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HomeMy WebLinkAboutDemolition Permit 16-1142 DATE TIME CITY OF PRIOR I AKE SCHEDULED 144-41� INSPECTION NOTICE I, '1 `? Li j `1__ , ADDRESS CONTR. OWNER ------ Co *___-1---=-111--------4 ')-- (f 4 7' PERMIT NO. ❑ GRADIFILLING PHONE NO. ❑ COMPLAINT 0 PLUMBING RI 0 FIREPLACE RI 0 FOOTINGUND0 MECH RI 0 COMPLAINT ACE FINAL ❑ FOUNDATION 7SEEWER HOOKUP 0 FIREPLACE AIR NAL ❑ FRAMING O INSULATION 0 PLUMBING FINAL p ❑ FINAL 0 MECH FINAL � 1 ❑ SITE INSPECTION /�� COMMENTS: l ik SATISFACTORY,PROCEED WORK ❑ CORRECT ACTION AND PROCEED CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING pwnerlContr. L, "-------- Inspector: SIN ADVANCE. 9850 FOR THE NEXT INSPECTION 2��HEALTH&SAFETY! CALL�L- CODE REQUIREMENTS ARE FOR YOUR PERSONAL INSNOTI o�.PRI04, CITY OF'PRIOR LAKE Date-Rec'd t i • DP,MOliTION PERMIT q_ 30 _ 16 • r 'Nrva ° PERMIT NO. itasa j cox end:; at ZONING( we) /7 l// r t aNS- 4 i d, S W LEGAL.DESCRIPTION(office use only) 4 44—et Gk �6� PID ZSR 0 . 1/9 LOT. MOCK ADDITION /1/1 of e-c•n teeG7--- .ioht4 4etGserfv0 - 6iZ--Sf, 917 — d,rdtiruy,4, efti'=1 ,f ei1" MINER k' '�ri�i ktiow..j �' ug` it ('bone) . b 11' o `( _ (Address) 2J! V gen/ E-ef t Feel,"'1 H,-46.1 Al-4 N S 5.0 � _. CONTRACTOR -• , .1' • (Phone) 5. Z (Company Name) �� s 7% :�. / . (ph�e) �1 S 2 -___42.3-- rS Z (Contact Name) T;w. C.u�� - (Address) 7-L23 5 / kw zS < / 0A;h e .A /v j' .x '60 --f 017‘;" � — /Z— ,i'.. — / .'f ,1- i• a - •: AGONAL.ounac NG'CODD A B Use o£Bedlding: I II RI IV V Type-of Construction: S V Olt Uwe` AkSzAtet OccupancyGroup: A R E F H 1 M R. tr Division: 1 2 3 4 S int rfGl�Gi`��l��. VIPCANOTIPICATION OFINTENT TO PERFORMADBNIOLTIION Whichis to the best of7a?�y lcntowl�'trae and egfreet- I alga cue I*. lila • I hereby:ee ; .. t I ioxi fd agent it tx�tioe ► P�lO� and that an construction will conform to .existing scale and local laws and the o .u,,-.• in•aa�1 agent submitted the ted plans. Ian why can revoke this p dt fur.�st causeFtp&moO.e, and will • .?._', accordance v�Isth submitted plans. am aware that the building official I Hereby.a:r• at the city officiaLor a designee may entet'upon the-' Y-to Perform sieeded',.•.•_,:'ons. F% I • Date I Signature • Demo-plication Becomes Your •l _ 'D ][ �O This • Vi`= e' if When Approved Btsitdin ' eiat �` U. Is to cuuty t9il it. in she above appl ion cad aecurnpoSl aB aoeum=Mv is in •• • .,. .vol,the lily zAne%Ordiaanoe and'4raY w�as requested. This .._ — t- eops,i m° _ "�s / 24 hour*settee for pit iespections 052)447-9855,fax( )447-4245 III4646 Dakota Street&F.,Prior Lake,Minnesota 55372 vitio 1. o • P Site Restoration Proposal For Demolition 0U matt" Applicant e#rte/ Hair'y 6 G . A z. Address!, 4 jvd fr-e-e t fav m l t / 4 . . Check boxes below: o -pill Excavation to grade u Sod or seed all bare soils ion control(see handout). Maintain.erosion control untilturfis established: Ervsx e * Mark location. Licensed contract© required. � Cap ewer below gra - . Capwater below grade.* laxkocaton. Licensed 852. 4 .95 3 r .o City of Prior Lake teeter Worksblic eDepartment 952.447.98a�1 for water moval. linea (By gas company) � Cap.gas electric company) is Diseonnect electric at meter. (By o Pump aud fill cesspooUsepti�c tat*. Certified contractor required. Abandon well. Certified contractor required. Existing well • Remove existing structure foundation and footings,.materlals, and debris.