PRE 2010 DOCSBUILDING PERMIT
Wage of Frid-le Minn. N° 2002
4 n
Date'' ..+.... .
R Builder .�✓..
Owner'"'.' ............................
Address ......... .............................. Address .........................................
LOCATION OF BUILDING
#7907qNo.�l
... � .... °Street 46 ............... :............... Part of Lot .......................
f.; ..
Lot ......,A 7. Stock' .......... Addition or Sub -Division
Corner Lot .. Inside Lot . Setback !'�".► Sideyard l.,,r. ...... .
DESCRIPTION OF BUILDING
To be Used as:
. � .... ° Front ... Depth ... Height J Sq. Ft......... Cu. Ft........ .
................:.. Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft.........
Type . Est. Cost . y'�.:i�A'A...��......... To be Completed 4..4&
of Construction i .� �,�'.
In consideration f the issuance to me of a permit to construct, the building described above, I agree to do
the proposed work in accord4nce with the description above set forth and in compliance with all provisions of
ordinances of the vill ge of 1iridley.
...............................................
In eration c I the payment of a fee of ,$• i f A$ , permit is hereby. granted to .. ... .
.ryl. .. to construct the building or ad dation as described above. t Is granted upon
e express condition t the person to whom it is granted and his agents, employees , d worlmaen, in all work
done in, around and said building, or any part thereof, shall conform in all respects to the 'ordinances of
Fridley, Minmesota re axdimgJocattion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits d this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.'
J!
Building Inspector
NOTICE:
,Thls permit d not cover the oonstructlon, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Bestirs to see the Building Inspector for, separate permits for these Items.
i -.
7�
0
City of Fridley, Minn.
BUILDING PERMIT
Date: Sept. 4, 1969
Oar; Frank M. Waks Builder Same
Address 7574 4th St. N. E. Address Same
LOCATION OF BUILDING
No. 7574 Street _.•_ 4th St. N. E. _ Part of Lot
Lot _27 __Block 2 Addition or Sub.Division .._.__Osborne Manor
Corner Lot — x Inside Lot — Setback _ - Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
AIA�?,j
N4 10393
To be Used as:
Addition Front 18' Depth 24' Height 20' Sq. Ft 432 Cu. Ft 8640
Front Depth Height -- Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost --,•000.00 __ To be Completed
Approved by the City Engineer
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 with a'l1 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $___13. 00 , permit is hereby granted to Frank M. Waks
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
F
dley,hin inances
`lei &o � Buildipg Inspector
Clarence Bels ile
• NOTICE:
Ste permit does not cover the constroettoe, leslaWan for wiring, plumbing, gas henthM serer or water. Be sire to no
the Building htgmftr for mparnle permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER 's _�� BUILDER
ADDRESS �'/ S -t Jul_ ADDRESS
LOCATION OF BUILDING
NO. 7 c- ! " / STREET J% f H 8 e &1—=
LOT BLOCK �. AUDITION OR SURUIVISION 0500AIVE J'Y( 3 ffo +
CORNER LOT INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
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:
fiQQ /iI® W, Front Depth _ Height
Square feet Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Construction ' Estimated Cost baa
To Be Completed /70
T
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.
DATE 9�✓G / SIGNATURE GY! loL/QdJ
(Schedule of Fee Costs can be found on the Reverse Side.)
;r W - v1 AC p, i f.. .x 4 iii
A
Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and1
Air Conditioning Systems and Devices U
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE TOTAL
Furnace Shell & Duct Work ..........................$10.00
$
Replacement of Furnace .............................
6.00 $
Repairs & Alterations—up to $500.00 ..................
6.00 $
Repairs & Alterations each add. $500.00 ...............
3.00 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ /4 e)
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam ...................... 3.00 $
Each add. 320 sq. ft. EDR Hot Water ............. .... 3.00 $
OIL. BURNER—to 3 gal. per hour ........................ 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) ................
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: N
1st 3 Fixtures ......................
Additional Fixtures .................
Gas Range to 199,000 ..........
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTr- 'S & REPAIRS
O RATE TOTAL
x$ 2.00 $
x .75 $
X$ 5.00 $
See Fee Schedule
TOTAL FEE
Dept. of Bldga. Phone SM -3480
City of Fridley:
The undersigned hereby makes application for a permit for the work herein,
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application aretrueand correct.
Fridley, Minn / 197
Ownerf�Z2
Kind of Building
Used as
To be completed about
Estimated Cost, $ /
Old—New. Building Permit No. Permit No. 4
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name JB1 SizeNo;& 'sal
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of FueL' 'ydd'e1
BURNER — Trade Name / Size No- / r
Capacity Sq. Ft. E.D.R BTU H.P.
17 CY
s 41-7 SignedJPLAO- �
By °
42 Business Phone No- ' F!
(REMARKS -OVER)
Original
PERMIT for Power ,ants and Heating. Cool-
ing. Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. o f Heating Plan69 )Q-4-TYA (1-t-1 to b installe ltered—repaired
Make ' ,Size /-�a
Oil fired—,- Coal fired --L, Gas fired ; Gas Authorization No.
