HomeMy WebLinkAboutDemo Permit 03-0173
CITY OF PRIOR LAKE
DEMOLITION PERMIT
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1. White - File
2. Blue - City
3. Yellow - Applicant
Permit No. 03-0/73
DIRECTIONS
1. DATE \ 1-\.7?\ \ Q-L
BUILDING INFORMATION
7. SIZE OF STRUCTURE
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8. NO. OF STORIES
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9. rv~E OF COt:!..STRUCTlON"\
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10. COMPLETION DATE
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SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
2. ~r; .ADDRESS . .
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3. LEGAL DESCRIPTION
LOT \ l ) lh... K: BLOCK
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ADDITION I. ~-'ll l.."l....
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4.~NER (Name) . . (AddreSS)";) . . (Tel. No.)
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5. A~TECJ (Naml) .. (Address) /_.J. iJ (Tel. No.)
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6. C5RACTOR (Na"Ae) , (Address) - 3 l) (Tel; Iio.:.l ~ ~' .
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I here y certify I have furnished information which is to the best of my knowle ge 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.
Fu~ore. I hereby agree that the city official or a designee may enter upon the ~roperty to p~\rf~rm needed inspections.
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I C) Sig~ture Date
METRO SAC UNIT DETERMINATION
FOR ADMINISTRATIVE USE
$5;tf'WJ.07.J /'CeJOIf.//'J{.,..- ehG~ ,::>
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MATERIAL FILED WITH APPLICATION
iJ Site Restoration Plan
CJ Utility Abandonment Plan
iJ Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
CJ Water Abandonment
Accepted by
iJ Electrical Abandonment
Rejected by
CJ Other
CREDITS
Division
2
3
4
. /'J. "'-0 -
Park Oed. Credit ................................................ $ ~:;:>..
SAC Credit ......................................................... $ /27r;; .-
Sewer & Water Connec. Fee Credit .................. $ 1200.-
Water Tower Fee Credit .....................................$1 a> -
Other ........... ............... ............ ......... ..... ....... ....... $
TOTAL CREDITS ........................ $
TYPE OF CONSTRUCTION:
II
III
H
IV
R
V
M
Occupancy Group A
B E
This application becomes your
demOliti~ermit .when approved
BY~~
Date //C;?;b3
Issued by
Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed as requested.
City Planner
Dale
Special Conditions if any
Site Restoration Proposal for Demolition
Applicant;_ \-~\J~,j-
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Address: ~ QJ~ u~S-\--f~-t-
Check boxes below:
rs/ Fill Excavation to grade
ar"" Sod or seed all bare soils
r$ Erosion control (see handout). Maintain erosion control until turf is established.
cY" Cap sewer below grade. * Mark location. Licensed contractor required.
si Cap water below grade. * Mark location. Licensed contractor required.
~ Call City of Prior Lake Public Works Department for water meter removal.
~ Cap gas line. * (By gas company)
'!I" Disconnect electric at meter. (By electric company)
~ Pump and fill cesspool/septic tank. Certified contractor required.
o Abandon well. Certified contractor required. Existing well
rs/ Remove existing structure foundation and footings, materials, and debris. * *
Comments: (provide surveyor draw site plan)
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*Capping of utilities must be inspected.
** Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
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