HomeMy WebLinkAboutDemo Permit 04-0507
3
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White
2, Blue
3. Yellow
- File
. City
- Appllcen.
Perm" No. 4 -507
DIRECTIONS
1. DATE
BUILDING INFORMATION
7, SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
B. NO. OF STORIES
'fSiTE ADDRESS ,
\ 1'\ 0 t (' A-1'-t~R.. ~.. ,., lA-
3, LEGAL DESCRIPTION U
LOT
SLOCK
QA ~"f;"o/? '- ""b M..t CC.;>,.;:L
PID Z51'Z1.~t:7'1-o
9. TYPE OF CONSTRUCTION
10. COMPLETION DATE
ADDITION
~c...r. 21
...
(leI. No.)
qS~'-)Cj {", -t. J.~9
(Tel. No.)
Glz - '1"'~ -~9.8 4 \.
6, CONTR~~~C (Address) [Tel. No.) .
I hereby certify I have furnished information which is to the best of my knowledge true and correct. I also certify that I am the
o er r authorized agent for the above mentioned property and that all construction will conform to all existing state and local laws
an will roceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Fu th re, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
^^f~
Signature
;J <":~f)
(Address)
<:'.:. ,,~~ ~ r,,'. \
- (Address)
N.--.J
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x
4- :>. ,- O~
Date
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION 0
MATERIAL FILED WITH APPLICATION
etf ~,;>rrc
0. Site Restoration Plan
Cl Utility Abandonment Plan
a Sewer Abandonment
USE OF BUILD!'G
AbC/:ff
SITE RESTORATION PLAN
o Water Abandonment
Accepted by
Rejected by
a Electrical Abandonment
Cl Other
TYPE OF CONSTRUCTION:
II
III
H
2
IV
R
3
V
M
4
CREDITS
Park Oed. Cred" ................................................ $
SAC Cred" ......................................................... $
Sewer & Water Connec. Fee Cred" .................. $
Occupancy Group A
B
E
Division
....
Water Tower Fee Cred" .....................................$
Other .................................................................. $
~ Llof ,.~.. fiJ/t>L"'""--:rd:.
e and~CCOmpanying documents is in accordance with the City Zoning rdinalce and
L/-.9Ci ,01-
Date
Special Conditions if any
Site Restoration Proposal for Demolition
Applicant:
S/11S'C
/3901 ~~T~8u~y ~~,
Address:
,.
Check boxes below:
J Fill Excavation to grade
;;Sod or seed all bare soils
0Erosion control (see handout). Maintain erosion control until turf is established.
tJj Cap sewer below grade. * Mark location. Licensed contractor required.
d Cap water below grade. * Mark location. Licensed contractor required.
" ,i:F'/ C",r,rCity of Prior Lake Public Works Department for water meter removal.
&1 .cap gas line.* (By gas company)
;; Disconnect electric at meter. (By electric company)
v/Pump and fill cessp~ol/septic tank. Certified contr~ct.or required,
'V Abandon welL Certified contractor required. EXistmg well
o Remove existing structure foundation and footings, materials, and debris.**
o Provide dust control by following means:
1. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure / ff /l /I /) fl ^
3. Other ~ /~ ~,'
Comments: (provide surveyor draw site plan)
(lOop ~ ~- ~~~....,.
f:d..~' ~ ~ -Y ~ (-''J-P, ,vb t!A--.. ~
~ ,AJel-i2, ~ ~ ,-t Ir- ~/~~ .
*Capping ofuUities must be inspected.
** Final inspection and approval of restored site required.
approved final inspection.
~M('~-'
- Signature
Deposit will be returned after
Date
,C; .I~S- -0 c.f
I
J:\BUILDI0iG\HA0iDOUTS\Demo Site Restor,doc
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
q-Zo/-dd
ADDRESS 13'1DI
L~I~~ ru..
OWNER
CONTR.
PHONE NO.
PERMIT NO.
"-/- $07
D~~'LL'NG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
)S-sITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: 'I~-r;,/7(P
-
,. "T::...ks 1-11..,,1
~K SATISFACTORY, PROCEED
o CORRECT CTION AND PROCEED
RK, CALL FOR REINSPECTION BEFORE COVERING
Ins peete Owner/Centr:
CA 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
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