HomeMy WebLinkAboutDemo Permit 02-0692
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
, a,
Permit No. 02 -D(p 12--
DIRECTIONS
1. DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
6 -/t)-oz-
BUILDING INFORMATION
7. SIZE OF STRUCTURE
8. NO. OF STORIES
2, SITE ADDRESS 4-2 2- ~
3. LEGAL DESCRIPTION
-3
6eA/NfVOOO
(!/1Ce<.6
A./E
9. TYPE OF CONSTRUCTION
LOT
BLOCK (Jh1/.AlIV()OO PID
P/1;e;L.
25-(.13+- 062--0
10, COMPLETION DATE
ADDITION
4. OWNER (Name)
J~~6
5, ARCHITECT (Name)
(Address)
/S~-~/ C~~UI
(Address)
(Tel. No.)
<../'17- ~6~
(Tel. No.)
6, CONTRACTOR (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.
F r m e, I hereby a,g.re,e that the city official or a designee may enter upon the property to perform needed inspections.
'---- ' /~ /-'~7rzZ?11 --,. E::0- 0/02-
Signature Date
METRO SAC UNIT DETERMINATION
~
FOR ADMINISTRA T/VE USE
"e6it-'p
o Site Restoration Plan
/
o Utility Abandonment Plan
USE OF BUILDING
SFU
o Sewer Abandonment
SITE RESTORATION PLAN
o Water Abandonment
Occupancy Group A
B
E
Accepted by
Rejected by
II III IV (j)
H CR> M
2 (J 4
o Electrical Abandonment
o Other
By
Date'. 10 -62
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
-r
TOTAL CREDITS ........................ $ ..L,
TYPE OF CONSTRUCTION:
Division
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
me eed r quested. ~, , t1 '. ~ /' p\".
0/ { L/'/ C 'L ~_ 1.J-1V~1\4: ~ U1>~t1fl1t:Z;-
Date Special Conditions if any
Site Restoration Proposal for Demolition
Applicant:
Jer~,.l36'1 DOUsCTT6"
4 Z z,.'lJ (j,er; / /\I W () on (!J eeA-6 N' ~
Address:
Check boxes below:
%" Pill Excavation to grade
/ Sod or 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.
~ Call City of Prior Lake Public Works Department for water meter removal.
~~ap gas line.* (By gas company)
;zr ?isconnect electric at meter. (By electric company)
o Pump and fill cesspool/septic tank. Certified contractor required.
o Abandon well. Certified contractor required. Existing well
.,e-Remove existing structure foundation and footings, materials, and debris. * *
7' Provide dust control by following means:
1. 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.
** Pinal inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
~~
___/ Signature
~~~
Date
',;
J:\BUILDING\HANDOUTS\Demo Site Restor.doc