HomeMy WebLinkAboutDemolition - House/Garage Move 02-0297
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City ~
3. Yellow - Applicant
Permit No.
oZ'o~q1
DIRECTIONS 1. DATE
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). 1/- S--t::> /
2. SITE ADDRESS
(>~d- ~.R.A-YP-- AI/iT I(/U!
3. LEGAL DESCRIPTION
LOT 56&r 34-- BLOCK PID 25 -C/3+ - 02./- 0
8. NO. OF STORIES
/
9. TYPE OF CONSTRUCTION
41"0 C)
10. COMPLETION DATE
4. OWNER (Name)
(?~~S7"t"
5. ARCHIT5tT (Name)
&
/
(Address)
I!J~U&;"t!:O.J7A1~"7U ," aC
/ (Address)
t!1;Jdg-~ AI N
/
g-3/-ol
(Tel. No.) .
t./...t - 7-f&7 - 47s<r
iT el. No.)
ADDITION
6. CONT~CTOR (Name) A (Address) (Tel. No.)
( ff ~ ~ Uhrz.t:I~Lo. a c-- C/I-A<f'r'- All ~~ - 7~7- ~/s4
I hereby..cjtrtify .t havr1urnished' ormation which is to the best of my K'nowledge true and correct. I also certify that I am the
owner or uthqlized agent for th ove mentioned property and that all construction will conform to all existing state and local laws
and will proc~ed in accordanc Ith su itted plans. I am aware that the building official can revoke this permit for just cause.
F,urth mo.~~, I hereb,Y agree at th ity official or a designee may enter upon the ~p~ toyerform needed inspections.
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FOR ADMINISTRATIVE USE
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MATERIAL FILED WITH APPLICATION
METRO SAC UNIT DETERMINATION
CJ Site Restoration Plan
CJ Utility Abandonment Plan
CJ Sewer Abandonment
USE OF BUILDING
<3f{)
SITE RESTORATION PLAN
CJ Water Abandonment
Accepted by
CJ Electrical Abandonment
Division
Rejected by
II III IV
H @
2 @
CJ Other
Occupancy Group
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
This application becomes your TOTAL CREDITS ........................ $ t
dBeyrsrJo?frmit when ,fpproved _
'~~ Da.../2'~-ol I,,~dby I'1I'l/LEO tfZ-02-coa..
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m~~~,X::-~..-;7 3/2 L/02_ ~ AA~ v~~ ()_~T-IftI\
City ~ner Date Spe-;jal Conditions if any - -
I
CREDITS
0-# Park Oed. Credit ................................................ $
TYPE OF CONSTRUCTION:
A (1/ E
M
4
- '..
..,
Site Restoration Proposal for Demolition
Applicant:
~,
Address:
/..s-oc;J.
4t ,tJ#u-;r--
[;{"AiCtc1"' ALt'7 /Y(.'/
Lee!-
Check boxes below:
u:YFill~ excavation to grade
o Sod or seed all bare soils
o Erosion control (see handout) Maintain erosion control until turf is established.
rn---cap sewer below grade. * Mark location. Licensed contractor required.
I94Stp water below grade. * Mark location. Licensed contractor required.
~~ gas line.* (By gas company)
lB15isconnect electric at meter. (By electric company)
o Pump and fill cesspool/septic tank. Certified contractor required.
o Ab~ well. Certified contractor required. 0 Existing well
~move existing structure foundation and footings, materials, and debris. * *
Comments: (provide surveyor draw site plan)
*Capping of utilities must be inspected.
**Final in ec on an.d appro:~restored site required.
ilier ap ~;;;/~
f,j ..~
Deposit will be returned
//4//
Date
DEMO.DOC
Q)
--
Minnesota Pollution Control Agency
Notification of Intent to Perform a Demolition
Type of Notification I] Original I] Amended I] Project Cancellation
Demolition Contractor:.
Name'
Address:
City, State, Zip:
Contact Person:
Phone Number(s):
Buildim! Owner:
Name: a1~c. 4"Af
Address: /
A!-?I6~~
/
Lee.
City, State, Zip:
t:1t49".,"
~
Contact person:
~t/ ~
~t:J L ~~ ~s~
Phone Number(s):
Building Information:
7~
5/97
Building Name:
&/~
/S'S1.J.. t!)/lAK'F" A$" AI tV
~~ G4,r""" $;v 5f'.3 ~
,
("~7/
Address/Location:
City, State, Zip:
County:
Phone Number(s):
Age of Bldg. (years): h
Size of Bldg. (sq. ft.):
Number of Floors Including Basement Levei(s): ~
Present Use of Bldg.:
Prior Use of Bldg.:
~t!'r/A~rlA-C-
Dates when demolition or intentional burning
will Begin .1/-.0 - 0 / & End ~ - ;>/-0/
Notification must be postmarked or received ten (10) working days
before demolition begins. .See item #5 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 rr:.ust be removed by a licensed asbestos contractor pl'ior to demolition. The State ofMN-
Notice ofIntent to Perform an Asbestos Abatement Project must be used to notify for the asbestos removal.
