & P) G&H BWA 0 MT, 10-13-70 fi �o�A 115 ,o�iRE Approx. Ceiling Weight: 3 psf Fire Test: UL R1319-65,11-16-64, UL Design L514 ,Field Sound Test:INTEST 5-761-3, 12-5-77 RESILIENT CHA 2-1:3 gypsum -sand piaster applied over 3/e° type X gypsum lath applied at right Iles to resilient furring channels 16" o.c with three 3/4" Type S drywall screws at ,h furring channel 3" wide woven wire strips applied over gypsum lath and parallel and directly over resilient channels with 7/e' Type S drywall screws with diamond shers 18" o.c. Resilient channels applied at right angles to 2 x 10 wood joists 16" with 6d coated nails, 1'/a' long, 0.0915" shank, 1/4" heads. Wood joists supporting — — — — — — — nominal wood subfioor and 1" nominal wood finish floor. Approx. Ceiling I tested with 3" glass fiber insulation batts in joist space, sound deadening felt, and Weight: 6.25 psf pet and pad. Fire Test: SFT -42, 5-7-66 i k Sound Test: CK 6712 5, 6&9-67 IIC & Test:. (68 C & P) 7777777 ..- 'Ty Cts Cr' t -the manufacturerfor more detaii� irdormatton onpPoprietary products. _. -,. , yCxP}:E 2T It �4 C One lay - angl, GYPS addit applil Woos sand fiber i shsetrock on walls A-1 9 Insulation Inside )ve below requirement stairway to snit currently in bedroom #2 extend joists to support floor plywooWunderlay floor upstairs Ing/rock In bedroom #2 the ceilings insulate w/ R-19 rc clumel 5/8" sheetrock R-19 Insulation e plumbing near bathroom ss windows for bedrooms #1, #2 e/rock utilityffumaoe room 1 0- 1 -Soo k ck-41G�g fg ��(;GF, S17. (-I I L -WI coa "#I 1U%jvv vulalue Oldliv , 1� Z /.-ILI/ I / -! f -� r %S3 R Entryway/Laundry :E CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS 5310 4TH ST NE PIN 233024340034 LEGAL DESC HAMILTONS ADD TO MECHANICS LOT 12 BLOCK 13 PERMIT TYPE LOAD LINUT MODIFICATION PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : LOAD, OTHER BLDG MATERIALS PERMIT Nlq.: 2004-00389 j DATE ISSUED: 03/25/2004 VALUATION NOTE: THIS PERMIT IS ISSUED TO ALLOW AN INCREASE OF AXLE WEIGHT FROM FOUR (4) TONS PER AXLE TO FIVE (5) TONS PER AXLE OVER THE FOLLOWING DESIGNATED ROUTE: UNIVERSITY TO 53 AVE TO ALLEY THIS PERMIT IS VALID ONLY FOR VEHICLES ENROUTE TO CONSTRUCTION ADDRESS DURING THE HOURS OF 8:OOAM TO S:OOPM. APPLICANT LOAD LMT MODIFICATION FEE 25.00 CHID, JOHN TOTAL 25.00 5310 4TH ST NE PAID WITH CHECK # 2529 FRIDLEY, MN 55421 OWNER CHIO, JOHN 5310 4TH ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. APPLICATION #04- C�-X3(5q CITY OF FRIDLEY 2004 LOAD LIMIT MODIFICATION PERMIT JOBADDRESS:�� DATE: MATERIAL TO BE HAULED: BEING HAULED BY: s°�;`��®� — PERMIT REQUESTED BY: DATES OF DELIVERY: 4Z/111? (Up To 3 Days) THIS PERMIT IS ISSUED TO ALLOW AN INCREASE OF AXLE WEIGHT FROM TONS PER AXLE TONT,qNS PER AXLE OVER THE FOLLOWING DESIGNATED ROUTE: NOTICE: This permit is valid only for vehicles enroute to contruction address during the hours of 8:00 am to 5:00 pm. See Resolution #01-2004 and State Statute Section 169.87 a Signature of Applicant PERMIT FEE: $25.00 RECEIPT # ISSUED BY Copies Given To Police [ I & Engineering [