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�-'' P R I ��� CITY OF PRIOR LAKE Date Rec' d
� � DE1I�OLITION PEl�IT .
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- PERNIIT NO. .�Z ,ll� �
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Please e or rint and si at bottom)
ADDRESS . ZbNIl�TG (ofl�ce use)
� 2- �3 7 a. i v � a.�n 1r�,�' `'�',, � � .
LEGAL DESCRIPTION (off'ice use only) .
LOT BLOCK ADDITTON S<< S�«� PID
OWNER y � n . r �/_ r q
(Name) L� vC +�C� �c K�-� ��`i � IJ �'l �� (Phone) �S Z'" Z 3 I" OL 3 J
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(Address) �,� 2' � 7 1 Q � , �' b� � �v �-�, N 1�
CONTRACTOR n 9S � ���^ ,��
(Company Name) � -1 .,�'^� (Phone)
(Contact Name) �C��— (Phone) �o I 2- GG 9 � l g 2�
(Address) (D � s� � ' - (� / 2- �
Use of Building: INTERNATIONAL BUII.DING CODE
� '� � Type of ConstrucCion: I II III IV � t�i �
�t.w. � Qccupancy Group: A B E F H I M�t? S U
�.
Division: 1 2� 4 5
NlPCA NOTIFTCATION OF INTENT TO PERFORM A DEMOLTTION •
� � ,� -„ -
.
� I hereby certify that I have fumished informarion on this applicadon which is to the best of my knowledge true and correct..s also certify that
I am the owner or uthorized agent for e above-mentioned property and that all construction will c�nform to all existing state and local laws
and will proceed ' acc ance with su 'tted plans. I am aware that the building official canfevoke this permit for just cause. Furthermore,
I hereby agree the ' ' or e may enter upon the property to perform needed inspections
. � , 8 � I Z--
• Signature ate
ZO � y . • .
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_ This A plicaf n Becomes Your Dem litia �����'. � �;� ���� u � ,�;� �, `"
e it � hen Appr�oved .
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Buiiding Official ate �/��� 4
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This is to certify that the quesc in the above applicadon and accompanying documeats is in accordance witli the City Zoning Ordinance and may proceed as requested.
�� �_�o_r�
P[anning Direc Daze Specia! Conditions, if aay
24 hour notice for all inspections (952) �W7-9850, fax (952) �47-�245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
LEGAL DESCRIPTION
DEED DOCUMENT N0. 193079 �
(PID #25-036007-0)
. That port of Lot 7, Maple Pork Shore Acres, lying easterly
of the following described line:
, Beglnning ot a point 'on the southerly Ilne of said Lot 7,
� distant 6.23 feet northeosterly of the southwesterly
corner of said Lot 7, thence northwesterly to a point �n '
� the northerly line of said Lot 7, distant 7.60 feet eosterly
of the northwesterly comer of said Lot 7, and there •
terminating, Scott County, Minnesota. "
DEED DOCUMENT N0. 192513
(PID #25-036007-1)
• Lot 8, Maple Park Shore Acres, Scott County, Minnesota,
and that part`'of Lot 7 of soid plat lying westerly of the
foliowing described line:
Beginning at a point on the southerly line of soid Lot 7, '
- distant 6.23 feet northeasterly of the southwesterly
corner of sald Lot 7, thence northwesterly to a point on
the northerly line of soid Lot 7, distont 7.60' feet easterly
of the northwesterly corner of said l,ot 7, and there �
termiriating, Scott C'ounty, Minnesota. `
NOTE: THE EAS'FERLY PARCEL FlRST DESCRIBED ABOVE
(PID /25-038007-0) IS DESCRIBED IN DECLARATION
OF COVENANTS. C�JDI710NS AND RES7RICT10NS
DOWMENT N0. 89174.
(OWNER TO.VERIFY CURRENT STATUS)
PRFPARFn FOR: , '
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��. ��� Site Restoration Proposal For Demolition
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Applicant: R , /4 . ��� � S �,,� L
Address: � S� Z- � 7 �a��r,�, a+� k.. � �vu-�, � �/L�,
Check boxes below:
� Fill Excavation to grade �
. � Sod or seed all bare soils ��a''-�- e�'"jr ��`�
� Erosion control (see handout). Maintain erosion control until turf is esta.blished.
Cap sewer below grade. * Mark location. Licensed contractor required.
� Cap water below grade.* Mark location. Licensed contractor required.
ya' Call City of Prior Lake Public Works Department (952.447.9898) for water meter
�� removaL
-� Cap gas line.* (By gas company)
�j Disconnect electric at meter. (By electric company) � .
N`�- o Pump and fill cesspool/septic tank. . Certified contractor required.
N� ❑ Abandon well. Certified contractor required. Existing well
� Remove existing structure foundation and footings, materials, and debris.**
�f Provide dust control by following means: �
�� � Water mist from a water supply (i.e. r
2. Enclosure �� � �„�KE
3. Other B���� REVIEV1l
�
� MISPECTi01t
Comments: (provide survey or draw site pla��
� /`'� � rL - �S
❑ ACCEl�I��
❑ NO
, n � M�IIk �11�N De donA
� 4 d�1�1�r�Mr��,saip ca� r
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*Capping of utilities must be inspected. ������A�� �S
** Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
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Signature Date
J:lBUII,DING�3ANDOUTS�Demolition Restoration.doc
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-� `�" � Site Restoration Proposal For Demolition
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Applicant: R , /4 . � �. �' � C
Address: � S� Z- ��] �a�ir,b a h�, f �v-�•.�, � �L� �
Check bozes below:
� Fill Excavation to grade � <
. � Sod or seed all bare soils p�p'' ea �"r�`
� Erosion control (see handout). Ma.intain erosion control until turf is established.
Cap sewer below grade.* Maxk location. Licensed contractor required.
�
� Cap water below grade.* Maxk location. Licensed contractor required.
�a' Call City of Prior Lake Public Works Department (952.447.9898) for water meter
�� removal.
�. Cap gas line.* (By gas company)
.�j Disconnect electric at meter. (By electric company) � � .
N��- o Pump and fill cesspooUseptic tank. . Certified contractor required.
,�/,� o Abandon well. Certified contractor required. E�sting well
� Remove existing structure foundation and footings, materials, and debris.**
� Provide dust control by following means: �
� Water mist from a water supply (i.e.�i r
. 2. Enclosure ; V� �' �„��,KE
3. Other B�� �„� REVlEVV
�
� nvs�croNc
Comments: (provide survey or draw site pZa�.�. ��y � L _�
- � ���M1.O��B AS NOTEC
� � . ��UBMIT
- n''�"' M� M�r es do�►A
����a��11►���Illrlr�ari�p �orr n
� �'��AN�'ldr�AT�i.t. T�s. �
Capping of utilities must be inspected.
** Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
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Signature Date
J:`,BUII.,DING�HANDOUTS�Demolition Restoration.doc
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Memo
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Date: Thursday, November 8, 2012
To: Janet Ringberg
From: Lynda Allen
Subject: Demolition Permit # 12-0951
_
15287 Fairbanks Trail N.E.
The memo authorizes the return of the $5,000.00 demolition deposit.
Please return the deposit ta
R.A. Kot Homes, Inc.
7694128"' Street West
Apple Valley, Minnesota 55124
Thank you.
� L � d S. en --------
'ng Services Assistant
Phone 952.447.9800 / Fax 952.447.4245 / www:cityofpriorlake.com