HomeMy WebLinkAboutDemolition 06-0223
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/J\rNE SO
CITY OF PRIOR LAKE
DEMOLITION PERMIT
Date Rec' d
3.s/,D(P
I PERMIT NO,O~. oZZ3 I
at bottom)
ZONING (office use)
(Please
ADDRESS
ijol/
/ ~Sl~ Ek
j)~~ S>3..,z..
LEGAL DESCRIPTION (office use only) .
LOT
BLOCK
ADDITION
PID2S. qlO.. OZ~. 0
OWNER __ ~ _
(Name) / C>UL.,c~ . C.JbV~""~ z::v c..
(Phone) 4'5"z" - qJ.>- /0/0
(Address)
tJ-' Ave. tJ:.. 0
CONTRACTOR
(Company Name)
(Contact Name)
(Address) B
Q.'1A-1 C<.:>N T"UG ~
/11 A./M,(,AfG.G,. -:s-~ Hwv5o../
O() I'J""'" ~
Co.
(Phone)
(Phone)
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---
Use of Building:
INTERNATIONAL BUILDING CODE
Type of Construction: I IT ill IV
Occupancy Group: A B E F H I
Division: 1 2 3
V A
M R
4 5
B
S V
CA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
I hereby certifY that I have furnished information on this application 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. Furthermore,
I hereby agree that t e ity official or a designe may enter upon the property to perform needed inspections.
'U-- 3/2- ,/()~
, .
Date
This Application Becomes Your Demolition
Permit When Approved
~.~
Building Official
i/s~"
, Date
1Ctod~. 3.31,0&
~#-~
ertify that the request iu the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested.
~
1/S/0f"
, , Date
Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
Site Restoration Proposal For Demolition
Applicant:
1(.,.'1~ Co""-'TMc~
Address:
<fj 1001 \~ -h\ ~ ~r ~~t:::.o~.H1.J >>37<1
Check boxes below:
~ Fill Excavation to grade
If Sod or seed all bare soils
)2!.. 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.
o Call City of Prior Lake Public Works Department (952.447.9898) for water meter
removal.
~ Cap gas line.* (By gas company)
.ll(, Disconnect electric at meter. (By electric company)
Ji.: Pump and fill cesspool/septic tanle Certified contractor required.
~ Abandon well. Certified contractor required. Existing well
~ Remove existing structure foundation and footings, materials, and debris. * *
P( Provide dust control by following means:
~ater mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide surveyor draw site plan)
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Cappmg 0 ul1ltles must e mspecte .
* * Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
~i~/,L-
8/2'/0(,
Date I I
J :\BUILDING\HANDOUTS\Demolition Restoration.doc
C Vtbite - BuildinQ:)
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
RY/lN ~ONTb1~T/N9
3.3/.0(0
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
40/ / /707H ST.
Accepted
Accepted With Corrections I/"
Denied
r
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~r ~4_t~6
~~~~
~ ~ ...A 411~.1J
~
Date:
Reviewed By:
Comments:
~
~
~~ ..lL
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
/'
FILE COpy'
PROJECT
01
-.J
~
(
CORRESPONDENCE
A Y ESTIMATES
o WORK SHEETS
o SUBCONTRACTS
o CONTRACTS
o OTHER
!
pVERNE'S
I = I \\n PrU~ING SERVICE .
I .'. tJ cJ 24;3~5it1ighview Avenue
. LAKEVIUtl~ll MINNESOTA 55044
2 '2006 SS2-469-2489
I . ;:
PHONE ~tt '-( - 326100
::l . /:J
~~~I
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l-
E...
----
08234
q\:) \ P,et. l'.!lJ~ G 12'(600753
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WELL OR BORING LOCATION
County Name
,., ,~
MINNESOTA DEPARTMENT OF HEALTH
WEll AND BORING SEALING RECORD
Minnesota Well and Boring
Sealing No.
Minnesota Unique Well No.
or W-series No.
