HomeMy WebLinkAboutDemo Permit 04-0467
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CITY OF PRIOR LAKE
DEMOLITION PERMJT
, I,;D~ ,. White ,File
) 1..'\ 2. Blue . City
"/, 3. Yellow - Applicant
..0 Perm~No. 04.04&1
DIRECTIONS
1. DATE (.J{ Z'? 104
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom)"
BUILDING INFORMA liON
7. SIZE OF STRUCTURE
30 ,,~S'
8. NO. OF STORIES
\
9. TYPE 01\ CONSTRUCTION
\.l.lClolD
~~~L~T10~ \ lSW
2. SITE ADDRESS 1 <1--5QO OAKL-I'1ND 136/tW AvE: 6t:.
3. LEGAL DESCRIPTION
LOT q/IO BLOCK PID z5. /15. (JOe:,. 0
ADDITION o 1'9 K.L. 1"1 NO i3 61'1 Crl RISO
4. OWNEH (Name)
nosey, WI'iVNe
(Address)
14-.524- GLEN'O,4t...E /lV6..
-.oi<tiIl
5.-Afl.vnllt:.....~
(Tel. No.)
J? L. . q52 . 44-0. 4-334-
(Tel. No.)
6. CONTRACTOR~ Poi: ,...., '" ,(AddreSS) ~,(Tel. No.) , I. I
A. t-uL.''''.Ii1'L..'-\ ~IT. [..0::'';:- ILO'>o""'t ':;.6. .co,5.1n QSDl-'-l'fO~l.\n"
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
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.
Furthe~. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X . d ~ '\' 'e.,,, S 1/1(/04
Signature J rr- Date
\JFOR ADMINISTRATIVE USE
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
METRO SAC UNIT DETERMINATION
II/AI /1
f1PCA ~771"{c.ATt.-l,,1'- J.tr6Vr'~ ~
A- W'1~tn....v (;VAs +~n':v 137 MPt....(~.
USE OF BUILDING
(,vO.JJtJ /7l./I-I'1G S'IN~
~ {<-\I c)c-~'-'t.. .
J
SITE RESTORATION PLAN
Accepted by ~ ct-
Rejected by
TYPE OF CONSTRUCTION:
III
H
IV
V
II
R
M
Occupancy Group A
B
E
Division
3
4
2
;eevo ~ ( I t;;/<-iF M6I:JIT:
ItV Vr/Vi,.1
MATER'L FILED WITH A LICATION--fJl1
Cl Site Restoration Plan
Cl Utility Abandonment Plan
o Sewer Abandonment
o Water Abandonment
Cl Electrical Abandonment
Cl Other
Other .................................................................. $
TOTAL CREDITS ........................ $
Date ~;;f3 if-
f
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may procee as~eq este* -,-L
, JJ .. i'J.(7CT
. Pia ;,ar Date Special Conditions if any
Issued by
Date
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULE~
6~/TIME
i
4~-/ A7~eL~
ADDRESS
/~~o
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~q- <;/67
o FOOTING
o FOUNOATION
o FRAMING
o INSULATION
o FINAL
/SITE INSPECTION
COMMENTS:
\,....~/e>,... .,?;;l....-:
o PLUMBING RI 0 EXIGRADIFILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
/f MECH FINAL.;::::J 0 /'
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I
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1\ ~~.o X DV.
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~RK SATISFACTORY, PROCEED
~.~RRECT ACTION AND PROCEED
o CORRECT WORK, C~ ~ ~PECTION BEFORE COVERING
Inspector: . /" /~ OWner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INS"''''
Applicant:
Site Restoration Proposal for Demolition
u, "'-<-l ;) "- - kl "")" \ ...\" ,-.1 IiA 0 SE.l
14SCJo OAKLAND BEAM /II/E:. S. 6.
Address:
Check boxes below:
'Iil Fill Excavation to grade -No-\- f'\..~\~\o~
'\'l :.: C'': ,. seed all bare soils
~ Erosion control (see handout). Maintain erosion control until turf is established.
'\? Cap sewer below grade. * Mark location. Licensed contractor required. -
~ Cap water below grade. * Mark location. Licensed contractor required. ........
<!.c....pk...h.. ~ Call City of Prior Lake Public Works Department for water meter removal.
c.o.mcP~~ Cap gas line.* (By gas company) ~ 1>.e.AP ~'\"'\-1:\91:\~ ~S"
CeJ'l1Fl-A-e... ~ Disconnect electric at meter. (By electric company)
::J Pump and fill cesspool/septic tank. Certified contractor required. l\l...-\: "w\\C...\.. \
::J Abandon well. Certified contractor required. Existing well" . __ ~
~ Remove existing structure foundation and footings, materials, and debris.**
~ Provide dust control by following means:
CD Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide surveyor draw site plan)
*Capping of utilities must be inspected.
** Final inspection and approval ofrestored site required. Deposit will be returned after
approved final inspection.
C. .::J. 4\ \<<\\04
Signature
(1'"
Date
J:\BUILDI~G\HANDOUTS\Demo Site RestoLdoc