** _ means: . . a :Provide dust control by following 1. Water mist from a water supply(i.e. water tank) e.neighbors, 2. Enclosure 3. mer Comments: (provide survey or draw site plan) 12 j5 Qwest �o as / - PG1- 4 Capping of u . •i es. must b�inspected.restored site Deposit willreturned after �-�x Final xnspec and Pp approved I :b inspection. . i.:�ai • �! Signature 1..-. ?ate i 1 i o 0 i HOUSE MOVING IN PRIOR LAKE ❖ A Demolition permit is required. •A $5,000.00 Demolition deposit is required(cash or check). + Site restoration plan is required, or an approved building permit application for a new house. curb shall be repaired in an approved manor with all costs to be .. walks street or P . Damaged sidewalks, paid by the permit holder. + The structure to be removed shall not be stored on the street or other public property. +.+ The permit holder shall control erosion on the property. + Open foundations or other hazards shall be protected with an approved safety fence. ++r The permit holder shall comply with the Tree Preservation Ordinance. All work shall be done outside the drip line of all protected trees. IIICOMPLETE THE FOLLOWING 1) Proposed house move date(24-hour Police notice required) No (For County Roads) Yes X ,���/ 2) Scott County Highway Permits No ��� -� � ��'�` 3) Site Restoration Plan X Yes 4) Utilities shut off notification: Yes No Electric No Water Yes Natural GasYes No Telephone Company Yes No 5) Tree removal or cuttingYes X No Yes No (Locate on City map) 6) Proposed route diagram L Name of Moving Company �4-zi f ver Address (I Co '10 2-7 - 141 ',' E2 4- !,et ke v 7 C. /141V 6-5-C2 City,State,Zip Contact Person t3Phone Number lz-� " FOS' �"� Date of Expiration l„ r7 State House Mover's License N . /3 4-____41-4.__,_ __) p Property Owner Name "t,k-, it t-to44,t GLC., Phone Number ` Properly Address (House to be ed) `?`t K ,v0i r3 tycl• 5 G✓ v^�o Date: Signature of Applicant: � 0 4 F PRIOR LAKE DEPARTMENT BUILDING G�INSPECTIONS IING INSPECTION RECORD SITE ADDRESS /740—/ TYPE OF WORK iyDu1'E /'fo✓E DEMO USE OF BUILDING ftQ /� PERMIT NO. /6, • ��� DAT ISSUED /D , 3. Iep BUILDER _F,,75/240,xie Mdes PHONE # /pr/. 440. 36 43 • INSPECTOR DATE ('!■■Ills gal OtlS 1.04 I Ulm I l6`ur'15- _J PLACE NO CONC1RETE UNTIL ABOVE HAS BEEN 51GNIED laiiiiitekl) ShiJ I \ -------- I \ 1\k(- ' I FINAL lQi,e,/ I ‘4.1i.*`‘s. FOR ALL INSPECTIONS (952) 447-9850 S . o ?Rl0o4 t) fly 41*NESOK MEMORANDUM DATE: Tuesday, October 25, 2016 TO: Janet Ringberg FROM: Lynda Allen RE: Demolition Permit#16-1142 17441 Langford Blvd SW This memo authorizes the return of the $5,000.00 demolition deposit. All requirements have been complied with and the file is closed. Return to: Premier Title Insurance Agency, Inc. 7300 Metro Boulevard, Suite 300 Edina, Minnesota 55439-2302 Thank you. is Lynda S. len, c Building ervices Assistant nS ' byk v'° -,Av' \D` ?�`2� r 1(a — ll 2!. ' j 16' t 42 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H341307 WELL AND BORING SEALING RECORD MinnesSealin3 to Oou Name iu ild—ora Unique Weil No; Minnesota Statutes,Chapter 1031 or Wearies No. µ Waaicallo, TavnSh ptdo.. Range No.Section No. Fraction(stn.