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Part of Lot Lot 7 _ Block 2 Addition or Sub -Division Summit Manor, No. Corner Lot Inside Lot Setback __ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: NeW MI g Front Depth Height Sq. Ft. Cu. Ft. Det. Garage Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Fast. Cost -584-0-0 --- To be Completed • New MWAMW Det. Gar. 0 In consideration of the issuance to me of a permit co bu the proposed work in accordance with the description ab orth and ordinances of the city of Fridley. agree to do provisions of In consideration of the payment of a fee of X5.00 , permit is hereby granted to James B. Schutt Mex Kag Const. Co. to construct the building or addition as described above. This permit is granted upon the xressL in, arryn the dty limitsthis permit may be revoked at any time upon violation of any of the.provisions of said ordinances. NOTICE: Ub pem* don not emu the censfivdion, lestatlillen for rrkb& plumbing, an hesdng, smu w wdw. Be sure to dee do Building lespKtor hr sepuaft permih for thea hems. i .tn•� ` ti N . 7- E� - r G ' 95� - p 3 '4 90 o M -A0 Y!. r.0. �m!�!0+60 WYG.Z+IZ E So. ' W b A �' INP. 12=6"SER. 0,04 WYE So. ro �4 , F INP.=12:6 SER.co 4 • O jrt p-4 0 •• •: -� a6�, 0 •folk 3x =' CA C)o SOL VO f • 84 %N••� NN • O APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER" S NAME BUILDER �� A C 0/ ADDRESS_ �� % -� �° ADDRESS_ -7 0 o LOCATION OF BUILDING of Lot LOT IC 2— ADDITION OR SUBDIVISION �� 7—,,2�6 ® / ' Corner Lot Inside La Setback Side -Yard ...SEWER' ELEVATION FOi16AIiON ELEVATf011 .r w ,, Applicant attach to this form Two Certificates df SWivey df tot and proposed building location drawn on these Certificates, DESCRIPTION OF BUILDING To be used as � Front Dept -� Height Sq. Ft. \- ,;;2 Cu. Ft. �2 Front DepthHeight Sq. Ft. Cu. Ft. Type of Construction_ Estimated Cost��/,,� To be completed 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, b � f (Schedule of Fee Costs can be found Reverse Side). 0•' ..'• 0 Fog " � r City of Fridley, Minn. BUILDING PERMIT • Date: august 12, 1965 • • Owner: She1v.n M Syverson Builder Address 117 - 53rd Avenue N. E. Address 1 3 00'T N? 8355 LOCATION OF BUILDING No. u7 Street % 53RD AVENUE N. E. Part of Lot Lot 7 _ Block 2 Addition or Sub.Division C.S.M. North addition Corner Lot — Inside Lot Setback Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Kitchen Acid, Front 8 Depth 10 Height 10 sq.* rL 80 Cu. Ft 800 Front Depth Height sq. Ft. Cu. Ft. Type of Construction Est. Costs$2110.00 To be Completed In consideration of the issuance to me of a permit to construct the the proposed work_bs accordance with the description above set forth a ordinances of t%e city of Fridley. above I agree to do pith, of l provisions of In consideration of the payment of a fee of s-4--0-0 , permit is hereby granted to SHELVIN SYVERSON 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 �g location, conatructfon, 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 ordinancm ALLEN G. JENSEN Building Inqmtor NOTICE Ub parmit den sial wwr the cenatrusthw, mon for whdng, phmbing, gn hea8ng, sewer or water. Be sura to we the BuBding kgmctor for separate pwmBs for these Name. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING NO, STREET —PART �� e- ///- PART OF LOT LOT BLOCK -Z_ ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK SIDE YARD SEWER ELEVATION FOUNDATION ELEVATION 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; Front Depth_ /4: LHeight Sq. Ft. yo Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. _ 1-1 Type of Construction Estimated Cost To be completed 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 f - SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). 0 MEM M: Jock Robertson, CwTmini.ty Development Administrator I -EM FRDM: Darrel Clark, Chief Building Official MOD DATE: August 4, 1988 RmARDnU: Foundation Problems in Carlson's Summit Manor North Addn. Please be advised that since July 21, 1988, I have received calls from six homeowners who own hones in the vacinity of the 5300 block of Horizon Drive, requesting that I inspect their house foundations because of apparent differencial settlements. Prior to these calls we had inspected 5 other foundations during 1987 arra 1976 that were in this general area. There appears to be a pattern of things that probably have caused these - settlements to occur or are present at each location: 1. They have all occured during long dry spells (1976, 1987 & 1988). 