HomeMy WebLinkAboutDemo Permit 03-0310
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
~
DIRECTIONS
SPACES NUIllBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please prinl4r type and s~n at bottom).
"2. 'tors; 0.. 0 C
2. SITE ADDRijSS i......
Q~od
I ~ ~Il-
3. LEGAL DES~RIPTION , /
LOP? of. ~/O I BLOCK 1-/ 'l'
::?/J r /;1J9
I
1. WhIte
2. Blue
3. Vellow
- File
. City
- Applicant
Perm~ No. 03- 03 10
1. DATE
BUILDING INFORMATION
7. SIZE OF STRUCTURE
5,- ~~ OJ
B. NO. OF STORIES
I
9. TYPE OF CONSTRUCTION
wocd
10. COMPLETION DATE
PID::2S- /,~3- 075- I
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ADDITION
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4. OWNE:H (N.me)
(Snp~ ~ ::'\.1S<>r.
5. ARCHITECT (Name)
(Address)
L'nJ~",.^..., C\?fS "'in'n, I"I~ ~.od
(Address) J
(Tel. No.)
q5(~ '-t<tCl- <nSt5
(Tel. No.)
6. CONTRACTbR (Name) . (Address) (Tel. No.)
MoM COAS-\AVdv'" '1cno [;:P'{ C-If>';~ L-i-ck f"n:u,", L.\::Q... <'olc-~s<j- c;?csi
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 prdceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furthermo~e, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
~ ~~ ~- ~-O./
Signature
x
Date
FOR ADMINISTRATIVE USE _L {
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MATERIAL FILED WITH APPLICATION - JU''''
METRO SAC iUNIT DETERMINATION
CI Site Restoration Plan
CI Utility Abandonment Plan
o Sewer Abandonment
USE OF BUI~DING
5F"D.
SITE RESTORATION PLAN
o Electrical Abandonment
TYPE OF CONSTRUCTION:
Acoopted by
Rejected by
11 III IV @
H @ M
2 (!) 4
Occupancy Group A
B
E
Division
This application becomes your
demolition permit when approved
BY~. li'dt--
Date J.fq 103
CJ Water Abandonment
CI Other
CREDITS
Park Oed. Cred~ ................................................ $
SAC Cred~ ......................................................... $
Sewer & Water Connec. Fee Cred~ .................. $
Water Tower Fee Cred~ .....................................$
Other .................................................................. $
TOTAL CREDITS ........................ $
Issued by ~ =/~~ Date 3~9~3
D./a Db
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed 1Is re u ted.
Date
-----------_.._-_.~_._----~..+~-'----~-----'_.~'~_."----~. .,.-.-.-
Special Conditions if any
Applicant:
Site Restoration Proposal for Demolition
cP ^J S,TI2-wih 00
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(V\6f11'-
2SI~
Address:
Check boxes below:
G(" Fill Excavation to grade - f.JGW ~O"'TI6~ 1>~.
.,.- Sod or seed all bare soils
a 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.
I!I'" Call City of Prior Lake Public Works Department for water meter removal.
.,. Cap gas line.* (By gas company)
... Disconnect electric at meter. (By electric company)
.,.. Pump and fill cesspool/septic tank. Certified contractor required. .. .. .
1!1" Abandon well. Certified contractor required. Existing well 'F" Elr$r"",~'~~ ~u..
[!!""' Remove existing structure foundation and footings, materials, and debris.**
~ Provide dust control by following means:
I. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other MIA.<;T ~f'" ,.L",.. f\'S 'DEM.u..il1~ f(UjlU."T.~~"
Comments: (provide surveyor draw site plan)
~ Tb f1~vE:" At-J Id:lPa.tlo~ 'fa 0~i'2:l ~I~ of txr<rl~~
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~"Ll'tr~ - rF" r t.J A7C.""YL ~flJt."/eE I~ NoT P,e~S"e;..n- _ rJCOlI ~
~1.t..c:E wi ,/1 flu",,- NIrW f-V,u.cE -p. ClA.R.b ~. IIJ:LL.. tJC'eo ~~/
~~~ ~o~tJ/) TR-El::'- "10 6€ PR..tSlEre.lfa>. IF AtJ) ~ 6F .
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*Cappmg of utilities must be mspected.@; ii-wo-L <:oF ~f?/':J'
** Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
I
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Signature
3/1'1/03
'Date
J:\BUILDlNG\HANDOUTSIDemo Site Restor.doc