PRE2010 DOCS Village of Fridley, Minn.
♦ BUILDING PERMIT
NU 1011 Office of INSPECTOR OF BUILDINGS
Owner '
V 6-
r
Architect Fridley, Minn.,
Builder
LOCATION OF BUILDING
No. Street Part of Lot
Lot "5 Block Addition or Sub-Division
DESCRIPTION OF BUILDING
Front f-- r Depth � Height Stories__ Manner of Construction
To be used ash i 6 -ti.e q.... To be compieted/*�%' Estimated Cost
Permit is hereby granted to . 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. p_
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 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 duly
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, Minnesota, this_
day of j~ A.D. 19 �_,•�%�,.cE: � �c�C -�-c-c
J
City of Fridley
A,p"sce'1n fw Flom ng and Cram R.Vgig
Dept. of Bldga. Phone 560-3450
DESCRIPTION OF WORK
Loaa�a
Number, Kind ao
and Location of Fixtures
ffi WATER NTA. City of Fridley:
3 r Z 17 Z z o u • •S a g .S 5 7 7 1 $ r N GAS Exec. The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the Citi Ordinance
Base and ruling of the Department of Buildings, and hereby declares that all the tact
—. and representations stated in this application are true and correct
1st �~ I
2nd — Fridley, Minn / / 19 e
3rd J Ownerl//« i -
4th Connected Kind of Building � ��
Future Connecdca Openings SowerZ"
+
Now Fixture, Old Openings Used as '" --�
Ccsspool El
To be completed about
PARTIAL RATE SCHEDULE Estimated Cost, $
Old New. Building Permit No. Permit No. 1
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures . . . . . . . . . . . . . . . . x $2.00 $ Signed ,� ->--
Future Fixture Opening . . . . . . . . . . . x $1.50 $ ByNew Fixture Old Opening. . . . . . . . . . . x $1.50 Business Phone No
Catch Basin . . . . . . . . . . . .. . . . . . . . x $3.25 $
Water Heater (.Up to 99,000 BTU). . . . x $3.00 $
New Ground Run Old Bldg. . . . . . . . . x $3.25 $ l ROUGH
Electric Water Heater. . . . . . . . . . . z $2.00 $
FINAL
SAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures . . . . . . . . . . . . . . • . . . _ x $2.00 $
Additional Fixtures x $ .75 $
Gas Range to 199,000 BTU . . ... . . . . .. x $5.00 $
REPAIRS & ALTERATIONS_—Refer to Code .50 State Surcharge
Description . . . . . . . . . . . . . . . .. . .. . . . . ... . . . . ... .. .. .$
TOTAL FEE $ ' �S
/Af,® CITY OF FRIOLEY
6431 UNIVERSITY AVENUE N. E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
November 16, 1983
Occupant
21 - 77th ►day Pd.E.
Fridley, MPJ 55432
Dear Fridley Business:
This letter is to notify you of the City's intention to rename
77th Way to 77th Avenue east of the railroad tracks. Your business
will be affected by this change. This action is necessary to bring
about street name consistency throughout the City. Every east-west
road west of the tracks will be a "Way" while all east-west roads
East of the tracks will be an "Avenue".
This consistency will aid the efforts of police, fire and other
emergency actions. The City will work with the Post Office to
allow your business to change to the new street name through
attrition. (i.e. Still deliver mail addressed to the old street
address and also allow you to use up existing paper supplies with
the old street name.)
If you have any questions regarding this matter, feel free to call
me at 571-3450, ext. 159.
Sincerely, /
-John G. Flora
Public Works Director
/Afk CITY OF FRIDLEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
January 30, 1984
M. B. Novack
21 77th Way NE.
Fridley, MN 55432
Dear M ,b,1N6Va(J
Enclosed is a copy of the resolution passed by the City Council
renaming that part of 77th Way and 79th Way lying between Main Street
and the railroad tracks, to 77th Avenue and 79th Avenue. Please be
informed that your street address has now officially been changed
from "Way" to "Avenue" . You may continue to use your existing letter-
head, paper, envelopes, etc. until they are used-up. The Post Office
will still deliver to the old address. If you have any questions feel
free to call me at 571-3450 extension 168.
Sincerely,
William S. Deblon
Associate City Planner
WSD/kh
C-84-06
S -za -x>a
MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring �0
WELL DR BORING LOCATION WELL AND BORING SEALING RECORD Sealing No. H �
47` ::�
County Name Minnesota Unique Well No. --
Anoka (L--Statutes,Chapter 1031 or W-series No. _
(L--Clerk n—k—)
Township Name Township No. Range No. Section No. Fraction ism.i Ig.) Date Seated Date Well or Boring Constructed
Fridley 30 1 24 1 3 2-25-00
Numerical Street Address or Fire Number and City of Well or Boring Location
21 77th Ave. NE, Fridley Depth Before Sealing ��2
h. Original Depth h
Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL
in section grid with-X'. location, showing property tX Single Aquifer ❑ Multiaquifer
lines,roads,and buildings.
N WELU80RING Measured ❑ Estimated
i Water Supply Well ❑Monit.Well
36
❑ Env.Bore Hole ❑Other h. Aelow ❑ above land surface
W -- - I--- -- E CASING TYPES)
-;-- - - -�-- --�-- [..Steel ❑ Plastic ❑Tile ❑ Other
Yzmile 11*0
- -- -�-- -�-- --�--
CASING(S)
Diameter C Depth Set in oversize hole? Annular space initially grouted?
S .`t 6 130 , Yes o Yes No Unknown
r male in.from to h. ❑ � ❑ ❑ ❑
PROPERTYWNER' NAME in,from to ft ❑ Yes ❑ No ❑ Yes ❑No El unknown
kstare a Mary 8. Novack
Property owner's mailing address if different than well location address indicated above. infrom to ft. ❑ Yes ❑No ❑ Yes ❑No ❑ Unknown
SCREEN/OPEN HOLE 1
Same Screen from to ft. Open Hole from 13€1 to 162 ft.
OBSTRUCTIONS
WELL OWNER'S NAME A Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction
Well ownei s mailing address if different than property owner's address indicated above. Type of Obstructions(Describe) 36' 1�M d.P♦ & Pig j et
Obstructions removed? ❑ 'es ❑ No Describe
PUMP nit y
Type
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO ❑T Removed ❑ Not Present ❑ Other
FORMATION
If not known,indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE:
9No Annular Space Exists
❑Annular space grouted with tremie pipe
❑Casing Perforation/Removal
in.from to h. ❑ Perforated ❑ Removed
in.from to ft. ❑ Perforated ❑ Removed
Type of perforator
❑ Other
GROUTING MATERIAL(S) (One bag of cement=94 lbs.,one bag of bentonite=50 Ibs.)
Kt cmt 6 162 10
Grouting Material from to ft. yards bags
from to ft. yards bags
from to ft. yards bags
from to_ ft. yards bags
REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS
Other unsealed and unused well or boring on property? ❑Yes EXNo 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.
Mora Well Co., inc. 02658
Contractor Business Name - License or Registration No.
2-25-00
Authorized Representative Signature Date
Ron Danielson
.00AS CO-' JH 160047
Name of Person Sealing Well or Boring