2. All have had mature trees growing in the general vacinity of the failure. 3. Yard and street settlement has also occured in front of those homes that had mature trees in the front yard near the failure. 4. All those that have had soil tests done have bad a layer of moisture receptive or active soil at or below the footing elevation. 5. All homeowners have been advised to contact a soils engineer to test and report their findings and to suggest the method of correction. 6. All of the hares were built in the mid 19501x. The cost of repair will depend upon the extent of the failures. We estimate the cost of such repair to range between a minimum of $500.()0 to a maximum of $20,000.00 or possibly higher. One home repaired in June, 1987 paid an estimated $3,000.00 to a contractor to replace the back wall (32 feet) of their basement. That repair consisted of the following: temporarily supporting the structure on post and timbers; removing the back foundation wall and footing; digging down through approximately six feet of clay or silt to granular gravel at three locations (each hole was about 4' x 2') ; pouring each hole full of concrete; pouring a reinforced concrete grade beam over the top of the new pads to form a nsw footing; laying up a new block wall; and setting the house back dawn. A composit map is being maintained that shows the reported dates and addresses of all reported problems. If anyone wants more information on this subject, please contact our department and we will be hapry to review our files. We do have individual records on each reported problem. Its possible that there could be more failures that have not been called in for our review. DGC/mh ATTACH: Map CC: Mr. John Flora, Public Works Director n�j'fh _-i T- .- Wyk �• d ads S N all 15 Sb, s.L-I.a �s4r' �: �r'�"C•�i X91$ Cr:�''�.I '� 'a j o Li.S S bl -it n Cab vr"QU:) VII U -N -M c' ,in ry �"i�'H ?�9 RIR -5-� rl EtiI S9 -h-,3 I I - CO) 'aa tJ�rni. �� eeEs Fvr, ti UC H �... ca �s4r' �: �r'�"C•�i X91$ Cr:�''�.I '� 'a j o Li.S S bl -it Cab vr"QU:) VII U -N -M ,in ry �"i�'H ?�9 RIR -5-� rl I I - CO) 'aa tJ�rni. �� eeEs Fvr, ti UC H �... ca I � S 3u�r V'wi,y4. e!1� UTYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 March 31, 1989 Mr. Larry Moorhouse HUD 6329 -104th Avenue Clear Lake, MN 55319 Re: 117- 53rd Avenue N.E., Fridley, MN 55421 Dear Mr. Moorhouse: Please be advised that the City of Fridley has inspected the vacant house at 117 - 53rd Avenue N.E. and has determined that the home can not be reoccupied until the foundation system and utilities under the basement floor have been properly repaired. The damage to the foundation is very extensive due to settlement of the footings. It is possible that the entire foundation will have to be replaced. Prior to the City issuing a building permit for the repair, the City will require that a qualified soils engineer do a soils investigation to determine why the existing foundation is failing and from those results, a structural engineer must then design a new foundation system that will permanently correct the problem. If you have any questions on this matter, please feel free to call me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh 01 SUBJECT P IT NO. City of Fridley 19971 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RE • ___ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED 8V L 612-571-3450 910-F15 6/28/89 / JOB ADDRESS 117 - 53rd Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Carlson`s Summit Manor North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Evanov 117 - 53rd Avenue N.E. 561-9363 3 CONTRACTOR MAIL ADDRESS ZIP- PHONE LICENSE NO. Same 817 Meadowwood Drive, Brooklyn Park, MN 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) REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Foundation correction by constructing new basement 9 CHANGE OF USE FROM TO STIPULATIONS Examination will be required of excavation prior to pouring new footings .by the structural engineer for final approval of footing design. Repair and restoration of garage is also required. Provide fire alarms on both levels of dwelling. Clean up construction debris and remove weekly. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $9,100 $4 55 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- $117.