HomeMy WebLinkAboutDemolition Permit #12-0989 y o❑❑ c� �000 =� o y�
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CITY OF PRIOR LAKE Date Rec d
� D� DElVIOLITION PEl�I'�' g �.36 ,/ Z
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- PERNIIT NO. fZ .
ease e or ' t and si at bottom I
ADDRESS . ZONIl�T ce use)
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LEGAL DESCRIPTION (office use only) ,
LOT BLOCK ADDITION pID
OWIVER � -
(Name) _ - u�i�tJ G,/�Af�� �i�:rP t,�tl�� �' ��l �'/P �PJ 1 Y'Tl /j✓G� (Phone) �/� ' 3�• �°g6
(Address) ,30 0 � AJ.0 AC�/3 �/�`�� �
CONTRACTOR
(Company Name) �S �RaBGA-5e' .S�iC.!/iG� ���i� (Phone) ����'y�' ��
.. (Contact Name) ,/���/1 kJ�}'A1 !�[ i/� (Phone) �/.2 36� 9.2.3�f �'�tG
., ddresS) / 766 � /!?GC� �sYcJ/v yQQ l i¢ �C� �?iVr ��
Use of Bu�ding: � INTERNATIONAL BUII.,DING CODE l
�/NC9l.c,�' l�1�t t� ��.--.�," Type of ConstrucCion: I II III IV � A �
--- --7�fltcupaacy Group: A B E F Ii I M� S U
�/" _.. _� Division: 1 2� 4 5
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MPCA NOTIF'ICATION OF INTENT TO PERFORM A DEMOLITION • �
I hereby certify that I have furnished informarion on this application which is to the best of my knowledge true and correct. I atso certify that
I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I hereby agree th city ' or a designee may enter upon the property to perform needed inspections.
� --�- � � �� 12
gnature Date
� � 4l'u`�t c7 �`" � ��'ES �€ "'s.r �.
_ This Appli ation Becomes Your Demoli n ���� .. �` .� �t,��� n � : >�
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ermit iNhe� Approved .
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This is to certify that the request in tha a ve application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested.
f-�Ill-/a �
Planning D' or Date Special Conditioas, if eny
24 hour norice for all inspections (952) 447-9850, fax (952) �t47-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
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� `� �' � Site Restoration Proposal Far Demolition
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Applicant: ��kS` ���� �j�/G�' //�G;
Address: �1��13' /�Ce�Yd�/� �� �� /�//�/� ,5���
Check boxes below:
� Fill Excavation to grade �
� or seed all baxe soils
.��/ Erosion control (see handout). Maintain erosion control until turf is established.
�. Cap sewer below grade. * Maxk location. Licensed contractor required.
a Cap water below grade.* Mark location. Licensed contractor required.
� Call City of Prior Lake Public Works Department (952.447.9898) for water meter
removal. �
� Cap gas line.* (By gas company)
� Disconnect electric at meter. (By electric company) � � .
t�► ❑ Pump and fill cesspooUseptic tank. . Certified contractor required.
�/e, a� Abandon well. Certified contractor required. Existing well
� Remove existing structure foundation and footings, materials, and debris.**
�. Provi dust control by following means: �
l: Wat�r mist from a water supply (i.e. neighbors, water tank)
. Enclosure "�
3. Other
Comments: (provide survey or draw site plan) u�+�n `,�� �.;,;� . r �,;;,�
� INSPECTOR
DATE y PERMiT NO._. f,�_ '��
� O ACCEPTED S SuBMITTED ,
� � ACCEPTEb WITH CORR�CT,I4NS��AS NOTED
-� {3 J�1' A�CC€FT'ED-0OFtAECT d REStJ�MIT ,
�`� � � TheM oOnxnNN� �n ta your i�Mnn�lo�. Alt wak �N b�done
o�; �� in fuN�ooAlpN�nd� MAMt M aPPMt� buf�p s��rp a9�M`` .
cequire�rienis Mdudinp items not tp�iqily no1�cF In lMs,�Miw.
* Capping of utilities must be inspected KEEP THlS PLAN SET ON SI'F� AT ALL T�MES.
** Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
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Si ature Date
J:`�BUILDING�HANDOUTS emolition Restoration.doc
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DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS �v c Z� cv.ar� s,-�� Qtv�
TYPE OF WORK p�.r►�.��T«.�
USE OF BUILDING cZ�s o�.�
PERMIT NO. (z• qb5 DATE ISSUED � o�2
BUILDER �s l�i6c.4r �c�% PHONE # �Iz•3�.•�z34
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
C �}' l 7 �G••�,i`' ' �'r � .
PLACE NO CONCRETE UNTIL ABOVE� HAS BEEN SIGNED
FINAL
FOR ALL INSPECTIONS (952) 447-9850
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Memo
��SO�P
Date: , Thursday, November 8, 2012
To: Janet Ringberg .
From: Lynda Allen
Subject: Demolition Permit #12-0989
16179 Evanston Avenue SE
The memo authorizes the return of the $5,000.00 demolition deposit.
Please return the deposit to:
Mark's Bobcat Service
196051VIushtown Road
Prior Lake, Minnesota 55372
Thank you.
,�,
L — . Allen Y-- -- _
uilding Services Assistant
Phone 952.447.98Q0 / Fax 952.447.4245 / www:cityofpriorlake.com