-.lg.) Date Sealed Date Wet or Boring Constructed ^ AV-ok-4, LIt et i " jO ge i t :. , c,: GPS LOCATION-decimal degrees(to four decimal places) Depth Before Sealing I ---__ft. Original Depth 1 i4 47 tt, Latitude ' _-___.:. _____ Longitude AOUIFER(S) STATIC WATER LEVEL Numerical.Street Address or Fire.Number and City of r Bori rt, t' `Single Aquifer ,} Multiequ ter . y ..k"f$ WELL/BORINGieasuref Q Est€mated =Date Measured: <(.3- t'i/t 7#' s �< t .5 a 7 water-sui)piy wai n Mon r.We€r Show exact location of welter boring t Sketcft.map of well or boring in section grid with X. .,c l 4.-w'•location. pro rl'y 0 Env.Bore Hoie Q Other " _ft ( below D above land surface showing ppeet N Tines roads,and buildings. CASINGTYPE(S) u {i L» Steel .1Plast€c [ j Tile Other t- .+ WELLHEADCOMPLETION '«,,, Outside Q Well House '° 0 At Grade inside: _,Basement Chet l If 014 foPitless Adapter/Linit 1, Buried Q wet€Pit r Buried t'-} : t 0 Walt Pit _ s k, ' I s rata (�; Q Cather - 4 D D Other , P O ERTV OWNER'S"NAME/COMPANY NAME / CASING(Sj t 4 ii41,N 3 e c I Diameter Depth Set in oversize hole? Annular space€nitiaily'grouted? . Property owner's matting anoress it differentthan weft tocanon resateld€cared above- C)- in.from to i it. p Yes l+lo • Q Yes 0 No °. Unknown Li .-.5 , t _ in.from' to ft. ,j Yes 0 No' 0 Yes Q No t]Unknown fn.from to 0 yes Q Ido Q Yes Q No Q Unknown WELL OWNERS NAME/COMPANY NAME SCREEN/OPEPklit7LE tAfelf owners malting°address it different than property owner's address indicated above Screen from •""- to ft. Open Hole from to' - ft. , OBSTRUCTIONS Q Rods/Dreg Pipe V Cheex Valve(i) Q Debris 0 Fill QF 4o:Obstruction < C -- Type of Obstructions(Describe) LOO HARDNESS oR FROM TO Obstructions temotred [,? Yes .Q No Describe GEOLOGICAL MATERIAL PUMP If not known,indicate estimated formation log Iron)nearby well or boring. ; � n G { ,..1 1 C) T�emoved Q 14(4 Present Q Other - 4 I 1 i , ..4 +w . METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AuppcinE HOLE: ' 1,14o Annular Space Exists 0 Annular Space Grouted with Tremie Pipe Q Cas€ng Perforation/Removat in.from to ft. Q perforated' (,;l Remdved in.from 4a.... iT. Q Perforated Q Removed aAb r ter " / :`'< Q " C^"-t,-f x ) Tl '4(61314. Type of Perforator VARIANCE Was a variance granted from the MOH forthis well?l.J Yes, } lo TN ^"- - GROUTING MATERIALOI . (One bag of cement n 94 lbs.,one begot bentonite t.pa lbs.) Grouting Malertall (�,: ^r from to 1 s ft. yards_esn bags _________ from to ft, yards bags , . front to ft, yards bags <...° OTHER WELLS AND BORINGS ET-MARKS,SOURCE OF"DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? j Yes Q"N'o How many?_ __, - r ,,, -� < LICENSED OR REGISTERED" CONTRACTOR CERTIFICATION This well or boring'was sealed in accordance with Minnesota Rules,Chapter 4725.The information'contained in this reports iatrue to the best of my knowledge. - Licensee Business Name '' ' . ' ' Licenser&Regisfralion`lVo. }' " be,,Ted Ftepres'enNtive Signature Certified op No. Lie 't ;. . 'LOCAL COPY Noma of Person ilrrB r '.HE.Q1434-14 OOP 53159 5}SR. =A AA AAA E. v o o H o a AD a - c. 1 u) a) �: .5 N a -a. �° a Vit. 4 Wa k ° a = o } ` Y x .w •o ❑ S to d H '"" V k r N c� i. cl* " .. +~6+ - o. N•, 0 .o 0 P O 0 P. E ( 0 U i". 0 s. , 0 �"-+ .0d) ' U N p 7:$ a... Cti t10 0 U 0 . s ,. Ih 0. �to o LW a H t = 0 +.+ 1 U E" Q. , .