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. P N CHECKFEE TOTALFEE $121.55 TOR OR AUTHORIZED AGENT IDATEI HEN PROPERLY V I ATED THI IS YOUR PERMIT "NATURE J12 r` - FrvER IIF OWNER DER) pDAiEI- BLDG INSP BATE 01 m MW [ ] Effective 5/1/88 ADEN [ ] R-1 AND R-2 AI8ER [ ] FA Building Permit Application a�n Address: legal Go 7 - Owner Owner NaQoe & I Address: Ax- $cn ro Bus application, a certificate of Survey of the lot, with the proposed construction drawn an it to scale. vkJ66ALSIS �Y�*i �J�I J'Y1.li1%ti MVM Ama: nth Width Height GRPJM AREA: Iergth Width Height EM AREA: length Width _ HWGround ii�{�: -04)'.t P's 40 A pzjd -"4 t Z *'d /I sq. Ft. sq. Ft. Sq. Ft. p J g ryp (fJGS r -O x /®, t4v - Cl, o7®eb® . r Q=Ier Lot [ ] Inside loot [ ] Ft. Yd Setback Side Yard Setbacks Type of Cbnstructicn: Estimated Cost• $ `'"" 00 Apprmc. cmnpletion Date: -' (3/0006 Prcposed Driveway Width If NewOpening Desired: Ft. $ $ a Width + 6' See Back Page DATE: 46. ZOO • APPLTCA� # f Permit Fee $ state Surcharge $ aJ SAC Charge $ Driveway F'gCrow $- Park Fee $ Sewer Main Charge $ Fee Schedule cn Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above -Fee Determined by*�� int Neoessary [ ] Not Necessary [ ] 70MRL C -e sTI UTATIOM: p� d3 FEA4o IA4 1 la r Or- F—,ec qu 011-1 (,,u PO4 F-0 rx. r v 4 pA rlo -&- CSC`= FCSryrtA3c rWSl C LA-) o `A- . rz- N QUI Kko 1(3) Pazoi614)w 91o6 a®'c(46 . (0 WZ`oo 11,00 Bernie Stroh, P.E. June 22, 1989 Mr. Jim Evanov 817 Meadowwood Drive Brooklyn Park, MN 55444 Consulting Structural Engineers 612/379.1005 Re: Foundation Inspection of Residence located at 117 53rd Ave. NE, Fridley, MLV Dear Jim: At your request, I have completed an inspection of the foundation walls at the above referenced dwelling. The the inspection was to make a structural evaluation of foundation under the one story residence and to advise replacement of the foundation. STROHENGINEERING St. Anthony Main Suite 406 219 Main Street S.E. Minneapolis, Minnesota 55414 perimeter purpose for the existing on the proposed I observed vertical cracks in the corners of the foundation walls which are exposed above grade. This is generally indicative of longterm differential settling of the footings. No inspection was made of the framing or the foundation walls from inside the house. It is my understanding that the decision has been made to replace entirely the existing foundation walls and footings. I have reviewed the soil boring logs which were taken around the house earlier this month. The borings were taken to a depth of about 9�2 feet and indicate a silty sand and silty clay soil. Mottled soils at the 4a to 62 ft. depth indicate a possible perched water table at that elevation. The Uniform Building Code (1985) Table No. 29-B allows a bearing pressure of 1000 to 1500 psf for this type of soil. According to my calculations, the net foundation pressure will be approximately 750 psf if a new footing 30" in width is used around the perimeter. In my opinion, the proposed increased footing width provides an ample factor of safety against future differential settlement. Please refer to the attached sketch for specific recommendations regarding the new footing and wall construction. If there are any questions or comments regarding this report, or if I can be of any further service in this matter, please feel free to contact me. Sincerely, Stroh Engineering �-� (�� JJL-' Bernie Stroh, P.E. Bernie Stroh, P.E. DATE: 6/22/89 PROJECT: NEW FDN.WA AND FOOTIN 117 53rd A Fridley,MN *4 mWCtA X x1d (p, 4$uo,d- Consulting Structural Engineers 612/379.1005 :; EwsrG FOAw,iN4 STROHENGINEERING r:J ' St. Anthony Main Suite 406 Q JJ11 219 Main Street S.E. r NE.IA/ PSRG Minneapolis, Minnesota X 1z" �,�,CA 55414 t4F�Rovc jo N N��,-fOr4 IdAu� L_ e� 000;11 ' VUA-o-twAL p Jour t�,ig, !� ' ALT. co u "r -s. ' S As. t�4 � - jr45,V1 t7 t� ,-- 1466 cc...aT- 4 113 �o�-.c� lo" x 30 _ TYPi cAL sec.Tio .4 3/��n --- I LD" "RD G. I hereby certify that this plan, specification, or lr1P.••-�••...!; report was prepared by me or under my direct �; �,Q,`•�'• supervision and that I am a duly Registered REGISTERE[ Professional Engineer under the laws of the 9 tPROFESSIONi State of Minnesota. = ENGINEER J' • 14269 Date, t 89 Reg. No. 14269 . ��''�9,,�k�pn MI V W 1 nn+m r 4 Logs of Soil Borings %S9- qac 4 Location or Project Jim Evanov 117 53rd. Ave. NE Fridley, MN Borings made. by P. Rudolph Joel Esteb Date 6/12/89 Classification System: AASHO ; USDA -SCS x Unified ; other Auger used (check two): Hand X , or Power ; Flight , or Bucket x other Depth, Boring number in Surface elevation feet Depth, in feet 0 8-1— fine to med fine sand 1— med. brown color, top soil 8 1!