Is non friable ACM present in the structure to be demolished?
If YES complete items 1-9. If NO complete items 3-9.
[ ] YES p('NO
1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II
non friable ACM left in place.
Categ. I . Linear Feet Categ. II . Linear Feet
. Square Feet
. Cubic Feet
~nrv I nnnfriahle ~ 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.
. Square Feet
. Cubic Feet
CateeOl)' II nonfriable ACM means any material, excluding
Category I nonfriable ACM, containing more than one percent
asbestos that, when dry, cannot be crumbled, pulverized, or
reduced to a powder by hand pressure.
.Category II non friable 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 #):
TOO (for hearing and speech impaired only): (612)282-5332
Prin'ed on recycled paper containing at [east JO%flbersfrom paper recycled by consumers
House Moving in Prior Lake
. A demolition permit is required.
. $5000.00 Non revocable Letter of Credit is required
. Site restoration plan is required, or an approved building permit application
for a new house.
. Damaged sidewalks, street or curb shall be repaired in an approved manor
with all costs to be paid by the permit holder.
. The structure to be moved shall not be stored on the street or other public
property
. The permit holder shall control erosion on the property.
. Open foundations or other hazards shall be protected with an approved safety
fence.
. The permit holder shall comply with the Tree Preservation Ordinance. All
work shall be done outside the drip line of all protected ttees. ){. ).....\~J
Complet~ the following: ~ I te/ q,;/ (] ,.
I. Proposed house move date. {
(24 hour Police notice required)
2. Scott County Highway permits Yes No
3. Site restoration plan Yes L-/ No
4. Utilities shut off notification:
Electric Yes L/
Water Yes
Natural Gas Yes
Telephone Co. Yes
5. Tree removal or cutting Yes
6. Proposed route diagram Yes
Moving Co.: . I /
Name of Co. D,\-,h'., l'tJu~e tM0J ("""vS .
Address Llhc{V' tC.s1- 27 )--ih Si'. foK.t;J//),.. W',.{1
City/State/Zip M~ 1/ {'/I ~ . /4/h <:"\G '-IV' - I
Contact person ---1)/// () H-"I/~~
Phone No. 9r;;-~'/&( -<; z-.--& (,-
State House mover's License No.~~~ /.3 if,ghO '-bY/).!
Date of expieration: r::- -30 -02.-
Property Owner.:
Name D /!,! (') fl-/"0
Property address: . f
House to be moved bvc)u~ C /. ')
40
Signature of Applicant:
r , ------....
/ ........-.....
JJ10 I.J :' '\
......
~D ~J^,. - I \~\- / G
I ,'t....( \~S
(F or County roads)
No
No
No
No
No-L,
No
(locate on a city map)
C! '-//1 -...... /" r-
phone# 7 \- d.. - I u.. - S .,?-'a ~
f) vc..K"e- tluc- "Jv ~.~~
Tht' C"t'ntt'r of rht' L.kt' Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
~5771 L-- BAvj DeW.
I '
I (- z, 1--0 I
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlicatio; ~;;:ctionD~ ~s PAV~at: Ai vtI
Accepted
Accepted With Corrections
Denied
Reviewed By:
Date:
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
03/21/2002 TBU 15:08 FAX 9524968365
141 002
APPLI(' ..ON PERMIT
SCLt LT COUNTY HIGHW A Y DEPARTMENT
600 Country Trail East
Jordan, MN 55352-9339
Phone - (952) 496-8346 Fax - (952) 496-8365
/J~ ~pli~a~tJJ
t:Y#fA./'V1 T!~
own,er o,f'Y':'!!,1! Equipment
~y-y-; r'
lnsurance cornp~vering Movement
Aqdress ,71
II'Lf{/-27t; Y1'r ~
Address
I Permit NO~ '-I J. ~
Phone:9's2. "'f,('r - 52 G9 .
Fax: 9~L -l(-C (- ~U;l-
Owner of Load .
Coverage
Policy No.
Has permit been issued for movement over:
Slate Highways? 0 Yes U No
Permit No.
'\~~~~.re~~1B~~_~~iit~~.fI~~~~P.~~~lDE:D'.~Ql;1IfMENT;"', :'
Check 0 Truck t1 Auto Check 0 Semi 0 House Trailer 1\
Type 0 TruckfTractor 0 Other Type n Trailer 0 Olher
: ~~::::::":u :1.~~~Od 1
Moveme~rr;~? . Movement To -f!.1Z/)/~ _
Entire !taute; p - 2-/ .~ P - ~~!
