HomeMy WebLinkAboutDemo Permit - Parking Lot • � p � P R I��P CITY OF PRIOR LAKE Date Rec'd
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� DEMOLITION PERMIT
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� PERMIT NO.
Please e or ' and si at bottom
ADDRESS ZONIl�TG (otfice use)
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LEGAI. I7ESCRIPTION (oft'ice use only) ,
LOT BLOCK ADDITION PID
OWNER �
(Name� �r"�,vr �af��G ° ��Vrxq � �rra� SGG•o� Z S (Phone) � 5 Z '" Z Z6 - oC�DD
(Address) S16y0 To war' S-��ee� . s"� /'�'�v�� 1,�../rr i'1c�(/.
CONTRACTOR
(Company Name) � T o 2(._.i4 KE � L.K}�-K�P , Z�� L. (Phone) 9 S� �C)b
(Contact Name) �Z M. S � �- (Phone) l� � ol - 31�21Q ' ' �
(Address) I 'I O�l � �t.V 2- '�JJ
Use of Building: � IIVTERNATIONAL BUII.DING COD�
Type of Cons�action: I II III �V Y A B
�ar�c✓�S tb� Occupancy Group: A B E F FI I M R S U
Division: 1 2 3 4 5
MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLTTlON � '
I hereby catify that I have Furnished information on this applicadon which is to the best of my knowledge tcve and correct. I also certify that
I am the owner or au orized agent for the above-mentioned property and that all construction will conform to all existing state and local laws
and will procee ' ccordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I hereby agr at the city al or a designee may enter upon the property to perform needed inspections.
��' o� 130 �� o
• Si ature Dau
_ T�rs Application Becomes Your Demolition �. �.,
Permit When Approved
Building O�fcial Date
Tl�is is to certify that tha requast in t6e abow appiicallon end accompanyiug dacuments is in �cordenca with the City Zoning Ordinance and may proceed sa ra�tbsted.
Planning Director Date Spacial Condirions, iF any
24 hour noHce fac all inspecHans (952) �W7-98S0, fax (9S2) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 553�2
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� Site Restoration Proposal For Demolition
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Applicant: I�R� o e- 1--►�- �-�-`��.�.r�c_�.7 P.��- •
Address: I ��] ��r �2�. t�� 1`�i � c�e. I.�--+�-� M t�-� 5�� �,
Check boxes below:
�f Fill Excavation to grade
�d' Sod or seed all bare soils
� Erosion control (see handout). Maintain erosion control until turf is established.
❑ Cap sewer below grade.* Mark location. Licensed contractor required.
❑ Cap water below grade.* Mark location. Licensed contractor required.
o Call City of Prior Lake Public Works Department (Call 952.447.9843 or
952.447.9844) for water meter removal. •
❑ Cap gas line.* (By gas company)
o Disconnect electric at meter. (By electric company)
❑ 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.**
� Provide dust control by following means:
�lE� Water mist from a water suPPIY �i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide survey or draw site plan)
*Capping of utilities must be inspected.
** Final inspection and approval of restored site required. Deposit will be returned after
approv in inspection. �
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Signature Date
J:�EiANDOUTS�Demolition Restoration.doc
Minnesota Pollution Control Agency
Min�ta Notification of Intent to Perform a Demolition
Polluti on Type of Notificat[on: (� Origina! ❑ Amended ❑ Prof ect Cancellation
Control
Agency
Demolition Contractor: Buildin� Information:
Name: ��U�Q._1--�4 P �Z�C. - BuildingName: Twi`t. �a/CS /�'1�C!/� �G� � �Lc�
Address: i"1 b O F�..�J�.-fL-� l�-�^1 Address/I.ocation: j,�S g� F,� !� D l.,, f,� � S
Ciry, State, Zip: �1� /�` � s �'�e-, !'ipr(/, .S.S7 �Z
cicy, s�a�, z�p: `1�2�-C�2 ��-�, 1�I►J �3'la. co,�„ry: S�o
Contact Person: �Z�..� S�y.,� Phone Number(s)::
Phone Number(s): q'�j�—�(�� — � A.ge ofBldg (yrs) �10 � Size ofBldg (sq ft) J
Number of Floors Including Basement Level(s): �
Buiidin¢ Owner: Present Use of Bldg. /�/s� �—
Name: ('�" fwr �a�'t � �� � ��'t�- �,0� �5 Prior Use of Bldg: ,erlcLwa, �7�"
Address: � Skl7 "�oyw�/' �'�/'G S �
Dates when demolttion or lntentional burnin will
City, State, Zip: �� /f,� �it�(/ .�S3�Z Begin: /�1�ny Z�O/� and End: Se�1�`. �O/O
Conlact Person: y � � w� (� tl (, w O Notificatlon must be postmarked or received ten (10) worldng dsys
Phone Number(s): q S Z" 2 Z( D� 5 y be(ore demoBtion begins. *See ltem #5 far eme�gency demolitions.