-X 1 1/2 silty sand, slight blocky struct r 9' — 2 — 2 1/2 same as above, slight oxidation streaks 9 1,L2..' 3 — same as above 4 — — same as above 5 — — med. to fine sand, blocky structire 6 clay -silt patches, mixed med.-lt. Irnwn — clayey sand,mixed, blocky,some gravel. 6 1/2_!_ grey sill loam, mottling 74 — same as above — 7 1/2' grey/orange fine sand, mottled. End of boring at - 9 1/2' feet. Standing water table: Present at feet of depth, hours after boring. Not pregent in boring hole X Mottled soil: Observed at 6 1/2 feet of depth. Not present in boring hole . Observations and comments: mottling at 6 1/2' may be due a perched w.t. condition of underlying dense clay soils 1 Boring number Surface elevation cjA%spa gith slight mixing of es grey silty clay, dense, tight clay, brown/grey same as above End of boring at feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole Mottled soil: Observed at feet of depth. Not present in boring hole Observations and comments: 6 i � Logs of Soil Borings Location or Project Jim Evanov 111 53rd. Ave. NE Fridley, MN Borings made. by P. Rudolph Joel Esteb Date 6/12/89 Classification System: AASHO ; USDA -SCS x Unified ; other Auger used (check two): Hand x , or Power ; Flight , or Bucket x other Depth, Boring number in Surface elevation feet 0 loamy sand dark brown top soil 1— 6 — med brown fine sand 6 1/2' grey silty sand, heavy bands of 7 — oxidation fine white outwash sands, mixed 8- Depth,J Boring number in Surface elevation feet �8 1/ same as at 8' level 9_ same as above 19 1L211 grey silty clay same as above with slight indicaio� s of mottling. End of boring at 9 1/2' feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole x Mottled soil: Observed at $_ feet of depth. Not present in boring hole Observations and comments: End of boring at feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole Mottled soil: Observed at feet of depth. Not present in boring hole Observations and comments: same as above 2— same as above 3— same as above with slight blocky blocky structure 4 — same as above with heavier block structure of silty clay S— loamy fine to fine sand 6 — med brown fine sand 6 1/2' grey silty sand, heavy bands of 7 — oxidation fine white outwash sands, mixed 8- Depth,J Boring number in Surface elevation feet �8 1/ same as at 8' level 9_ same as above 19 1L211 grey silty clay same as above with slight indicaio� s of mottling. End of boring at 9 1/2' feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole x Mottled soil: Observed at $_ feet of depth. Not present in boring hole Observations and comments: End of boring at feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole Mottled soil: Observed at feet of depth. Not present in boring hole Observations and comments: Logs of Soil Borings Location or Project Jim Evanov 117 53rd Ave NE Fridley MN Borings made, by P Rudolph Joel Esteb Date 6/12/89 Classification System: AASHO ; USDA -SCS x Unified ; other Auger used (check two): Hand x , or Power ; Flight , or Bucket x other Depth, Boring number in Surface elevation feet 0 loamy sand dark brown top soil 1— same as above 2 — loamy fine med brown 3 — same as above with slight blocky structure of silty clay pathces 4 — same as above, mottles at 4 1/2' S— light brown fine sand mixed with loam 6 — at 6 1/2 feet -fine grey silty sar heavy patches of silty clay streaks of oxidation 7 — fine white outwash sands mixed 8 same as above with indication of mottling End of boring at g"1/q, feet. Standing water table: Resent at feet of depth, hours after boring. Not present in boring hole x Mottled soil: Observed at 4-1/2' feet hhof depth. Not preaenI Raboring �hole0ugh 9' Observations and comments: Depth, Boring number in Surface elevation feet 3 1/2-19' same as in level at 8' 9 1/2'Igrey silty clay End of boring at feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole Mottled soil: Observed at feet of depth. Not present in boring hole Observations and comments: Loas of Soil Borings Location or Project 'Jim Evanov 117 53rd. Ave. NE Fridley. MN _ Borings made- by P. Rudolph Joel Esteb Date 6/12/89 Classification System: AASHO ; USDA -SCS x Unified ; other Auger used (check two): Hand x , or Power ; Flight , or Bucket x other Depth, Boring number a Depth, Boring number in Surface elevationin Surface elevation feet I Ifeet 0 top soil loamy fine sand dark brown 1 — med brown fine sand slight block structure mixed with silt patche 2 — fine silty sand