(Laave blank if not known)
Minnesota Statutes, Chapter 103/
Township Name /TownShiP No. I Range No. Section No. I Fraction (sm.... Ig)
SnrinO' 'Lkke 114 22 10 I 'I. 'I. 'I,
GPS
LOCATION:
Latitude _ degrees _ minutes _ seconds
Longitude_degrees _minutes _seconds
Numerical Street Address or Rre Number and City of Well or Boring Location
, ,.....,... ... --,~ . . ~. ~
Show ex"", l""",uuI' ol'RlllI drilerinii"
in section grid with "X:'
N
-,-- -,-- -.,-- -.,--
:
W nr- -T- _:u uT- E ~
-T- n,__ -+- -;-- T
J!lmilo )..
-+- -t- -t- -;-- 1 :::i
f-- 7:"'--+
-. ~,
- J.. f-V.J.. -'SE~P of well or boring
Iil 'on, showing property
i?r s, roads, and buildings.
~
o
^
"
n
PROPERTY OWNER'S NAME/COMPANY NAME
'D~T__ -:- . ~
Properly -owner's mailing address- If differer'lt than wetHocatfoo address indicated above
8700 13th Ave S
ShakGpee~ MN 55379
>
WELL OWNER'S NAME/COMPANY NAME'
Well owner's m~i1ing address if different than property owner's address indicated above
GEOLOGICAL MATERIAL
COLOR
HARDNESS OR FROM TO
FORMATION
,\
(y
~O
Date Sealed
Date Well or Boring Constructed
&
LJ n /)/L
9-R '
ft. Original Depth
STATIC WATER LEVEL
0"
Depth Before Sealing
.A<WjFER(S)
~ingle Aquifer D Multiaquifer
WELUBORING
~ater Supply Well
D Env. Bore Hole
~easured 0 Estimated
D Monit. Well
D Other
90
f
ft.
CASING TYPE(S)
~teel
r:~... To' ro'PY'
.. I..L-'-"'"
o Plastic
o Tile 0 Other
WELLHEAD COMPLETION
aQmCl'
[;:itCZuV-
Outside: 0 Well House
Inside:
D Pitless Adapter/Unit
J:(Well Pit
o Buried
..-
CASING(S)
Diameter r Depth ,f
z.. "in. from~ to~ ft.
Set in oversize hole?
DYes
_in,from_to_ft.
DYes ONo
_in.from_to_ft.
DYes ONo
SCREEN/OPEN HOLE f
Screen from 9 "
OBSTRUCTIONS
)l! Rods/Drop Pipe
f
ft.
qf3
to
Open Hole from
H 2459-83
ft.
~elow
D above land surface _
ocoRRESPQNDEN~~
n o"y ESTIM~TES
U vvVacn*CTS
,0 S\U 'Tkl'1 LWl.-)
!,J,.j\J.l.~1' '>'1':) '"
""""O\'::Vl' i /:
(J OTHER__ -.Jl
.- ------=..--==:-------
~NO
Annular space initially grouted?
DYes D No D Unknown
DYes o No o Unknown
DYes o No o Unknown
,
to ft.
Type of Obstructions (Describe)
/y?;/)0
"",.
pz;a <Q:
o Check Valve(sk 0 Debris 0 Fill 0 No Obstruction
CI/L., TA:JAf:./(
Obstructions removed? lX'Yes 0 No
PUMP
Type 'BTf26KE... Pump
. .~emoved 0 Not Present 0 Other
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
~o Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal
in. from to ft. 0 Perforated 0 Removed
Describe
If not known, indicate estimated formation log from nearby well or boring
rJ " ,J l- 0 q~
ff
'-'
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
IMPORTANT-FILE WITH PROPERTY
PAPERS-WELL OWNeR COPY
/H 245983
in. from
to
Type of perforator
o Other
ft.
o Perforated
D Removed
GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite = 50 Ibs.)
f Ct"i f
Grouting Material /V~J41'".....,~ J7f7om~ to ----.t-c:l- fl. _ yards --Z..-- bags
/l'~.
from_to_ ft. _ yards _ bags
from_to_ ft. _ yards _ bags
OTHER WELLS AND BORINGS
Other unsealed and unused well or boring on property? 0 Yes ~o How many?
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION .
This well or boring was.sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is
true to the best of my knowledge.
v -..... '1-'
Name of Person Sealing Well or Boring
27172
Ucense or Registration No.
v_ 7- Ob
Date