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Home My WebLink AboutDemo Permit #13-510 o rru0 �y, Memo '�'NESOS Date: Thursday, February 6, 2014 To: Janet Ringberg From: Lynda Allen Subject: Demolition Permit #13-0510 14510 Glendale Avenue 'The demolition permit has been closed on the above referenced project. Please return the $5,000.00 demolition deposit to: Jeff Scherer 15548 Red Oaks Road Prior Lake, Minnesota 55372 Thank you. 41' S. Allen Lry Poppler Building Services Assistant City Engineer Phone 952.447.9800 / Fax 952.447.4245 / www.cityofpriorlake.com %ra CITY OF PRIOR LAKE DATE TIME lNSPECTION NOTICE SCHEDULEO Cr- 7` %�� ADDRESS I � � � �..., � ' t`C:.c-t,.kc;�-�..� OWNER CONTR. � �, PMONE NO. PERMIT NO. t' �= "� > I � O FOOTING 0 PLUMBING RI ❑ FJ(/GRAD/FIILING O FOUNDATION ❑ MECH RI ❑ COMPLAINT ❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI O INSULATION O SEWER HOOKUP ❑ FIREPLACE FINAL O FINAL t] PLUMBING FINAL ❑ GASLINE AIR TST ❑ SITE INSPECTION O MECH FINA� ��"? ,; -�;� COMMENTS: ❑ WORK SATISFACTORY, PROCEED ❑ CORRECT ACTION AND PROCEED ❑ CORRECT WORK, CALt FOR RElNSPECTION BEFORE COVERING inspector: � OwnedContr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH � SAFETY.� lNSNOTI , � O� P R I � �✓ � �� CITY OF PRIOR LAKE Date Rec' d � �� DElV�OLITIOlV PERN��T �- l�' E S �` ' � - PERMIT NO �3 --Sr o (Please e or rint and si at bottom) ADDRESS � ; , �- � , , , ZONING (office use) j � J /"�r r �? ,� � �� LEGAL DESCRIPTION (otfice use only) . LOT BLOCK ADDITION P � (Na�me) R `5 �'- � "r- `; �. ,`� f. � � � . . � _ � �..P' � _ � f C,_ � ` " l (Phone) (Address) / ;� �� , k : f' ' - - - fJz- '�� - ,�� i_,..�� r� * � � - i V CONTRACTOR , (Company Name) l�. � t_� �a c� � � ..,.�. . �l-. � �� t � a- �� f r �° � .t ` � � � (Phone) � "�,� - i' -l�-- '' V ..t '� (ContactName) �.. �� - b_d � -- ,. «' ',� `a (Phone) �' ,.� - �; � j _ r I� � (Address) I J �) ` � -, .�,:;'� � � r � : � %�.- �''. , P J �<� S ' i Use of Building: � INTERNATIONAL BUII,DING CODE N � �ij „�, Type of ConstcucCion: I II III IV V A B //'�+'` r`v``�``'�`'�'Occupaucy Group: A B E F H I M R S U � Division: 1 2 3 4 5 CA 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 also certify that I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all e�cisting state and local laws and will proceed in accordance with submitted plans. I am aware that the buildin� official can revoke this permit for just cause. Furthermore, �.hereb�! ,, _ e that the city ofFicial or a designee may enter upon the property to perform needed inspections. �x N�„ �£ . . 1 • Signature Date ° ��i��L' ' �°�S�'��i�,F..- ' �`�� , r�� a'�" =t� ,�f = '� �� _ This A plicatiart Becomes Your Demolition ��'��,�,� �-� ��c ,r t .�,x k m"t When Approved - � �� f. � �'� 1� �s� c1Z+ n. i.�2< <`.�9�lfs,��-s Cf�?:1c� Bnilding Official Date � J �� -�� .¢, i3 L'/�� 197d�Z.� 1'his is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. .5��9�/3 lanning D' or Date Special Conditions, if any 24 hour notice for all inspections (95Z) 447-9850, fax (952) �47-�245 16200 Eagle Creek Avenue, Prior Lake, Minnesota �5372 . s `' �' .r-' : ��''�. "i ��. �r.:r:s. � . �' ' 4dl o� P�°� , � � Site Restoration Proposal For Demolition � �. V � �INi+i�so`��' � . Applicant: �� ' � �; - .� , � �� ,'� Address: 1 L � � I�� `, I r� �� r�- ,j�� ,� Check boxes below: �f Fill �xcavation to grade ,� Sod or seed all bare soils �1� Erosion control (see handout). Maintain erosion control until turf is established. �a Gap sewer below grade.* Mark location. Licensed contractor required. fd Cap water below grade. * Maxk location. Licensed contractor required. �r' Call City of Prior Lake Public Works Department (952.447.98981 for water meter removal. - � Cap gas line.* (By gas company) � Disconnect electric at meter. (By electric company) � � N�,i� Pump and fill cesspooUseptic tank. . Certified contractor required. P:�/.,. ❑ Abandon well. Certified contractor required. Existing well ,a Remove existing structure foundation and footings, materials, and debris.** ,er Provide dust control by following means: � 1. Water mist from a water supply (i.e. neighbors,� ater ) 2. Enclosure 3. Other Comments: (p�ovide sur-vey or draw site plan) �� I� �.. �� - il�IMII�'MQ � , i��l�tl� ��C�O�M�M � C�tNt"�t � � �� 'M"�""°�. "�`� *Capping of utilities must be inspected. �j�r �� '�"` �� ** Final inspection and approval of restored site required. Deposrt will be returned after approved final in tion. ign e ate J:4�LJII,D OUTS�Demolition Restoration.doc �� M��1�� AG�"�� .