HomeMy WebLinkAboutDemolition Permit 02-0298
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
Permit No. 0 z,"'o 2f/?J
I
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).
II-~-~ I
8. NO. OF lTORIES
9. TYPE ~~TRUCTION
10. COMPLETION DATE
2. SITE ADDRESS
/rS-f"6 L>/?,4~t;:T AI/g' J!W
3. LEGAL DESCRIPTION
LOT ~~-r .3+ BLOCK PID
,.:).579 31-0 ~ D
ADDITION
neI.No.)
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(feI.No.)
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6. CONTRACTOR (Name) (Address) (fel. No.)
C.RvC;-J;k_ ~ ;bG"pN?o/m~ ,(('" L'Mt:*'A 11I# 6/,.) - 7~7 - 4'7..>~
I hereby/cer . ayev1urnished inftKmation which is to the best of my kno'ofledge true and correct. I also certify that I am the
owner Or a ori ed Ige ent~or th above mentioned property and that all construction will conform to all existing state and local laws
and will oce in accordan ith submitted plans. I am aware that the building official can revoke this permit for just cause.
Fupt'ler ore hereb,Y agre l'1at ~ city official or a designee may enter upon the~rop,rty to perform needed inspections.
if A ___ ///b~,/
~L / , / Date
4. OWNER (Name)
(?'.I?rs/AC &9v
5. ARCHITIiCT (Name) /
(Address)
LJiT()~""'A1f11Wr ~ ~ (?
./' (Address)
(?'/Ir4.tv H
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A71V
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DENNV ~t<<\F6"'
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METRO SAC UNIT DETERMINATION
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FOR ADMINISTRATIVE USE /)1 h
/G6b'.O 1-0 ~#() 46'&_~/
MATERIAL FILED WITH APPLICATION
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o Site Restoration Plan
o Utility Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
o Water Abandonment
Accepted by
Rejected by
o Electrical Abandonment
o Other
Occupancy Group A
B
E
M
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
TYPE OF CONSTRUCTION:
II
III
H
IV
R
V
Division
2
3
4
Thi ppli f ~o~ms our TOTAL CREDITS ........................ $
de olitio hen roved
B Date fa. - _~ -0 ( Issued by 1'1.4/ L-bD f-2< - 0 2- Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
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Site Restoration Proposal for Demolition
Applicant: aV.STA--C
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Address: /.s-.s-..s-~
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LJ~"+Ktcr A-Ve-
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Check boxes below:
~l excavation to grade
o Sod or seed all bare soils
o 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.
G-eap gas line. * (By gas company)
~Disconnect electric at meter. (By electric company)
l:9--1>ump and fill cesspool/septic tame Certified contractor required.
g}--J\bandon well. Certified contractor required. 0 Existing well
e---R.emove existing structure foundation and footings, materials, and debris. * *
Comments: (provide surveyor draw site plan)
Deposit will be returned
// ;{;{/
Date
DEMO. DOC
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- - -
Minnesota Pollution Control Agency
Notification of Intent to Perform a Demolition
Type of Notification I) Original I) Amended I I Project Cancellation
Demolition Contractor:.
Building Information:
~AJorr 2~.r
/.5".5".('""6 ~~.er At.tt"- hId
City, State, Zip: A/IIL ~~ //f~ s::J?,?d-
5/97
Name:
Building Name:
Address:
Address/Location:
City, State, Zip:
County:
.$(L.n
Contact Person:
Phone Number(s):
Age of Bldg. (years): I~ Size of Bldg. (sq. ft.):
Phone Number(s):
Building Owner:
Name: l?1<~' ~)"~~
Address:
Number of Floors Including Basement Level(s): ~
~('
Present Use of Bldg.:
Prior Use of Bldg.:
~,
City, State, Zip:
(?~
. ~Il'~
~/~ f.
H#
<A-P~
7~7- 4"754'
Dates when demolition or intentional burning
will Begin II. /0 - 0/ & End ~- f/~t? r
Phone Number(s):
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.
Contact person:
If there is >260 linear feet or >160 square feet of Regulated Asbestos-Containing Material (RACM) in the building
to be demolished, it n:ust be removed by a licensed asbestos contractor pdor to demolition. The State ofMN-
Notice orIn tent 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 p1NO
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 Categ. II Linear Feet
Square Feet
Cubic Feet
Square Feet
Cubic Feet
~ I nonfriahle &eM means asbestos-containing packings,
gaskets, resilient floor covering, and asphalt roofing products
containing more than one percent asbestos.
.Category I nonfriable ACM is not allowed to remain in place
for demolition if it is in poor condition.
~orv " nonfriahle acM..means any material, excluding
Category I non friable 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 #):
TDD (for hearing and speech impaired only): (612)282-5332
Prinled on recycled paper containing at least IO%jibersfrom 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 trees.
Complete the following: To I r eJ ,A (, 0'-' +- I~J f I .~ +.\
1. Proposed house move date. ?
(24 hour Police notice required)
2. Scott County Highway permits Yes t"" No (For County roads) ~
3. Site restoration plan Yes ~ No
4. Utilities shut off notification:
Electric Yes i/ No
Water Yes No
Natural Gas Yes No
Telephone Co. Yes No
5. Tree removal or cutting Yes No ~
6. Proposed route diagram Yes No (locate on a city map)
Moving Co.: ~
Name ofCo._n. I . t l \. ~.:I. b1-1d '../~ FS
Address j f /;-) (j Ij . f-o <.: ...> _ 7 ~ ~ J f....
City/State/Zip /,.-,.;--"" _ ~J//?:".. din \,'0'/((
Contact person ! ~ / II - >, ",-I- ,<..~ -
Phone No. 'j' C- ~_ - Y(' I - r ~. e:-
State House mover's License No. f....8. <';i.t_j-'jO ~-1J nf
Date of expieration:.J'" _ 50 v L' .-
Property Owner:
Name --D' i { I 0+ f-;' ^ ohone# 1 \' /_ - V~( - J ''-4if'-J-
Property address:~
House to be moved (~~ y- v ue'.... c- I ' f l,
jo K.. ~
Signature of Applicant: ,/,-- ____
rl1rJu/'J ~Om - /~~-\-b
~ (0... k.. e Jig G f1 v 01'-~.1.
White - Building
Canary - Engineering
Pink - Planning
Tht" Ct"ntf'r or the I..kr Counlr}'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
('~ / A'G bAY DE-V.
[f-z,q-Ol
. I
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
15550 D~t::E: It V E IV rV
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."