Both Beglnuing and Ending dates eLould be amended in wrlHng as
neceasary to reflect current proJect dates.
If there is >260 linear feet or >160 square feet of Regulated Asbestos-Containing Material (RACNn in the building
� to be demolished, it must be removed by a llcensed asbestos contractor prior to demolition. The State of MN-
Notice of Intent to Perform an Asbestos Abatement Project must be nsed to notify for the asbestos removal.
Is nonfriable ACM present in the structure to be demolished ? ❑ YES �NO
If YES complete items 1-9. If NO complete items 3-9.
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.
Category I Lineaz Feet Category II Linear Fcet
Linear Feet Linear Fat
Linear Feet Linear Feet
CateBory I non&Iable ACM means asbestos-containing packings, Cateeorv II non&table ACM means any material, excluding
gaskets. resiliem floor covering, and asphah rooSng products Category I nonfriable ACM, vontaining more t6an one percent
containing �re than one percent asbestos. Asbestos H�at, when dry, csnnot be ciumbled, pulverized, or
*Category I nonfriable ACM ia not allowed to nmain in place �ced to a powder by hand pressure.
for deewliHon if it la in poor conditlon. 'Category II nonfrlable ACM is not ailowed to remain In pinee
for demolitlon lf it has a high probability of becaadng crurr�led,
pulverlaed, or reduced to a powder during demolition, traneport,
or disposal. (ez trans�te, cement, slate roofmp�
2. Deseription & Location of ACM remaining in place (incincllng floor # and room #�: .
Notification of Intem to Perform a Demolition form (w-sw4-21.doc) Revised 3/00
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 de�nolition all buildings must be inspected
by an U. Enviro ental Protectlon enc (EPA) accredited inspecfor.
�� ° �a �1�?�.� /O ,� -en-�6 ��7�E-
4. D sc�} ption of planned demolition and the spec'if'ic method(s) that will be us : IQr.�r���l �{� �.��.u_
���'�C�Hl�►Oacs a� v'c /�, �uZ7�t ���V 1� SoG� a.nC Sd a�-S�Q�
�Sz- 07�' �i.tc a��s t91�'lDAY� ,wZ// �� �''t lvo,ly�['.
5. If the demolfHon was ordered by a government agency, please identify the agency and attach a copy of the order:
Name: Title: Authority:
Date of Order (M/D/�: Date Ordered to Begin (M1D/�:
* Notiiieation for an emergency demolition must be submitted ea early as poasible before demolitlon begina, but not later than the
following worldng day. A demolition is conaidered an eroergency ONLY when the fscillty has been deemed shucturrlly ontound and
in danger of fmminent collapse. If the atructnrally unsound bullding ia la�own to contain any regulated ACM or ia suspected to coatain
any regulated ACM, special procedures MUST be followed. If you are unaware of the speclsl procedures, instructioaa/regnlatlons can
be obtained by contacting the MPCA at the address or phone number listed below.
6. Description of procedare to be followed in the event that uneapected RACM is found or Cat. II nontMable
ACM be�qmgs crnmbled, pulverized or reduced to powder:
/V ff -
7. Waste Transporter(s) Information: 8 Waste Disposa! Informa
Transporter Name: /� �� Landfill Name: �� �
,
Transporter Contact: Owner/Operator:
Transporter Address: Address/Location:
City, State, Zip: City, State, Zip:
Phone Number. Phone Nwnber(s):
9. I certify that the above Informatfon 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.
Si ture of Contractor/Owner Date
Send to: Minnesota Pollution Control Agency For questions call:
Metro Districts - Regular Facilities Section 651-296-7300
520 Lafayette Road North 1-800-657-3864
St. Paul, MN 55155-4194 FAX: 651-215-1593
PCB RemoVal InfOrmat'lOn Polychlorinated biphe�ryls (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 questtons cal! the MPCA
Hazardous Waste (HW) business assistance unit at 1-800-65�72�.
