HomeMy WebLinkAboutDEMO (Non-structural) 04-0456
CITY OF PRIOR LAKE
DEMOLITION PERMIT
,. White - File
2. Blue - City
3. Yellow - Applicant
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Permit No.
64.0456
DIRECTIONS
, " DATE '{ /2 c..J / D 'f
BUILDING INFORMATION
7. SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom),
8. NO. OF STORIES
2. SITE ADDRESS / (, 7 u,' 0
3. LEGAL DESCRIPTION
/7)K-l/tV IV
;-IV st;
25. q~z OZI. 0
9. TYPE OF CONSTRUCTION
LOT
BLOCK
10. COMPLETION DATE
PID
ADDITION
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4. OWNER (Name)
(Address)
(Tel. No.)
. ~ .:-,v, ". ~v, ",.. _) (Address)
eOrYlmerc~~1 Go.1':;:i:tf\It,.,+;::>.", ?A.f-l-ne/?
6, CONTRACTOR (Name) (Address)
(Tel. No.)
~c, l./'V Wi,;!, '1 ~ D-tt-- <;T ~2 II. q ~ 2..- q 4]. -/2/J
Ed. \ - _I (Tel. No.) /J
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I hereby certify I have furnished information which is to the best of my knowledge true and correct. I also certify that I am the
owner or authorized agent for the above mentioned property and that all construction will conform to all existing state and local laws
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Further~Jre, I herebY. aa~g e ~ ~official or a designee may enter upon the property to perform needed inspections.
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Signature . , Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
-0 -
MATERIAL FILED WITH APPLICATION
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1t1,l'c,1 )//;>77;: I ~r~.v i?P /;Vie~ Fe>
'Pi.....'f?fi::r'!,/11 ;4 i)tEfi1OC IT/OW'
CJ Site Restoration Plan
CJ Utility Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
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A0# Sl--RuG T'-IVt'- D6rJo
SITE RESTORATION PLAN
CJ Water Abandonment
Accepted by
Rejected by
CJ Electrical Abandonment
CJ Other
TYPE OF CONSTRUCTION:
II
III
IV
V
M
4
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other ....... .... ............ ........ ....... ............................ $
TOTAL CREDITS ........................ $
[)
Occupancy Group
A
B
E
H
2
R
3
Division
This a~PIi f n be'i
demoliti e'
By
~4!o4-
Issued by
Date
Date
This is to certify that the re est in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may p.' roce~as ~.eques .~
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C~Plar ner J ./ "':""'-u Date Special Conditions if any
Site Restoration Proposal for Demolition
Applicant: COm...-ne("'-~O\..I Co.,~"rVL-\-:J'_ ~~r+"ers.
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Address: ~Cj ..., ~
LUe~\ S-o +\r--. <;-\-("Q.eT # 2"
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,
Check boxes below:
o Fill Excavation to grade
o Sod or seed all bare soils
::J Erosion control (see handout). Maintain erosion control until turf is established.
o Cap sewer below grade. * Mark location. Licensed contractor required.
o Cap water below grade. * Mark location. Licensed contractor required.
o Call City of Prior Lake Public Warks Department for water meter removal.
o Cap gas line. * (By gas company)
o Disconnect electric at meter. (By electric company)
o Pump and fill cesspool/septic tank. Certified contractor required.
o Abandon well. Certified contractor required. Existing well
o Remove existing structure foundation and footings, materials, and debris. * *
o Provide dust control by following means:
1. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide sLlrvey or draw site plan)
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*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
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Signature
ijj2-t( /0 l.f
, I
- Date
J:\BlJILDIl\iG\HANDOCTS\Demo Site Restor,doc