-, 0 Ck "tia 0 u po o = s0 'pop jx � , o , 4 z ' cA o ¢ o o ea mo 0 ❑ o cop H E+ ai p� ❑ � > u - ,+, o PO q Z o E] E to z 0 .... 0 g o o o tFco n z U to -S? 0o❑ o a 'C U) ❑ U N •0 — U 4a' is 0., r z . eas 4 rte+_ ' W> x im i i 10 v-+ H o U G N '-. ° v . :%) , .4_, .... a) =.L �., 11 1 lJ � -8� C \ xU W , e o OvO d v .. N - 4.., i" 'yam -."" N ✓• F .0 Or Q i0 . c� + a4 . . 0ri 0 o 0 G 0. --- ctN d 0 a ~5 = as ; oo 0Z AA in o ct) N O a U 0 A -, zUa O w _ Minnesota Pollution Control Agency SSTS Abandonment 520 Lafayette Road North Reporting Form St.Paul,MN 55155-4194 Subsurface Sewage Treatment Systems (SSTS) Program) Instructions This form is offered to meet the abandonment requirements of Minn.R.7080.2500 and Disclosure Requirements of Minn.Stat. §115.55,subd.6.Future water supply well placement can also be affected by an abandoned SSTS. The use of this form is not mandatory;however the information on this form must be submitted to the local government unit(LGU) within 90 days after the abandonment.This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned. Property Information Date of abandonment: 1-3 1 w Reason for abandonment: .l x t,se 40 1?e„- sr m p®u� Property owner name(s): 5..4-ettp t 4y ,o ,� e Property owners address: Lf s — ' S`1 City: P O3/4-P m c m`1'cka,,, State: /HA) Zip: Site address(if different): I' 7 111 Pp„&.- lt (D- City: . '"hLce a.. L&k State: 1114 Zip: ,S' -"3->.2 Compliance Information 1. All solids and liqui s removed from all tanks? Yes 0 No lv Disposal Site: L,q.k 37J� ,�Cc1 pL, • 2. All electrical devices and devices containing mercury removed? 0 Yes 0 No - Disposal Site: to► 3. All underground sewage tanks crushes = • fill-d with soil or rock material? Yes o or Removed and disposed off sit-? I ps No Disposal Site: e t co e1 CO 5 4. Contaminated materials*removed and disposedoff site? 0 Yes trog.No Disposal Site: 5. All underground cavities**crushed and filled with soil or rock material? &eyes 0 No or: Removed and disposed off site? 0 Yes ge_No Disposal Site: 6. Future discharge to system permanently denied? ftMYes 0 No Method(s)used: tOus, 4'&e44 *Contaminated materials= Distribution media,soil or sand within three feet of the system bottom,distribution pipes,geotextiie fabric/rosin paperlstraw, tanks, contaminated soil around leaking tanks, any soil that received sewage from a surface failure(7080.2500 subp.3). **Underground cavities= Cesspools, leaching pits,drywells,seepage pits,vault privies,pit privies,pump chambers (7080.2500 subp. 1). Does not include chamber media,drop boxes,or distribution boxes. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats u,-u.ui�tcd-n't • 11/71/aft Page 1 of 2 Map Include location of building sewer, septic tank(s), soil dispersal system, cesspools, seepage pits, and other pits. Also include a permanent reference point(s) and dimensions. T North \Ufs' ill / 4"44k, ft),rivvir 1, S s_ / Rot's ci Certification I hereby certify the system was abandoned in accordance with Minn. R. 7080.2500 and any local requirements. Name(please print): 1�,,.{,( .e.:‘ h Title: ,e_S' Address: 3 -- Ll0 is au-P..- I,City: -V 449 4State: yr) r./ Zip: -..S.—..s-‘59 Phone: S7 96 k ....,71 I License#if ap liccable) (p,ST ? Date: p I kt I i& Signature: ( �1✓L www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wa-wwists4-03 • 11121108 Page 2 of 2