blocky, mixed wi patches of silt, moist grey 3 same as above 441/2, Silty clay , moist grey/brown, t med fine sand, blocky pockets of 5 — of silty clay,mottled silty loam to fine sand, moist 5 1/2' clay moist mottled with pockets silt sand 6' — I silty sand with patchy pockets o silty clay 6 1/2' same as above 7' 1 same as above End of boring at 9 1/2' feet. Standing water table: Present at feet of depth, hours after boring. Not present in boring hole x 7,1/2' gold fine sand, no blocky structure Q' — med to fine sand, slight blokcky patches of silty clay 8.1441 fine sand mottled 9' same as above 9 1/2' same as above 5 — f 6 — 7 — 8 — End of boring at feet. Standing water table: Present at feet of depth, hours after boring. lot present in boring hole Mottled soil: Mottled soil: Observed at feet of depth. Observed at feet of depth. ar� gain at 8 1/21 Not present n or ng hole Not present in boring hole Obsurvations and comments: Observations and comments: mottling appearing at 4 1/2' again appears due to a peching of w.t. by clay soils beneath. �• elAM GNOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 25, 1989 Mr. James Evanov 817 Meadowwood Drive Brooklyn Park, MN 55444 Re: 117 - 53rd Avenue N.E., Fridley, MN 55421 Dear Mr. Evanov: It was called to our attention that you may have caused a dangerous situation at the construction site at 117- 53rd Avenue N.E. by not having secured the excavation to prevent toddlers from falling into the old basement. Our visit to the site on August 22, 1989 indicated that you have started the foundation repair and the site was covered with old concrete blocks and the banks of the old excavation were vertical. In our opinion this is not acceptable. The site must be cleared of all debris. The slope on the banks must be sloped so as not to present a danger to a person accidentally falling into the hole, or an alternative would be to fence the excavation to prevent children from endangering themselves. This needs your immediate attention. If you have any questions on this matter, please call me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official fir. DGC/mh ��' m gwnleStroh, F.E. Consulting Structural Engineers 6=79.10081 FAG 6121379.2814 STROHENGINEERING St. Anthony Main September 7, 1989 Suite 310 219 Mein $ftet S.E. Minneapdis, Minnesota 55414 Mr. Darrel Clark Building Inspection office City of Fridley 6431 University Ave. NE Fridley, MN 55432 Re: Replacement of Foundation at Residence located at 117 53rd Ave. NE, Fridley, MN Dear Mr. Clark: At the request of Mr. Jim Evanov, the.owner of the above -referenced property, I have reviewed the soil boring logs and have recently inspected the site to observe the soil condition at the ,,-ter footing bearing elevation. The soil boring logs were taken by Ms. Pat Rudolph of the Anoka County District conservation Office. (Please note that this office is not empowered nor qualified to make any structural recommendations regarding the soil. The borings were performed at the request of the land owner for identification and classification purposes only.) The soil boring logs indicate that the soil is predominantly clay and silty -sandy clay at a depth of 9 1/2 tt. from the surface. Based on your observations, you have indicated that with the use of a hand auger, the clay layer extends deeper. According to the Uniform Building Code (1985) Table No. 29-B, the allowable bearing pressure for this type of soil profile is 1000 to 1500 psf. According to my calculations, the maximum net foundation pressure with the proposed 30" footing width with full design loads on the floor and roof framing is only 750 psf. In my opinion, the design for the footings is adequate and appropriately conservative given the soil condition. in addition, the concrete footing is reinforced to act ars a grade beam in order to bridge any soft spots below the footing bearing elevation. considering that the house has been supported on this location for approximately 30 years with minimal structural damage due to settlement, I do not feel that any additional soil testing or investigation is warranted mod Soo 1;S3AN1 IVVI 62-C VV:EI 10-60-696' or necessary. Furthermore, since the footing redesign is fully in compliance with the Uniform Building code and no variance or special circumstances exist, the owner assumes full responsibility for the new foundation installation. If there are any questions or comments regarding this report please feel free to contact ate. sincerely, Stroh