PCB remover name/address/phone number: /`f '
PCB remover name/address/phone number:
Mercury Removal Information Mercury containing material must be removed from the buUding prior to demolition.
Merrury containing materials may include fluorescent, metal halide, htgh pressure sodium, neon, mencctty vagor [amps, mercu►y
swftches, thermastat probes, manometers, and gages, For questij�call the MPCA FlArbusiness asststance unit at 1-800-637-3724.
Mercury remover name/address/phone number: /f��
Mercury remover namcladdress/phone number:
RefrigerantS/CT+Cs/HCFCs Recovery Information A certified rechnician must reco�r refr�gerants from refrdgerati�n
equipment and systems in the building prior to demolition. For ques io call the CFC program at 1-800-657-3864.
Refrigerant recoverer name/address/phone number: �1 J�
Refrigerant recoverer name/address/phone number:
Norification of Intcnt to Perform a Demolition form (w-aw4-21.dce) Revised 3/00
M i n nesota Pol lution Control Agency
�� Pre-Demolition Environmental CheckList and Guide
Mercury
This section of the checklist is designed to assist you in deterniixiing the likely sources of
mercury in a building demolition project.
In general, do not remove the mercury from a device such as a switch. Keep the product intact
and remove and store in a covered container in a manner that will prevent breakage, spillage, or
release. Label and store the mercury containing devices to ensure proper handling and disposal.
This guidance will list product categories and examples from each.
Specialty Buildings and Concerns:
Hospitals, Clinics, Laboratories, I)ental Off'ices, and Schools. Mercury can be found in sink
traps and many other pieces of equipment and devices. Special care should be given to mercury
items in these buildings.
Batteries:
Smoke Detectors:
Emergency Lighting Systems:
Elevator Control Panels:
Exit Signs:
Security systems and Alarms:
Lighttng:
Fluorescent Lights:
High Intensity Discharge:
Metal Halide:
High Pressure Sodium:
Mercury Vapor.
Neon:
Switches for lighting using mercury relays: look for any control associated
with exterior or automated lighting systems:
"SilenY' Wall Switches:
1
Pre-Demolition Environmental Checklist and Guide frnm (w-sw4-20.doc) Reviaed 12/00
Heating, Ventilating, and Air Conditioning Systems:
Devices in this category control a variety of functions such as water pressure, air pressure, on/off,
and flow control. Check any control associated with air handling units.
Thermostats:
Aquastats:
Pressurestats:
Firestats:
Manometers:
Thermometers:
Boilers, Furnaces, Heaters & Tanks:
Mercury Flame Sensors by pilot lights:
Manometers, Thermometers, Gauges:
Pressure-trol:
Float or I.evel ConGrols:
Space Heater Controls;
Electrical Systems:
Load Meters and Supply Relays:
Phase Splitters:
Microwave Relays:
Mercury Displacement Relays:
Other Industrial Eqnipment and Areas of Mercury Concern:
Any control used for measurement of vacuum, pressure, fluid level, temperature, or flowrate
could contain mercury. Included are thermostats, thermometers, manometers, pressurestats, etc.
Other switches may have been used in old clocks, water cleaning systems, pneumaric control
switches, and other areas.
It is the expectation of the MPCA that all aquipment control boxes and panels be exam'vned for
mercury contaixung devices prior to demolition.
Poly-Chlorinated BiPhenyls (PCBs)
PCBs are a family of chlorinated compounds that were dielectric or especially non-conductive.
PCBs are oily liquids that are usually pale yellow to clear. The following is a list of areas in
buildings were PCBs may be found.
