HomeMy WebLinkAboutDEMO 04-0852 (FORMERLY NAPA BLDG & THRIFT STORE)
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
lilflNAL
o SITE INSPECTION
COMMENTS:
C. tN
I
SCHEDULED
DAfe / TIME
3f5PS'"
/&9~L' P/l/V~n
CONTR,
PERMIT NO.
Of'. G 652-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
Oe7-vJCJL / T7 0 ILl
,
S~ ~ L,J /l-rt54L. _
/
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION W PROCEED
o CORRECT wt4~ dilL FOR REINSPECTlON BEFORE COVERING
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .{ SAFETY!
INSNOTI
CITY OF PRIOR LAKE
DEMOLITION PERMIT
Date Rec' d
PERL"lIT N04_ 95"2-
(Please type or print and si~ at bottom) ",'\-It-J /l ~ A-
ADDRESS . ~"" I 'II'
!6c;c;o~..:..' Sf,
-:r-Jl-R-IPr- =::~
ZONING (office use)
C-4-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION ~i~~.
PID'ZS-..qOZ -t:?'lb-o
OWNER
(Name)
t:-; ft,.
,r
of'
f1c., 'pr
L:.le
(Phone)
.(A~
~ .~
'.CONTRACTOR) I. ' T. (' I
'q.cQmpanyName)0 ;r) Jle.rv _CC-5 f ,pM ~
(Contact Name) ~1"e.mL he.., /Ic,/I/
(Address) dt/.; tI
(Phone) '75J - L/,) - -5/C1CJ
(Phone) ~S J - 7"7 J. - 5 't::'O
L {'cJ /01.'I4k6=r A tJ t- ,J;rd~n/ /"?p
- . S.sJ..5~ J-
Use of Building: INTERNATIONAL BUILDING CODE ~,
~ , ~J?w? .c- Type of Coustruction: I II ill IV <-.,!.../ ~
I (T(~ ~t;;;f~ Occupancy Group: A,~"'')E F HIM R S U
Division: . t.....:.--" 1 2 3 4 5
~CA NO ill' iCATION OF INTENT TO PERFORM A DEMOLITION
.J.NL .
I hereby certify that I have furnished information on this application 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. Furthermore,
I hereby agree that the city officia.1 or a designeer;z...a....y. e ter u~the property to perform needed inspections.
4f~,~ ~. ~/ ~ - /7- cJ 'I
I Signaturl )' Date ,
'..
Tht:iill"S App lie.. tion Becomes your.rJemo ition
I rmit ~hen APprOved!
/ . B ((~ 04-
" Bui lling~ ] Date
~TRO (M
,DEn;4~
!/UIU-
I
/ tt-e-
86' ~/r
Cl"i[
to
This is to certifY that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested.
~. {J'~~/L
/ Planning Director
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
<tl J 'f./ D tf
t I Da~
Special Conditions, if any
Applicant:
Site Restoration Proposal for Demolition
I {; 1 <)0 ?/\f\J AtY\n ..-
(~ /1/\, I C:I'-'T0 Lcc.- ~ ( . .,
- .)- II f \ I \ U -J.. ~s
-.- .\
Address:
Check boxes below:
r~ Fill Excavation to grade
/~ Sod or seed all bare soils
o Erosion control (see handout). Maintain erosion control until turf is established.
J!, Cap sewer below grade. * Mark location. Licensed contractor required.
/"6. Cap water below grade. * Mark location. Licensed contractor required.
P' Call City of Prior Lake Public Works Department for water meter removal.
~A Cap gas line.* (By gas company)
? 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 surveyor draw site plan)
I )/51'15-qzD I3r C: { 'rt;
tJo ~ aft- ~t>Ac...
*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required,
approved final inspection,
~~ure /;j)J
Deposit will be returned after
;? - /7-CI Y
Date I
J :\BCILDI}\;G,HA\iDOCTSDemo Site RestoLdoc
650 quaker Avenue · P.O. Box 69 · Jordan, MN 55352
Phone: 952.492.5700 · Fax: 952.492.5705
S.M. HENTGES & SONS, INC.