Remarks An .Py o z.6.Q F Gt-QJ s.A-/vt fie,
Approved
Final Inspection Date , 19_
, Inspector
Pert N° - 480'7
Fee $ s7f,
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. -22 , 191`12
Owner '
Location 9,5294
Kind of Building��
How Occupied
Work to be Commenced—, 19
To be Completed ,19_
Estimated Cost, $
(Dew, Building Permit No
Permission is hereby granted tosj) . CAA, ,e ) IAQ 1 b %:� L? to install—erect—use the material and devices 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 and materials used under this permit, and in the operation of the devices 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 specificat' ns se forth in the approved application for this
permit on file in the office of the Inspector of Buildings. ( ®
Ail �/�.l - /c� � .f �� , Inspector of Buildings
01�42 sM 11-67 v
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing to Well and Boring I„' 257382
County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No.
Minnesota Statutes, Chapter 1037 ° seaees No.
Hennepin
rownship Name Township No. I Range No. Secdon No. Fraction (am. -+ Ig.) Date Sealed Data Well or Boring Constructed
Fridlev 30 24 11 SVS NV N° 04/16/2007 1 Unknown
,S Latitude degrees_
minutes_ seconds
Depth Before Sealing 105
ft.
Original Depth 101 ft.
)CATION: Longitude_ degrees_ minutes_ seconds
AOI
®'Singleingle A Aquifer ❑ Muidaqulfer
❑ Yes ❑ No ❑ Unknown
STATIC WATER LEVEL y l l
imerical Street Address or Fire Number and City of Well or Boring Location
r I�
WELLIBORING
cured El Estimated Date Measured
7574 4 St. N W
2<ater-Supply Well ❑ Mond. Well
iow exact location of well or boring
section grid with °X."
Skqjqhjmep of well or boring
I ation, owing property
❑Env. Bore Hole ❑Other
47' Blow L] above land surface
N
nes, road and buildings.
CASINGTYPEIS)
NONE
Annular space I ally grouted?
El Yes V0
e
NONE
EN
❑ Yes ❑ No ❑ Unknown
NONE
❑ Yes ❑ No ❑ Unknown
�-- t Mlle
P RTY OWN FJCOMPP
comas War s
Property owners malling address d differei
7574 4" Street NW
Fridley, MN 55432
' Steel ❑ Plastic ❑ Ttle ❑ Other
WELLHEAD COMPLETION
Outside: ❑ Well House ❑ At Grade
❑ Pitiess Adapter/Und ❑ Buried
❑ Well Pd
❑ Other
CASING(S)
Merril Depth n
above in. from 0 to 961L
In. from to ft.
In. from to ft.
Inside: Basement Offset
❑ Well Pit
❑ Burled
❑ Other
Set In oversizeehho�9?
Annular space I ally grouted?
El Yes V0
❑ Yes o ❑ Unknown
❑ Yes ❑ No
❑ Yes ❑ No ❑ Unknown
❑ Yes ❑ No
❑ Yes ❑ No ❑ Unknown
OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE
wner's mailing address d different than property owner's address Indicated above Screen from t0 ft. Open Hole from 96 to 101 n.
OBS CTIONS
Rods/Drop Pipe ❑ Check Valves) ❑ Debris
❑ Fill d No Obstruction
Type of Obstructions (Describe) Jet & P-rp
OLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ZY1. ❑ No Describe , ' -
FORMAMON
P known, Indicate estimated formation log from n -- P.UML-
nearby wed or boring.- _ _ Jet
,, TvPe
and Brown moved ❑ Not Present ❑ Other
USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
No Annular Space Exists ❑ Annular Space Grouted with Tremle Pipe ❑ Casing Perforation/Removal
In. from to ft ❑ Perforated ❑ Removed
la-y-Ssand Brown 1 185 00—
In. from to ft. ❑ Perforated ❑ Removed
IEMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
Geology From: 7620 University Ave N
Water Level in Above Well: 40'
Date Water Level Taken: 06/24/1969
Map Codc: E I I
Type of Perforator
❑ Other
GROUTING MATERIAL(S) (One bag of cement - 94 lbs., one bag of benton to - 50 Ibs.)
Grouting Material Neat Grout from 0 to 101 ft yacs4 bags
from to ft. yards bags
from to ft. yards, ----bags
OTHER WELLS AND BORINGS
Other unsealed and unused well or boring on property? ❑ Yes ❑ No How many?
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed In accordance with Minnesota Rules, Chapter 4725. The information contained In this report
Is true to the best of my knowledge.
E H Renner & Sons, Inc 1431
Contractor Business License or 1eg11 No.
e V �f4ty� 04/26/07
CerBBed Rep. No. Date
IMPORTANT -FILE WITH PROPERTY ��� Kevin Scheiterlein
PAPERS -WELL OWNER COPY JH ( Name of Person Sealing Well or Boring
HE -01434-09 IC# 14D-0423 nn 6/06R