Transformers:
Transistors:
Capacitors (old appliances, electronic equipment):
Heat Transfer Equipment:
Light Ballasts:
2
Pre-Demolition Enviroxunental Checklist and Ciuide form (vwsw4-20.doc) Revised 12/00
Lead
Lead and lead based paint (LPB) are common items in ma.ny older buildings. The use of LPB
. was discontinued in 1978, however, many buildings have multiple layers of paint and should be
examined carefully. Lead can be found in the following azeas: �
Lead Based Paint: (woodwork, metal equipment, interior/exterior uses)
Lead-Acid Batteries: (lighting, exit signs security systems)
Lead flashing molds and roof vents:
Lead Pipes and solder:
ChloroFluoroCarbons
CFCs (chlorofluorocarbons) and HCFCs (hydrochlorofluorocarbons) are man-made refrigerauts
that destroy the ozone layer.
Fire Extinguishers (both portable and installed halon suppression systems)
Air Conditioners (rooftop, room, and central)
Wallc in Coolers (refrigeration or cold storage azeas)
Water Fountains and Dehumidifiers:
Refrigerators/Freezers/Chillers: .
Heat Pumps:
Vending Machines/Food Display Cases:
Asbestos
Asbestos is a naturally occurring mineral that separates into strong, very fine fibers. These fibers
float in the air and are easily brea.thed into the lungs, causing serious health problems.
Asbestos is not combustible, has high tensile strength, has good thermal and electrical insulating
properties, is moderately resistant to chemicals, and has good frictional properties. It is durable,
flexible, strong and resistant to wear. Thus, asbestos has been used for thousands of coxramercial
and public applications including:
Asbestos can be found in many types of building materials, products and
insulation. You can't tell whether a material contains asbestos simply by looking
at it, unless it is labeled. Asbestos presence or absence must be confirmed by
professional sampling and laboratory analysis.
Asbestos type materials can be found on, or in:
3
Pro-Demolition Emironme,ntal Checklist and Guide forni (w-sw4-20.doc) Revised 12/00
Boiler rooms:
Boilers, Furnaces, Fireplaces, and their components:
Cement sheets near heating equipment:
Boiler insulation:
HVAC Duct insulation:
Ductwork fleacible fabric connections: ,
Fireproofmg materials:
Firedoors:
Flooring:
Vinyl floor tile:
Vinyl sheet flooring:
Asphalt tile:
Linoleum paper backing:
Mastic (floor tile, carpet, etc.)
Electrical:
Electrical panels:
Electrical wiring insulation:
Heating and electrical ducts/conduit:
Pipe and other insulatlon:
Aircell {corrugated cardboard):
Millboard:
Preform:
Joint compound:
Spray applied insulation:
Blown-in insulation:
Surfacing materials:
Acoustical plaster:
Decorative plaster:
Textured paints coatings:
Spray applied materials (acoustical, decorative, or insulative):
Roofing:
Roofing shingles:
Roofing felt:
Base Flashing:
4
Pre-Demolition Environmental Checklist and Guide form (w-sw4-20.doc) Revised 12/00
Cement materials (Transite):
Cement pipes (flues & vent pipes)
Cement Wallboard:
Cement siding:
Pegboard:
Ceiling materials:
Ceiling tiles:
Ceiling tile adhesives (pucks):
Lay in ceiling panels:
Acoustical tiles:
Miscellaneous:
Taping, joint, and spackling compound:
Caulking/putties:
Fire curtains and blankets:
Laboratory hoods, table tops, gloves, etc.:
Gaskets:
OTHER
The following is a list of other environmental and regulatory issues that should be addressed
prior to demolition:
Solid Waste (all non-building components such as files, books, trash, desks, chairs, etc.) must be
removed prior to demolition.
Hazazdous Waste: (all HW including household HVV) must be properly handled and disposed of
prior to demolition.
Oil: (used oil, hydraulic oils in door closers, elevator shafts, etc) must be collected and properly
disposed of prior to demolition.
Tanks: no evidence of former heating tanks or storage tanks exists
This guidance document is not intended as a substitute for reading the rules and statutes and
making your own independent determination of their applicability to your demolition project.
Examples in this gnidance document do not represent an ezhaustive listing of types of
materials that may be required to be removed from a building prior to deraolition.
If you have any question or comments about this checklist, identify any additional items not
found in this list, or would like to discuss an individual project, please do not hesitate to contact
the MPCA demolition team at (800) 657-3864 or (651) 296-6300.
5
Pre-Demolition Environmental Checklist and Guide form (w-sw4-20.doc) Revised 12/00