� '��a �� 1�'� � 1''��'�I��i �A T�M Q �u��w�►+u► .�+�taaMr��wnA .M�1111�M�� 1'.i�MT�! 1�!'t� IM�� T �31 � Minnesota Pollution Control Agency _ • � �_� Notification of Intent to Perform a Demolition Minnesota Pollution Type of Notification: �Ori inal Control g� ❑ Amended ❑ Project Cancellation ' Agency . Demolition Contractor: Buildine Information: Name: L 1 � �/� 5 C •. -. �� ( , )( i � � � � � �tE � � L . , Building Name: � r..- . z,., r � . � `' :�-. �,, '� _ � •. � Address: J '�i l�" �f (. � � .)�i � '� �� - � � �' Address/Location: J' I S 1 Cl �� j-<• - ej,. �- f1 ��, ' . City, State, Zip: '.-. ,�� ' ��,. /►'t* � , -r � — City State Zip: � �, ' —_ , , '� � � -�, j?_� o�; �P� 1 � ' " I � Counry: � , � r. Contact Person: � �a �- 1 1,� �� Phone Number(s):: - �.�l'�� Phone Number(s): � � � �;t - �"� ~ y , � �" s � Age of Bldg (yrs) r �� Size of Bldg (sq ft) �; ��-j � � Number of Floors Inciuding Basement Level(s): ,�, Buildin� Owner: Present Use of Bldg: , r,�, -: .,�,,, ;�,� Narne: � .�:�- �" � ,1, 4 ( � �` Prior Use of Bldg: �� .. , �, .� Address: � r� �� `'_., ei, (� K s c� Dates when demolition or intentional burning will Ciry, State, Zip: `''� � �, ;- i ,_ �� /r �, ; � ��id Begin: and End: Contact Person: �),p ,(�- '�_,� t � � (" Notiticallon must be postmarked or received ten (10) worlting days Phone Number(s): �� j� �' j.- 3� L � before demoliHon begins. *See item #5 for emergency demolitions. Both Beginning and Ending dates should be amended in writing as necessary to reflect current project dates. If there is >260 linear feet or >160 square feet of Regulated Asbestos-Containing Material (R.AC1Vn in the btulding to be demolished, it must be removed by a licensed asbestos contractor prior to demolition. The State of 1VIN- Notice of Intent 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 ? ❑ 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 Feet Linear Feet / - . ', Linear Feet Linear Feet Linear Feet Cateeorv I nonfriable ACM means asbestos-containing packings, Cateeorv II nonfriable ACM means any material, excluding gaskets, resilient floor covering, and asphalt roofing products Category I nonfriable ACM, containing more than one percent containing more than one percent asbestos. Asbestos that, when dry, cannot be crumbled, pulverized, or *Category I nonfriable ACM is not allowed to remain in place reduced to a powder by hand pressure. for demoHtion if it is in poor condition. '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 #): Notificarion of Intent to Perform a Demolition fortn (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 demolition all buildings must be inspected by an. U. S. Environmental Protection Agency (EPA) accredited inspector. J � � � �r Q,� �� < ��t � Y � ,, . �-, k -� � , �� pL � �� 4. Description of planned demolition and the specific method(s) that will be used: 1�� k►: � ac .,,,: ,.. c �"�.,? .�11��\ -/ o�� .�:� -_ ��r1F_i�' . 5. If the demolition 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 (M/D/I�: � * Notification for an emergency demolition must be submitted as early as possible before demolition begins, but not later than the following worldng day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsound and in danger of imminent collapse. If the structurally unsound building is ]mown to contain any regulated ACM or is suspected to contain any regWated ACM, special procedures MUST be followed. If you are unaware of the special procedures, instructions/regulations can be obtained by contacting the MPCA at the address or phone number listed below. 6. Description of procedure to be followed in the event that unezpected RACM is found or Cat. II nonfriable ACM becomes crumbled, pulverized or reduced to powder: �,— �� f '� i- �.(S � 1 E C w.� I..t.: G t" � ry��t' y` ;,, �9 ,)''. l-� 7. Waste Transporter(s) Information: 8. Waste Disposal Information: Transporter Name: ��y A < � .�,�. ., '-� , �,•;�_ � :.,� .r ; � ,►�, . Landfill Name: ��. .- T.,� . /_ . - � � . I � Transporter Contact: � ,�' � -� : .°� r.. Owner/Operator: �'�'„� � I� �� t� �, Transporter Address: i,;� �l"i �' ) � +� `! i - t. �' Address/Location: � �l.�o�U �v� _�� ! ' , ' i � Ci State, Zi 5 �c.� .