P.O. BOX 69
JORDAN, MN 55352
OFFICE PHONE 952-492-5700
FAX PHONE 952-492-5705
PAGE J
,6 c- 'c':r::..
frJPLA
FAX NUMBER h_~/ - ;2 / _L( -
TO:
COMPANY
OF
-3
FROM: JEREMY GYLLAND
RE:
COMMENTS:
~W~Q)
3 J&//P7
FAX TRANSMITTAL FORM
DATE e"'l()
~ CJf/
/573
&,.,' kX,,>';1-- /)~/Tl~ lk",rJ
/ a ;( IJ / piA ~~< '<',.,~ ~
-;~C/A~/L3
TI,.--
Equal Opportunity Employer
U'll ~U U4 12: Jt> !<AX 651 297 2343
NORTH DIST
141003
/
/
3. Company and/or individual that conducted the building inspection and the procedure used to determine the
presence or absence of ACM (including analytic method): *Prior to demolition all buildings must be inspected by
an U. S, Entjr,anmental Protection Agency ( EP A) accredited inspector, ( .
jp r J:.t:PrJ ~ /Vc...//"I1 ~-"~ r//lJ<;; Z/lJI./ '''0 /'1/-'-~ Ic< ,~J~.I,'r7.rJ J
!) e r,4-.J.. .J 1~A.N'i'D,.J V'
4. Description of planned demolition and the specific method(s) that will be used: fie.., c..- Lih ~
5. If the demolition was ordered by a government agency, please identify the agency and attach a copy of the
order:
Name: IV A. Title: Authority:
Date of Order (MIDIY): Date Ordered to Begin (M/D/Y):.
* Notification for an emergency demolition must be submitted as early as possible before demolition begins, but not later than the
following working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsonnd and
in danger of imminent collapse. If the structurally unsound building is known to contain any regulated ACM or is suspected to contain
any regulated ACM, speciai procedures MUST be followed, If you are unaware of the special procedures, instructions/regulations can
be obtained by contacting the MPCA at the address or phone number listed below,
6. Description of procedure to be followed in the event that unexpected RACM is found or Cat. II nonfriahle
ACM becom~ crumbled, pulverized or reduced to powder: I {
. ..5.1~~ Itt/t'n' Ie: ,j"&uu. tJ, f~, VUCt_lp.r, c:.C7~ ICf,G r
. '.J I' A I c h I
C!.l.E-L-l::"" &-troJO'v (/f.//r~/);cJl""d erA. /~-rjl_~/:tA_
7. Demolition Waste Transporter(s) Information: , . 8, Demolition Waste Disposal Information:
Transporter Name: -.S /Y) l-fc:!JV fSr-5 L .i./IJ-> Landfill Name: De/~~LJ~ LQ..-Jd -r; )/
Transporter Contact: . 5 ~ J t::: /-1 C' /\) t~ Owner/Operator; fYl ~ ; Iz- fJ t::>t.. J.. I _ i.,
Transporter Address:_h, <; f/ ()"'A k.r A () "L Address/Location: 3 J 3 0 0,:2,5 j I? C) )- _ <) T
City, State, Zip: vlf2Ld':::;...J (!1N ,t).L:; 3.5.d- City, State, Zip: _5/ &. )c.-,/),o/Co /YJ,.,J ,<,~- ? ') c:;
, '- l
Phone Number: "o/S-:l- - Y7.:l- ...s-')O() Phone Number: 9_~J-l-JL/_). ."'-;,S5-
9. I certify that the above information is correct and I am a bonafide representative of the demolition
contractor or building owner and have authority to enter into agreements for my employer.
Signature of Contractor/Owner ~ C ~~ Date..&..Ln - 0 y
Send to: Minnesota Pollution Control Agency. For questions call:
Regional Environmental Management Division 651-296-6300
520 Lafayette Road North 1-800-657-3864
St. Paul, MN 55155-4194 FAX: 651-215-1593
PCB Removal Information Polychlorinated biphenyls (PCBs) must be removed from the building prior to demolition. PCBs
may be found in light ballasts, small capacitors found in old appliances, and transformer oils. For questions call the MPCA
Hazardous Waste (HW) business assistance unit at 1-800-657-3724. A
PCB remover name/address/phone number; (lj
PCB receiver name/address/phone number:
Mercury Removal Information Mercury containing mate~ial must be removedfrom the building prior to demolition.
Mercury containing materials may include fluorescent, metal halide, high pressure sodium, neon, mercury vapor lamps, mercury
switches, thermostat probes, manometers, and gages. For questions call the MPCA HW business assistance unit at 1-800-657-3724.
