HomeMy WebLinkAboutDemolition Permit 99-0569
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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PHONE NO.
PERMIT NO.
WtL-DS PKWV
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C/9-S70Q
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o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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ADDRESS
14-3(05
OWNER
CONTR.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.O/INAL
~SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~. \, ()..M.I! OwnerlContr:
CALL 447-9850 FOR ~HE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
CITY OF PRIOR LAKE
DEMOLITION PERMIT
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(Address) '1" (Tel. No.)
MAY l 9 1999
DIRECTIONS
SPACES NUMBERED 1 THRU 10 MUST BE F;ILLED(t,I
BEFORE PERMIT ISSUED /(/3 f.:; <') t4-yo 5"
(Please print or typ, e and sign at t>s>noJl1). f)/ _ ,I
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2. SITE ADDRESr,'" ,j ',' ' OJ r " J
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3. LEGAL DESCRIPTION ,1 /
LOT
BLOCK
ADDITION WT LDT ~
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4. OWNER (Name)
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5. ARCHITECr (Name) --I
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6. CONTRACTOR (Name)
(Addres~ /' r.;'",.
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(Address)
1. White - File
2. Blue . City
3. Yellow - Applicant
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Permit No.
11. DATE'
BUILDING INFORMATION
7. SIZE OF STRUCTURE
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8. NO. OF STORIES
9. TYPE OF CONSTRUCTION
10. COMPLETION DATE
(Tel. No.)
(Tel. No.)
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 a,gent for" the, above m~tioned property and that all construction will conform to all existing state and local laws
and will procee~'n aC,cordance,with sub itted plans. I am aware that the building o,fficial can revoke thiS" permit for just cause.
Furthermore, I r reby agreEt\ihat the ci.t fficial or a designee may enter upon the ~.!:.o)ert~. to perfor'!,! needed inspections.
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I Signature Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
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SITE RESTORATION PLAN
o Utility Abandonment Plan
o Sewer Abandonment
USE OF BUILDING
TYPE OF CONSTRUCTION:
Accepted by
Rejected by
II III IV Q
H 4? M
2 6) 4
Occupancy Group A
B E
Division
Date 5=-lr - r7
o Water Abandonment
o Electrical Abandonment
o Other
CREDITS
Park Oed. Credit ................................................ $ B SC.J. d~
SAC Credit ......................................................... $ I. 0 S'O. c;l C'
Sewer & Water Connec. Fee Credit .................. $ ~ /, 20(, .~
Water Tower Fee Credit .....................................$ 700. c.:J
Other .................................................................. $
TOTAL CREDITS ........................ $ .3. ~()(J .fJt.}
Issued by
Date
This is to certi that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m::;;~:~sr~ 5-L~--4q
WP~n"-er'- II - Date Special Conditions if any
Site Restoration Proposal for Demolition
Applicant:
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Address:
Check boxes below:
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A::!FjIl e~n to grade
~od 0 see 11 bare soils
D frosion control (see handout) Maintain erosion control until turf is established. c.Y\~ \.I....j 1(,)t~
Map. sewer below grade. * Mark location. Licensed contractor required.
....rr Cap water below grade. * Mark location. Licensed contractor required.
D ~ gas line. * (By gas company) Nit
~isconnect electric at meter. (By electric company)
D Pump and fill cesspool/septic tanle Certified contractor required. t\J A-
D Abandon well. Certified contractor required. 0 Existing well N A-
~emove existing structure foundation and footings, materials, and debris. * *
Comments: (provide surveyor draw site plan)
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*Capping of utilities must be inspected.
**Final inspection and approval of restored site required.
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Sidh'ature J '
Deposit will be returned
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Date
DEMO.DOC