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PRE 2010 DOCSN° VMa.ge ®f Frlidf.®y, Mm. BUILLBING PERXIT Office of INSPECTOR OF BUMDINGS Fridley, Minn., AL 2L—, 19— `M LOCATION OF BUILDING Street o�IL& LtJ�_Part of 31ockr'n �7 Addition or Sub -Division Front 6 Depth 411 Height Stories-- Manner of To be used as To be completed l Estimated Cost%CSC% _ _s- 4(—, a / DiiA .o� Permit is hereby granted to � the building described in the above statement. This permit is granted upon the express C' ndition that the p on to whom it is granted, and his agents, employees and workmen, in all P .Q the work done in,,, around and upon ffaid 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 lingits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. I, dL�%�JtJ Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above pernot, 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 duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. ;a Subscribed and sworn to before me at Fridley., Minnesota, this A_.o'�Z e�1 !� c�r.� o� . i day of D. 19 j j li II • Village WoRl oriTe y 9 Minn. BUILDING PERMIT Date:4) Y ............... ................. Owner ....... Builder 1--nn'-Z., AddressAddress ..... ........... 1870 TI LOC C ON OF BUILDING No 14; .. ME ... .0 ...... Street ... ;t4 ................... Part of ........................ .... Lot .......... Block ....... /-� ....... Addition or Sub -Division ... ... .... Corner Lot ........... Inside Lot ... Setback ........... Sidleeyard ..... . . DESCRIPTION OF BUILDING To b Used as, U I ...... Front Depth Height l Sq. Ft. ........ Cu. Ft. ........ ....................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cai. Ft . .. ..... el- C+Type of Construction .... Est. Cost' ................ To be Completed 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 all provisions of ordinances of the village of Fridley. .............. ....... 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 express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, 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. .......... Building Inspector NOTICE: This permit does not cover the co �fructlon, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. City of Fridley, Minn. BUILDING PERMIT N® 3793 Date: ... ........................... Owner.. Builder ..... ............................... Address................... ................. Address ............................................. LO ATI OF BUILDING No. .�.. � .. Street W R .. Part of t ^ ..... Lot 9'>f:.30.;,./&1,ock ..../ f ........ Additio or Sub -Division .......... .,.` ................ corner Lot ............ Inside Lot ............ Setback ............ Side ........................... DESCRIPTION OF BUILDING To ;.��Us- ..... w ®? ®'� Ft. ®.. Cu. Floc ®C'� .... Front :.� Depth l .. Height Sq. .................... Front ........ Depth ...... Height .... Sq. Ft. ........ Cm Ft. ........ d� Type of Construction ................... Est. Cost.. / %� ." .... To be Completed .................... In consideration of the issuance to me of a permit to construct the building degribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. A... // ..( .. W.. .. .................. 4" V 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 express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation off of the provisions of said ordinances. / a .,/ _ Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. c APPLICATION FOR BUILDING PERMIT CITY 'OF MIDLEY, MINNESOTA Owners Name ^ _i� 1AJ �7T/e Builder Address .1ja A.In _W,Acy-L---Address LOCATION OF BUILDING No.Part of Let 65�._! Lot L_.. Bck . Addition or 'Sub. Div. * - Corner Lot Inside Lot A 'Set Back � ; L ° cA Applicant attach' -to this forma Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as '.. APA TO d A. 7-` 9c 4 Front Depth Height . Sq. Ft. Cu. Ft. Front ._ Depth -eight Sq. Ft. Cu. Ft.._.._� Type of Construction EX A.4z r 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 Ordinances and ruling of the Department of Buildingsv and hereby declares that all the facts and representations 6tated in this application are true and correct. Date °'!' ' Signature' ' tJ (A Schedule of Fee Costs can be found on the Reverse Side) City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number. Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x $1.50 6• x 1.20 $ y, � } Z F N K Z Z W J W 6 ? � � WATER HTR. GAS ELEG Base 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x $1.50 $ x 1.20 $ x 1.00 $ x 3.25 $ x 2.00 $— x x 3.25 $3,2_L NO. RATE TOTAL x $1.50 $ x .50 $ x 2.00 $ City of Fridley: (91 1, C' . The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. a� Fridley, Minn. Owner 4 C h Kind of Build'n Used as 9 , To be completed about )21, -2 2 6 Estimated Cost, $ Old Newuilding Permit No i�� Permit No. �3 Signed By Business Phone. ROUGH FINAL Description ................................................$ TOTAL FEE $ 42 2M Application for Po%fer Plants and Heating. Cooling. Ventilation, wommion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: IRATE TOTAL Furnace Shell & Duct Work ................. .... 8.00 $ Replacement of Furnace .............................. 5.00 $ Repairs & Alterations—up to $500.00 ............. . ... 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gaf. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 40D,000 BTU) ....................... 5.00 $ GAS FITTING FEES: - NO RATE TOTAL 1st 3 Fixtures :..................... x $1.50 $ Additional Fixtures ............... x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ' ROUGH FINAL Dept. of Bldgs. Phone SU 4-7470 Location 60 — 62nd Way N.E. City of Fridley: 4 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 are true and correct. Fridley, Minn i y/y6 , 19 �7 Owner Harvey 0. Wagar Kind of Building frame Used as dwg • To be completed about Estimated Cost, $ 7 3 5.00G J Old New. uilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No 1 Trade Name AFC O Size No GB 1103 0HD Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load 32,576 Kind of Fuel Na t . Ga S BURNER —Trade Name AFC' 0 Size No Capacity. Sq. Ft. E.D.B BTU H.P. (REMARKS—OVER) Signea Mill City Heating Co. BS X__— .VIM ! _ e 42 Business Phone No 544 —i501 llm g `PJp WT LOSS CA1,C(Jj,,,,gn0� DEPAR OF INSPECTION Weat6rstrips Guide CousNo• All I Reference Out. WaU ap Roof Floor Kind 0 0 19— I F1.1 AW t-FrIAFaKoom I Length Wm owa and Doors—Cracks a and Area Windows and rs--Cratkage and Width Height No. of L Insal f , Area /� of p of 1 fife Width Height No. Lineal ft. Of crack sq. fl, No. of pane of Daae its of crack T � i l Caef. 10 Btu ifiltration lass Infiltration tp. well h Glass 1110)11 et exp. wall Exp. wall alNetexp. wall it. wl eiling Int. wall loor Ceiling tu. Floor Total tu. :equir or sq. ins. W.A. Leader area Required sq. t. R. or sq. ins. W.A. Leader area Room Length Width He �. >u I Length Width Height Windows and D00ra--Crackage and Area r Windows and Dews--Craekage and Area Width Height No. of Lineal ft. Area idth Height No. 04 Ltneal ft. Area o. or pa of pane lights of crack g ay. ft. No. of pan of pane IIBPoes o4 crack c$. tL qG YC� f. to A (filtration Infiltration lana � : tp. wall Glass Ezp. wall et ezp, wall t. wall Net sap. wall Inc. wall eiling 9 Ceiling Gil oor O Floor it Btu. Total tu. quir . ft. -& or aq. ins. W.A. Bader area Required aq. ft. ,Dlt or sq. iris. W.A. lAa&r area F1.1 RRZA Room I Length Width Height Fl, I Length �% �Iidth kleight Windows and Doors—Craekage and Area Windows and Doors—Crackap and Area oWlan o! pdth ent INlghte of era k prtt, width Height No• of Lineal it. Area No. 0 0 of panne lights of crack -Ill. 8t. Ce 13t caef Epu _9 ltration Infiltration �j Glass r. wall d K Exp. wall i X ill 71 exp. wall wall Net ezp. wall Inc. wall 6 ling Ceiling or Floor � s � ��� , a tu. ,aired sq. ft. ED.R, or !P4 Fit, (_431 r S i `DS3 / HCl �`.SS�?r y� , v�' r �e• -�' ; .