Mercury remover name/address/phone number: N A
Mercury receiver name/address/phone number:
Refrigerants/CFCs/H CFCs Recovery Information A certified technician must recover refrigerants from refrigeration
equipment and systems in the building prior to demolition. For questions call the CFC program at 1-800-657-3864.
Refrigerant recoverer name/address/phone number: rJ A
Refrigerant receiver name/address/phone number:
(Notification oflntent to Perfonn a Demolition form (w-sw4,21.doc) Revised 09/02
UI!.! ~t.I U4 l~: J::J l'AA 001 2H7 2343
NORTH DIST
I4l 002
Minnesota Pollution Control Agency
Notification of Intent to Perform a Demolition
~.~
Minnesota
Pollution
Control
Agency
Type of Notification: (] Original [] Amended [] Project Cancellation
Demolition Contractor:
<; !1 /!e.;J 1 =-r ~
t, ?;/r)
,"
L -..J,CNV. ~
T-J <..
Name:
Address:
'-'
QIAJ;'/c~ r-
~ ,) t,
City, State, Zip:
:T.a/ d &; ,J {!1,;
~ /' ,,-;> /'YI L.
';7, f J- ' 1./'91.,
Contact Person:
.5 .:-- 3.6'" d-
IS/..., I/~,-J)
l/
c; ') t?O
Phone Number(s):
Buildine Owner:
C/'/t....
Address: ) b ~ /:0
t:.r e..e.,~ A LJ {.
of H,'p,.. L~l~
Lc,_<=- / ~
Name:
City, State, Zip:
Pr,. I1r j,.., k ~ (fJrJ I): t) r ') ).
8(,.. J I) \' /Yl t. rA -;,,,,,,J
- .
Contact person:
Phone Number(s):_ 15 d- ' 'I LJ '7 - <=1.:;{ ~ IJ
Buildine Information:
Building Name: '?A/';~I <' I&'r~"
Address/Location: /69SO . .I t)r:} 1.b ....:S r
City, State, Zip: /J r ,. D~ L CI Ie..,-.. /Y1I,v '). ~ -.? ) ).
County: ~~ 1-1 ~ /'1
Phone Number(s): 1\/ ~ rr
Age of Bldg. (years): ~ . <) Size of Bldg. (sq. ft.): /e::70()
Number of Floors Including Basement Level(s):_ _5
Present Use of Bldg.: / A f' /' t f _ -) I~'/ tt:!::..
Prior Use of Bldg.: tV Ci .(.Jc.. fi\ 1/\.. t IJ (J~/, f..s
Dates when demolition or intentional burning y
willBegin7<'-~I.I.tJtl&End - 9-)~"'dt
,
Notification must be postmarked or received ten (10) WORKING days
before demolition begins. *See item #S for emergency demolitions,
Both Beginning and Ending dates should be amended In writing as
necessary to reflect current project dates.
If there is >260 linear feet or >160 square feet of Regulated Asbestos-Containing Material (RACM) in the building
to be demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of MN-
Notice of Intent to Perform an Asbestos Abatement Project must be used to notify for the asbestos removal.
Is nonfriable ACM present in the structure to be demolished ?
If YES complete items 1-9. If NO complete items 3-9,
[ ] YES 0 NO
1. IF ACM will be left in place for the demolition indicate the amount of Category I and/or Category II nonfriable ACM left
in place.
Categ. I
Linear Feet
Square Feet
Cubic Feet
Category I nonfriable ACM means asbestos-containing packings,
gaskets, resilient floor covering, and asphalt roofing products
containing more than one percent asbestos.
*Category I non friable ACM is not allowed to remain in place
for demolition If it is in poor condition.
Categ. II
Linear Feet
Square Feet
Cubic Feet
Category II nonfriable ACM means any material, excluding
Category I nonftiable ACM, containing more than one percent
Asbestos that, when dry, cannot be crumbled, pulverized, or
reduced to a powder by hand pressure.
"Category II nonfriable ACM is not allowed to remain in place
for demolition if it has a high probability of becoming crumbled,
pulverized, or reduced to a powder during demolition, transport,
or disposal, (ex Transite, cement, slate roofing)
2. Description & Location of ACM remaining in place (including floor # and room #):
(Notification of Intent to Pelform a Demolition form (w-sw4,21.doc)
Revised 09/02