:/
y10verncnt ~bC ~iI~~S): Lf - .!?- - tJ 1-
Has permit been issued for fmallocation? tJ Yes 0 No
See lion Township Range
1 (we) certify that the above information is correct. If granted this permit, 1 (we) do hereby agree 10 comply with
the regulations on the reverse side of this permit and with Minnesota Statutes, Chapter 160.26, Moving BlIildings
Over Highways.
.A.~j~nt'~ ~~naNre "1 ~. Date Buildjn,8 Mover, ,Licen,e No.
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TRANSPORTATION PERMIT
PERMISSION FOR THIS MOVEMENT IS HEREBY GRANTED subject to compliance with the prOVisions of the
Minnesota Highway Traffic Regulations Act, and under the tenns, conditions and restrictions contained herein and un the
reverse side of this pennit and is subject to revocation upon non-compliance.
Movement Huurs /2; YJ A f( -- 5: 00 A 11
Planning, Inspectiom & Envirorunentul H~alth Permit No
SPECIAL REQUIREMENTS: APPROVAL IS FOR COUNTY ROADS ONLY
PLEASE REVIEW THE RESPONSIBILITY CONDITIONS.
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03/21/2002 TBU 15:07 FAX 9524968365
SCOTT COUNTY PUBLIC WORK
It! 001
APPLICATION FOR TRANSPORTATION PERMIT
SCOTI COUNTY HIGHWAY DEPARTMENT
600 Country Trail East
Jordan, MN 55352-9339
Phone - (952) 496-8346 Fax - (952) 496-8365
~~~irNo. .:l,Lj.(}.7
. N~.~UpP).icanc L/ AddrCJs nl ('
UA/lhl1~ (7~ r(bWJ.-27~ Ylr ~.
Owner ofTow~quipment Address
Phone: 972-- Cf6( - ~ 'UY'
Fax: 9>,?-- 4-(;; r - 1 2-1: Z-
Owner of Load
A'~~ _
(U-1A ,..
Policy 1%. ~ //
. ~!~~ ~
Has permit been issued for movement over: State: Highways'? 0 y~ No Permit No.
!.'~,'f;'~l~!lj!!f/~:m:9.~;F;iP!{~m~Q:(lJ:_~}~!i;t~~~!Mn~J).\~IMClI~rO:R.:TAAILEDEQUIPMEN1'.'.
Check 0 Truck 0 Auto Check 0 Semi 0 House Trailer
Type~TrucklTractor 0 Other .. Type 0 Trailer 0 Other
n~:z;~i,,}}fijf,[~flt.::~\~t~rM'.;J~!]'A1i;!~~~t~a"~~:~~~A)hMA.'fJ9N~;:~;-::;'::\..! '\ ..:";'..
~rial ~~N~4- ...... --. .... .
Overall Dimensions including Towing 'Vehicle . Width 7 '\ Length / 0
_.~r/ <b ?::J
K~:f~;i,}jk~~~~15~ff~ti~~i~f.":,;'~~f:~t::g;;-~jt~;~~~-t~~~~J~~~l);~~~QRI\f1\:tJQ~;yr3~.<;:' .....
MovementFror5 ~~ ~~.:; ~~ M.ov'et;::,,~
EntileRo~~_:-:E_ 2-( - i."- ~-fr~
Insurance Company Covering Movement
Coveroge
Weioht of Load
., ..
.3 0 CC:C)
Height '7
(
Movement to be during Date(s) of
.3 - 2-~
Has pennit been issued for final location? 0 Yes 0 No
Section Township Range
I (we) certify that the above information is correct. If granted this permit, r (we) do hereby agree to comply ""jth
the regulations on the reverse side of this permit and with Minnesota Statutes, Chapter 160.26, Moving Buildings
Over Highways.
AP~~.:L::: 04 -p ~:l- 1-/ {)Z Btdinr;4~qce e 'u.
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TRANSPORTATION PERMIT
PERMISSION FOR THIS MOVEMENT IS HEREBY GRANTED subject to compliance with the provisions of the
Minnesota Highway Traffic Regulations Act, and under the tenns, conditions and reSlTictions contained herein and on the
reverse side of this permit and is subject to revocation upon non-compliance.
Movement HOUI~ (i" ; 30 ,A 11 .- J; 00 r"/J
Planning, Inspections & Environmental Health Permit No.
SPECIAL REQUIREMENTS : APPROVAL IS FOR COUNTY ROADS ONt.. Y
PLEASE REVIEW THE RESPONSIBILITY CONDITIONS.
~
Dace I J Authorized Signature Scott County Highway Depat1menl~ ~ _ I .
3 2.. ( 0 2- ( I ~11tfI'-I.
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