` s•.._ _, __. ._..,�,._.._.-a� w ut m. Insulation HOW &I\ w ta- a,3—I6 1� , YV\ , - --- 2 in. from 0 .to so fL ❑Yes L�s,yy�� No El Yes E] No ❑Unknown //❑ WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and BoringSeal No. H 107528. County Name WELL AND BORING SEALING RECORD ng SCREEWOPEN HOLE .AMXA Minnesota Statutes, Chapter 1031 Minna ota Unique No. or W -series No. OBSTRUCTIO WDEBRIS/FlLL ❑ Obstruction ❑ Debris El FIJI No Obstruction Type of Obstruction/Debris/Fill WELLOWNER'S NAME SAMEWell owner's mailing address If different than property owner's address Indicated above. (Leave blank If not known) Obstruction/Debris/Fill removed? ❑ Yes [I No ToQit�iiµl rEy Township No. Range No. Section No. Fraction (sm. � Ig.) Date Sealed HARDNESS OF FORMATION Date Well or Boring Constructed TO ii ll��llAA iiss 30 24' 15 NW�� � AUG 1 , 1996 SAND 1950's Numerical Street Address or Fire Number and City of Well or Boring Location ❑ Annular space grouted with tremae pipe IS � , Depth Before Sealing 53 R Original Depth n Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL In section grid with °X°. �� IN roads, buildings Single Aquifer ❑ MultlaquHer N L9 Iinaes and Measured ❑ Estimated LLBORING I I I I ly Water Supply Well ❑ Monit Well ' I ' ' ¢, N; l a e; c f ❑ Env. Bore Hole ❑ Other 40 ft. R below ❑ above lend surface W -r- - - - ;-- --;-- E CASING TYPE(S) -- - -;-- - I-- --i- _ IvSteel ❑ Plastic ❑ Tile ❑ Other CASING Diameter neMh Set In oversize hole? Annuwlar srwra initkaiiv —ded? $ t mneir�fe - --- 2 in. from 0 .to so fL ❑Yes L�s,yy�� No El Yes E] No ❑Unknown //❑ In. from to R ❑ Yes No ❑ Yes [-]No ❑ Unknown PROPERTY OWNER'S NAME TIM SC51LUENDER In. from to fL ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address ff different than well location address indicated above. 60 62ND WAY SCREEWOPEN HOLE FR1 DLEY , MN 55432 Screen from 50 to 53 fL Open Hole from to h. OBSTRUCTIO WDEBRIS/FlLL ❑ Obstruction ❑ Debris El FIJI No Obstruction Type of Obstruction/Debris/Fill WELLOWNER'S NAME SAMEWell owner's mailing address If different than property owner's address Indicated above. Obstruction/Debris/Fill removed? ❑ Yes [I No PUMP t Type JET j,.Removed ❑ Not Present ❑ Other GEOLOGICAL MATERIAL COLOR ! HARDNESS OF FORMATION FROM TO If not known, Indicate estimated formation log from nearby wall or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE P' HOLE: " No Annular Space Exits SAND BROWN ❑ Annular space grouted with tremae pipe SANDY CLAY BLUE Z. 4 ❑ Casing Perforation/Removal In. from to ft. ❑ Perforated ❑ Removed NF— in. from to ft. ❑ Perforated ❑ Removed Type of perforator MTER S ❑ Other GROUTING MATERIAL(S) Grouting Material ""JIMLAND from 53 to SURD ft. yards 1 bags from to ft yards bags from to fL yards bags from to tL yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS GEOLOGY FROM: 82ND & HU-46OL other unsealed wall or boring on property? ❑ Yes No LICENSED OR REGISTERED CONTRACTOR CERTIFICATION .' WATER LEVM 1N ABOVE WELL: 115" DATE WAFER 1"EL TA EN m 12 ~ 01 — This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The Information contained In this report is s to the bast of my knowledge. W0-45DO4.821 W093D'16. 332 E.H. PENNER & NS , 1M. 71015 Contractor Business Name License, a., Registration No. -- !.-1SEALED According to MN State Regu� Authorized Date Date JON WAG I' k F"]:N H-OPPE LOCAL COPY H 107528 Name of Person Sealing Well or Boring HE -01434-02 I 0196