Engineering Bernie Stroh, F.E. cc Jim Evanov Eod Soo 1S3ANI Ittl GLC Sb:El tiVVT 62-1 9� 1.o-6o-b86'l' � A F` or necessary. Furthermore, since the footing redesign is fully in compliance with the Uniform Building code and no variance or special circumstances exist, the owner assumes full responsibility for the new foundation installation. If there are any questions or comments regarding this report please feel free to contact ate. sincerely, Stroh Engineering Bernie Stroh, F.E. cc Jim Evanov Eod Soo 1S3ANI Ittl GLC Sb:El tiVVT 62-1 9� 1.o-6o-b86'l' � BUILDING DIVISION MEMO MEMO TO: V r H rrick, City Attorney MEMO FROM: r ar , Chief Building Official MEMO DATE: September 8, 1989 REGARDING: 117 - 53rd Avenue N.E. Foundation Repair - Lot 7, Block 2, Carlson's Summit Manor North Addition We have issued a building permit to James Evanov, new owner of 117 - 53rd Avenue N.E., for the repair of the foundation that failed due to the drought effect on the fat clay underlying the footings. Prior to the issuance of the permit, he was required to submit soils reports and a corrective footing design by a structural engineer which he did. I do not feel comfortable with the structural engineer's design and do not want to jeopardize my position or the City's responsibility in approving his design. The structural engineer's design is to construct the footings wide enough (3011) to reduce the load to the underlying soil to 750 pounds per square foot. In my opinion, if the soils dry out, it will shrink without any or very little loading causing anything above the clay layer to settle. The owner and the structural engineer are apparently willing to accept all responsibility and waive and/or hold the City harmless if such a settlement problem should occur in the future. Is there some agreement that we could have the owner and the structural engineer sign, and if so, would you please draft the document and we will then sign it for recording at the County. The owner/builder is James Evanov; the structural engineer is Bernie Stroh, P.E. Please find attached all the pertinent data from our files for your review and comment. The owner/contractor wants to pour the new footing as soon as possible since he already has removed the old foundation and footing in anticipation of the new footings being installed. Please call me if more information or consultation is desireable. DGC/mh ATTACHMENTS 86691 S AGREEMENT made this Z6!2 of September, 1989, by and between James Evanov, his heirs, successors and assigns, and Bernie Stroh, P.E. (the "indemnitors"), and the City of Fridley (the "indemnitee"). WHEREAS, James Evanov, as the owner of the structure located at 117 53rd Avenue N.E., legally described as Lot 7, Block 2, Carlson's Summit Manor North Addition, located in Anoka County, has requested a building permit to repair the structural problems which have developed on the structure, and WHEREAS, the City of Fridley has conditioned issuance of a building permit upon the preparation of a structurally sound foundation design, and WHEREAS, James Evanov has hired Bernie Stroh, P.E., to design the new foundation to withstand the soil problems which originally caused the foundation damage. NOW, THEREFORE, James Evanov, his heirs, successors and assigns, together with Bernie Stroh, P.E., hereby agree to defend, indemnify and hold the City of Fridley harmless from any and all claims or actions arising out of the design and construction of the foundation and footings on the property legally described as Lot 7, Block 2, Carlson's Summit Manor North Addition, located in Anoka County. The indemnitors shall, within thirty (30) days of notice by the City of any such claim or action, retain competent legal representation approved by the City to represent the City's interests or the City may retain independent counsel to represent its interest at indemnitors' expense. STATE OF MINNESOTA ) ss. COUNTY OF ANOKA ) The foregoing instrument was acknowledged before me this 2 % day of Erna 1989, by James Evanov. ---------------- --------------Z, CLYDE V. MORAVETZ Notary bl i c e NOTARY PLq= • LONNESOTA ANOKA COUNTY ttj Corton EXP. Jon. 24, 1994 Bernie Stroh, as resident of Bernie Stroh, P.E. STATE OF MINNESOTA ) ) ss. COUNTY OF ANOKA ) The foregoing instrument was acknowledged before me this µday of ZIP1989, by Bernie Stroh, the President of Bernie StrohJ P.E. Notary P611 c THIS INSTRUMENT WAS DRAFTED BY: HERRICK & NEWMAN Suite 205 6401 University Avenue N.E. Fridley, MN 55432 (612) 571-3850 r-, CLYDE V. 5RAVOTARY PUBLANOKA rh Cmmt Eq .4 S EX ("1 19 i 1� Numerical Grantor Grantee. Recorded/ Checked Margin Tr, Index WFICE OF CONNTY STATE OF AwhNEMTp.. I hereby cenili. ptal Itc. MAI was free ia ,jjjs , On tha OCT 6 198 kZil- a id was r.