HomeMy WebLinkAboutDemo Permit 01-0122
6~\
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White
2. Blue
3. Yellow
. File
- City
. ApPlIcant
,.
Perm~ No. 0 /.,,'72 2-
DIRECTIONS
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
1. DATE
BUILDING ~RMATlON
7. SIZE OIjll'TRUCTURE
2A, ..,t, A: C':)
8. NO. Oi STORIES
9. TYPE Of CqNSTRUCTlON
"3r - tJ
- 2. SITE ADDRESS
\ c.." 1 S rlZ-MJ \C-ur-' T <f2--
3."LEGAL DESCRIPTION
LOT
8LOCK
PID
S.C.
'l..S-"1V2-0,t3-0
1>e~2.li'T1~
10. COMPLETION DATE
ADDITION SE'e-r. '2. Tt-tJ\"r\4 RNbn'2.2.
4. OWNER (Name)
TOM toO! 0 ~Sc.l-\
5. ARCHITECT (Name)
(Address)
, i <;;> 2,& MA 12-S~
(Address)
,
--''''f'-WJJ
(iel. No.)
<;")~3"Z..
(Tel. No.)
6. CONTRACT(J)R (Name)
(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
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.
:urther~reb)(;;~:[he city official or a designee may enter upon the prop~y I ;t, needed inspections.
~ Signature I f Date'
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
SAc.. U..... I.
MATERIAL FILED WITH APPLICATION
f 5DDd'''L . o. c; .
LJ Site Restoration Plan
/$ WAiVEO
o Utility Abandonment Plan
CJ Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
CJ Water Abandonment
Accepted by
Rejected by
TYPE OF CONSTRUCTION: II III IV TV
Occupancy Group A (y E H R M
Division 2 3 4
LJ Electrical Abandonment
o Other
CREDITS
Park Oed. Credit ................................................ $
SAC Cred~ ......................................................... $
~
Gis certify th~t t e r???qu t in the above and accompanying documents is in accordance with the City Zoning Ordinance and
ay pr eed as req ted.
'-. ~ _ 7 -ZO-Or
City Planner Date Special Conditions if any
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
2> So. ,-
If<;o
/'Lib -
,Ct:>-
This ap~lica . becom s
demolitio l'I wh
By _
,
> /
, '
1./'20/01
TOTAL CREDITS ........................ $ '3 'r au -
Issued by
Date
ADDRESS
/6 (0 '75'
DATE TIME
SCHEDULED f5.h1 -1:0cJ
F~KLIAI 1/2.
CITY OF PRIOR LAKE
INSPECTION NOTICE
PHONE NO.
CONTR.
PERMIT NO. 61- 1-2.:L-
OWNER
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
R., FINAL 0 PLUMBING FINAL
I'" SITE INSPECTION ~ MECH FINAL
COMMENTS: -r...T S '1ti I.IJ J;.JQ,
T~ ~ c:o o.J _~ r-JJ- a..-
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r~ ~j'()~~~ :~;:~~1
~ .... ...,,.-/
~-". --'0 ,,-_.......ou..:p,IIJ':~...-~'_..-._- -~-
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
/
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR Rto/.tL.ECTION BEFORE COVERING
Inspector: ~. o!Petl;onlr:
'"'" / .
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
3.,4.0/ /,'30
ADDRESS
I (0(0/5 Ff<.A N k.. Ll NTI:-.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01 - 0/2..2-
o FOOTING 0 PLUMBING RI 0 EXlGRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP I'S\ 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL I\.fY & GASLlNE AIR TST
o SITE INSPECTION 0 MECH FINAL -'" DF-1-1()
COMMENTS: I -.JS TI t<..E/rOV'J I N~
(fJ .4<J~ .~o,j) ~.. I -;1:;a I~ ~ CLn.-c.
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~ 3kt",~ (7" r!~
~AA..e..-.. ~..a ~~ '~-/-,.,
~. V() I
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~, Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