�e � � • '�� 3 � City, State, Zip: � ,,- < �,,t /"r-P ) _ . � tY, P� � �. � � ) 9 �a - �! � - s"� SS Phone Number: �` .i - / r �-,-�� _ ��- Phone Number s : 9. I certify that the above information 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. Signature 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 Information Polychlorinated biphenyls (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 questions call the MPCA Hazardous Waste (lYYi� business assistance unit at 1-800-657-3724. PCB remover name/address/phone number: �J � PCB remover name/address/phone number: MerCUry RemoVal InfOrmatioII Mercury containing material must be removed from the building prior to demolition. Mercury containing materials may include fluorescent, metal halide, high pressure sodium, neon, mercury vapor lamps, mercuty switches, thermostat probes, manometers, and ga For questions call the MPCA HW business assistance unit at 1-800-657-3724. Mercury remover name/address/phone number: J a��Or�t+'c c,��. 1-L � '�'� 3 S�°�''�r''" P`"rk' R�', �ON SS � Mercury remover name/address/phone number: � Refl'igex'ants/CFCS/HCFCS ReCOVeIy IIIfoI'matloil A certified technician must recover refrigerants from refrigeration equipment and systems in the building prior to demolition. For questions call the CFC program at 1-800-657-3864. Refrigerant recoverer name/address/phone number: �a� (�,,,.�ro.c.�__� Lti-� �� 3 S��"` p `"`�` ��N �� a� Refrigerant recoverer name/address/phone nutnber: • Notification of Intent to Perform a Demolition form (w-sw4-21.doc) Revised 3/00 Minnesota Pollution Control Agency . �'� Pre-Demolition Environmental Checklist and Guide � Mercury This section of the checklist is designed to assist you in determining the likely sources of mezcury 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, ar release. Label and store the mercury contauung devices to ensure proper handling and disposal. This guidance will list product categories and examples from each. Specialty Buildings and Concerns: Hospitals, Clinics, Laboratories, Dental Offices, 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: Lighting: 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 systexns: "Silent" Wall Switches: 1 Pre-Demolition Environmental Checklist and Guide form (w-sw4-20.doc) Revised 12/00 Heating, Ventilating, and Air Conditioning Systems: Devices in this category control a variety of functions such as water pressure, air pressur�, 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 Level Controls: . � Space Heater Controls: . Electrical Systems: � Load Meters and Supply Relays: Phase Splitters: . Microwave Relays: Mercury Displacement Relays: . Other Industrial Equipment and Areas of Mercury Concern: Any control used for measurement of vacuum, pressure, fluid level, temperaturep or flowrate could contain mercury. Included are thermostats, thermometers, manometers, pressurestats, etc. Other switches may have been used in old clocks, water cleaning systems, pneumatic control switches, and other areas. It is the expectation of the MPCA that all equipment control boxes and panels be examined for mercury conta.uung 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 faund. Transformers: Transistors: . Capacitors (old appliances, electronic equipment): . Heat Transfer Equipment: Light Ballasts: 2 Pre-Demolition Environmental Checklist and Guide form (w-sw4-20.doc) Revised 12/00 Lead Lead and lead based paint (LPB) are common items in many older buildi.ngs. The use of LPB was discontinued in 1978, however, many buildings have multiple layers of pai.nt an.d should be examined carefully. Lead can be found in the following areas: 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 refrigerants that destroy the ozone layer. , Fire Extinguishers (both portable and installed halon suppression systems) Air Conditioners (rooftop, room, and central) Walk in Coolers (refrigeration or cold storage areas) 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 breathed into the lungs, causing serious health problems. Asbestos is not combustible, has high tensile strength, has good thermal and electrical insulatin.g 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 commercial 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 Pre-Demolition Environmental Checklist and Guide form (w-sw4-20.doc) Revised 12/00 a Boiler rooms: _ Boilers, Furnaces, Fireplaces, and their components: , Cement sheets near heating equipment: Boiler insulation: ' HVAC Duct insulation: Ductwork flexible fabric connections: Fireproofing 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 insulation: � 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 . � �I � ''�� '-::: s. �. � �.�';: 3s � �. � ' � � � � � . . �. „ . . . ; � ,; �. 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