HomeMy WebLinkAboutDemo Permit 04-1006
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/NNESO
CITY OF PRIOR LAKE
DEMOLITION PERl'1IT
Date Rec'd
CITY'S COpy
I PERi'YIIT NO. O.t'(- I OO~
(Please tvoe or -print and siltD. at bottom)
r ADDRESS
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S~f'r~D<?e~, (0\.0 S-S- 379
ZONING (office use)
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I LEGAL DESCRIPTION (office use only)
I LOT BLOCK ADDITION
PIDz.5. "1Z8. 0 II. ()
OWNER S
(Name) Y\, <;. L
(Address) ,;:1 j -3 c Sic, CL 'J.--\-Yc"o '\
(Phone)
VV' 11: f- L~~ \Y\.~I
SSSl."l
i COl'iTRACTOR
I (Company Name) <) "^'i, ~ L
(Contact Name) 00-.'" < \" ~A
(Address)
(Phone)
(Phone) G: I;) - C, 1.'/ - C,""7 Is-'y
Use of Building:
INTERNOATIONAL BUILDING CODE
Type of Construction: I II III IV V
Occupancy Group: A B E F H I :\f
Division: 1 2 3 4
A B
R S U
5
o yl1'CA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
I ~e:eby certify :hat I have furnished information 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 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.~e. that the city official or a designee may enter upon the property to pe..>form needed inspections.
, ~
\:, v,(l,~ /t,.- "'-.ell
. Signature Da'te
Building Ofticial
Date
I METRO (MCES) SAC UNIT I
i DETERMINATION
Mr~~'
~ ~-<J/
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This Application Becomes Your Demolition
; Permit When Approved
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"rniy tjl,j[ :he req~:est in ,be :lbove Jpplic:l.lIon ;md accompanying jocumenlS is in accordance '.vllh the City Zoning Ordirlllnce md may proceen as requesteo
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24 hour nocicc for :\11 inspections (95'::) oU7.9850. fax (952) .W7~4245
16200 Eagie Creek Avenue. Prior LJke. Minnesota 553T:
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Planninu: Direcror
Soeciai':Jmiilions.;roan'-'
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lJU OCT 0 5 2004 J I
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Site Restoration Proposal for Demolition
Applicant:
S "y\ S L.
Address: ~330 S/C'-<>- -J-yc., I
S<Q \,...(.-
wvAI
Check boxes below:
.611 Excavation to grade
z( Sod or seed ali bare soIls
::J j:rosion control (see handout). Maintain erosion control until turf is established.
e( Cap sewer below grade. * Mark location. Licensed contractor required.
/Cap water below grade* Mark location. Licensed contractor required.
::J Call City of Prior I.,ake PEblic "N orks Department for water meter removal.
-a-/Cap gas line. * (By gas company)
d Disconnect electric at r.1eter. (By electric company)
~ Pump and fill cesspool/septic tank. Certified contractor required.
o/Abandon well. Certified contractor required. Existing well
0/ Remove existing structure foundation and footings, materials, and debris. * *
::J Provide dust control by following means:
(]) Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide surve:v or draw site plan)
&d" ~ .~,~
*Capping of ut::ities must be inspected.
** Final inspection and approval of restored site required.
approved final inspecti on.
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Deposit will be returned after
Siznature
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J; .BCILDI:\G,E.~l.:\-~'\jL-TS .De::10 S;t~ K-=:5ll1!".jOC
Oct 20 04 08:37a
952-466-4797
p.~
Minnesota Well and Boring
SualinllNo..
~nesaIa Unique Well No.
orW--seriesNo.
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IH
218073
I WEl.I..OII BORING LOCAnoH
MINNESOTA DEPAoATMENT OF HEALTH
WELL AND BORING SEAUNG RECORD
Minne!oIa SlaMe. OJapJer 1031
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I GEOlOGICAL MATERIAL I COLOR t==':1 FROM I 10 ~ctions reml3Wd1 0 Yes 0 No
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UTY\P.~ , ~IMETHOD USEDlU SEALANNUlAJI SMCE BETWEEN 2 CADilGS" OR CASlIIIG At.ID BORE HOLE:
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REM"'RKS, SOURCE OF D...T.... DlfFICULnfSllI SEALING
I f,lPORTANT.ALEWlTHPROP,Rrv IH 218073
PAPERS.VW:Ll OWNER COf'Y
DIItII W-'l or Bomo Consaruded
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Screen from
OIlSlJlUClIONS
o RodsIOrop PIpe 0 Chack Vaf\le(s} 0 Debris 0 FlfI )Ill No Obstruction
Typo of ObllNctlons. (Describe)
Ooscrlbo
In.fram
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o Perforated
o Removed
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l'ypeof per1oralor
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GROIJTING .....TERlAL(S) (0'" blgat CleIIl......M _. DIIe... of ..rdortI~ '" 50....)
Grvutino~~ rlOtll~Io~ft.~y.vdS-&b:lgS
tIom_to_f1._yards_bags
1"""'_10_"_ yMls _ b"P
IOTHER WEllS AND BORINGS
OIhel_led..-du!lllledwellorboringOllpn:lpe/1y? 0 v.s 'pi Nil HawINl'lv?
UCENSED OR REGlSTERED CONTRActOR CERnFlCAnoN
This _I or boI1ng WIll seUId In IIlCQlIdIgg with N1nnesata fWle8. Chqder4725. The inIorma\lon Cllf1lBinlld In Ibis tepOO is
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-. . f UI" PRIOR LAKE
INSPECTION NOTICE
--s'l.~D
ADDRESS
..2J CJ.'!
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OWNER
cotfiTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
TIME
...--"'-
/~.J!a~;/
o.c/ -//Z?G
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o ~1I-INE AIR TST
/"I p~..AffO
COMMENTS:
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G'/C<;..t?/ o/le~ '(}'4-,r ~/e
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~ OwnerlContr:
,
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/NSNOn
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!