-Mv recardw Gy City of Fridley SUBJECT IT NO. ~° ' 2 2 6 5 2 AT THE TOP OF THE TWINS BUILDING PERMIT o L _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. -�f� r ; NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 ..--�/'�'>,•� L 612-571-3450 910_F15 6/28/94 JOB ADDRESS 117 53 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 1 Carlson's Summit Manor North Addn SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Schreen/Greg Hegdahl 117 53 Avenue NE 572-9724 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 ❑X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10'5" x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors adjacent to all sleeping areas and in basement. WARNING Before digging call for all utility locations 454.0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 1 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 $855 $050 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $23.00 Fire SC $,78 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $24.28 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI E RL LIDATE THIS IS Y UP, PERMIT BLDG INSP GATE S,GNATUREOF OWNER(IF OWNER BUILDERI IDATEI W NEW I Effective 1/ 1/94 ADDN I t CITY OF FRIDLEY ALTER I I SINGLE FAMILY AND'DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: _ / `7__ A! -.5-3 RD__ Legs[ Description: 6C fC 0cGl (' 1ST Owner Name &. Address: nchreent&pqJ 17 I/E S3 [2►) Tel. # J- -79-c Contractor: MN LICENSE # Address: Attach to this application, ai Certificate of, :Survey of the lot, with the proposed construction drawn on it to scale.' Tel. # DESGRIFION .OF IMFROVEME'F LIVING AREA: Length. Width 'Height ' Sq. Ft: ' GARAGE AREA: Length ' Width . Height - Sq. Ft. DECK AREA: Length ' Width' j(� , :Hgt/Ground � Sq. Ft. :10(f) OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: - o f-ee Y1 +I —�-- -en feGY Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x $_ $ DATE: -V - APPLICANT: Tel. # CITY USE ONLY Permit Fee $ d3-00 Fee Schedule on Reverse Side Fire Surcharge $ ' ' 1 .001 of Permit Valuation (1/10th%) State Surcharge $ .,,—)O $.50/$1,000 Valuation SAC Charge $ $800 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 $_5) f1%Agreement Necessary (] Not Necessary [ ] TOTAL $ STIPULATIONS: g SUBJECTNO. of Fridley 3 93 PCity AT THE TOP OF THE TWINS BUILDING PERMIT Ir , RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��® 1 � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 1'j 612-571-3450 910-F15 11/15/94 JOB ADDRESS 117 53 Avenue NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 2 Carlson's Summit Manor North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE S. Hegdahl 117 53 Avenue NE 572-9724 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Seasons Builders & Remodelers 1410 Quant Ave N, Marine on St Croix 6334 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 433-4846 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (Tear-off) 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE ,OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,084 $1.54 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 $63.00 Fire SC $3.08 PLAN CHECK FEE TOTAL FEE License SC $5.00 1 $72.62 SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT BLUC INSP SIGNATUREOFOWNERIIF OWNERBUILDERI IDATEI NEW. I I Effective 1/1/94 ADDN I I CITY OF FRIDLEY '4U(00 ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: Legal Description. Owner Name & Address: N Contractor: —T(-)�Ir S4)c,(\ Address: 1 W 6 LIVING AREA: GARAGE AREA: DECK AREA: I OTHER: (.1 ) V- 1% A,, i Tel. # \yy� MN LICENSE # '�S7 6 7 Tel. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. I DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft Sq. Ft. Corner Lot Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: --Tcarr+�� 'CC --(GO+ Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ $ DATE: APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC. Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ Fee Schedule on Reverse Side ..001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $ $8W 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 Building MECHANICAL Permit No.: - Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY n g 'd' _ DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: WNER CONTRACTOR PROPERTY NAME: OWNER ADDRESS -CITY STATE IPS. Jl'7v1 TENANT .b �y 1 PHONE: "I CONTRACTOR COMPANY NAME: SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE # EXP DATE 10* LICENSE WITH ADDRESS: CITYIf STAIP APPLICATION xmlf PHONE FAX- n— V-- -f.(o PERMIT TYPE /SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' W EPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESC14PTION OV WORK WWel G► Z , P PER MS 1613.665 the permit fee is omi minimum of $15.00 o 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZEIBTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEIBTU _A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00_GAS P G $10.00 _VENTILATOR $15.00 PERMIT FEE PROJECT_ S FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ 17 1 fxj Number of fixtures @ $10.00 x $10.00 = $ Surcharge 50 Number of fixtures @ $15.00 1 x$15.00=$ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Total = THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of al w ' requires review and approval of plans p P2. lV�� SIGNATURE OF APPLIC PRINT NAME DATE PLEASE NO PARATE PERMOS ARE REQUIRED FOR BUILDINGELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 1] Building BUILDING Permit No.; �� -dR 033 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY D °' DATE 101 VN J � YOUR E-MAIL ADDRESS Fire Surcharge e1 SITE ADDRESS l I'l- < 3 CVsy�N Y, Surcharge THIS APPLICANT IS: ❑ OWNER CONTRACTOR License Surcharge PROPERTY OWNER/ NAME: Cj kf-�r L. cxmk SAC Charge TENANT ryE ADDRESS: `, 7 pro D Ny Ws ri�-' CITY e' � Ll'��i STATEN-ZIPtS f "e)-% $ PHONE:��~ Erosion Control CONTRACTOR NAME: SC.)?,*'"ZQ'N %%4-U4, , rC . Park Fee ��qq 7 STATE LICENSE # )1,0 Ck EXP DATE ®7 17 I 1 0% Fee Determined by Engineering SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS % %, S-% CITY I-WIVyOr W tsA Vr4STATELN-WIPP* '-o WITH APPLICATION PHONE CSS- $1 &- FAX C\ -S-4 ` "i"t S -t 1, 9 Make checks payable to: City of Fridley Attach PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED 0 WINDOWS ❑ BASEMENT FINISH ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site PlwVS—ey showing the existing structures ❑ Other ❑ Fascia and proposed project. WIIHDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �(� (USING THE 1997 U.B.0 FEE SCHEDULE) T� TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .12 . U69 .001 times the total job valuation Surcharge $ [ , .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) _q Total Due $ 1, 9 Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work giich requires review and approval of plans. SIGNATURE OF APPLICANT _ PRINT NAME�.�� {�� DATE Engine WATER AND SEWER Permit No.: b0 Iv V" 7 -57-2"355 PERMIT APPLICATION Received By:1 7 - - 87 fax CITY OF FRIDLEY Date RIM Nov 2 9 EFFECTIVE 10/27/2010 ^� APPLICATION DATE: YOUR E-MAIUFAX: U vZ^— THIS APPLICANT IS: OWNER WONTRACTOR ,, ` JOB ADDRESS: f 17 S7�� ' V NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY OWNER/ TENANT NAME: 1 ADDRESS: I 1 ^% .� N t PHONE: ^7147 — 7 `Z 17 7?W ATE rnm"LIP CONTRACTOR NAME: 64 J w4ka- A -,.p SUBMIT A COPY OF ADDRESS: 31'3 4 G�L�'f�yyn,� 4f. PVCCITY YX z STATE7"'2IP / YOUR STATE LICENSE WITH PHONE Jam%- iPI 3 ? CELLPHONE: APPLICATION STATE LIC # STATE BOND: EXP DATE: old 1. Narrative/written des c 'ption: G; ,..e 7w vve 400 -1v 2. Please attach sketch showing curb line, utility line, building, etc. with distances on back page. Z , �. �7)M 3. Stipulations: I . � i/ 7C4D' �,y,,� /� n /� s— 1 1 I5 M'- �C7�/-�tJL42� / YJC2 p /'� J G t lel S d V' -t jz3j�a,•�� Com- +4�` gPf�( �a PERMIT Y x �r. C SEWER CONNECTION PERMIT 71 SEWER DISCONNECT PERMIT. $50 _.1 WATER CONNECTION PERMIT L! SEWER DISCONNECT PERMIT - $50 11 WATER LINE REPAIR $40 .f" SEWER LINE REPAIR $40 L/O C ADD STATE SURCHARGE $5.00 for each permit S Ll SAC CHARGE @ $2100 = Lr— TOTAL $ T OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST - SEE UTILITY BILLING SPECIAL ASSESSMENTS - SEE FINANCE WATER TAP - SEE ENGINEERING TE: WATER METER REPAIR, INSP OR SHUT-OFF / EVENINGS, WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a permit and work is n t to start without a permit. j SIGNATURE OF APPLICANT -L PRINT NAME: Z- '�� S°"` DATE: I) )sA / 1 O APPROVED BY: DATE: COPY q6YCN T4K ❑ UTILITY BILLING (only if new meter) -I PUBLIC WORKS 7 ENGINEERING City of Fridley , Engineering Department 6431 University Avenue NE, Fridley, MN 55432 FAX: 763-571-1287 L- 763-572-3552Y`� C. /10..' ,U t