HomeMy WebLinkAboutDEMOLITION 04-0433
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
OWNER
CONTR.
~~/c.I1h tV/! Y
.
03_072fo
o 4-. (j 4-35
ADDRESS
'72-1 f.c
PHONE NO.
PERMIT NO.
COMMENTS:
o PLUMBING RI 0 EXIGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
OE/--;C.-;L-/770IJ
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector:
Owner/Contr:
,CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
I1'lSNOTl
.~~~
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
Permit No.
04. 0433
DIRECTIONS
1. DATE
BUILDING INFORMATION
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
Lj- :;2 0 --0 L(
7. SIZE OF STRUCTURE
i'ltD
8. NO. OF STORIES
.J.
9. TVP~ OF CfO~TRUCTI~N
! ifty{h ,1f)lG
10. COMPLETION DATE
2, SITE ADDRESS / 17 d. /1.0
3, LEGAL DESCRIPTION
LOT
BLOCK
R(~Ubre (j)(LL/
PID ,~'-)- - 9; ,).. -- ~:c) /- 0
ADDITION ,-<;~ -1-1'0 ~ /;;;-
- .
4. OWNER (Name) ~ _ J /7; k!J (Addres~ /' -~
t::-uq Ie l!-Yc.-c e,V. '//I'f:,s E. / /};j
(Address)
P.L.
(T el. No.)
C/ t'1 /7 - L)l.1 S-~
(Tel. No.) .'
6, CONTRACTOR (Na~.
~arne
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 proceemin ccordance with submitted plans. I am aware that the building officia~c revoke this perm" for just cause.
F~ I a ree that the city official or a designee may enter upon the f~P t~ to perton, needed, infpections.
i ,/) ~ r;. ~ _~/( _______ ) Lf CZ. 'l Q 'f
,; I ~ Signature ( l Date \ ,/
(Address)
(Tel. No.)
FOR ADMINISTRATIVE USE
METRO SAC UNIT DETERMINATION
MATERIAL FILED WITH APPLICATION
o Site Restoration Plan
o Utility Abandonment Plan
&A v& rfPCA M>nrlv-rr<<c-NOF (1J18Vr r;
~ It iJ6"'1O'-I Tr aN j?iif
USE OF BUILDING p6:j2. SITE RESTORATION PLAN
o Sewer Abandonment
o Water Abandonment
Accepted by
Rejected by
o Electrical Abandnnment
o Other
TYPE OF CONSTRUCTION:
II
III
H
IV (j;)
R M
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
/2/ 111-
I
Occupancy Group A
B E
Division
2
3 4
This ~it~~on b,e omes your
demotJ)rmtf~ hen appr,o-:ed
, ~ \
I his is to certify that the-rnquest in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed, as re~ue ~ _
'41 . F5 I~O~
<t!R~lal r:er L., Date- Special Conditions if any
5;hJ4
Other .................................................................. $ -
/l0' YJ
TOTAL CREDITS ........................ $ - '1. r:
Date
Issued by
Date
Site Restoration Proposal for Demolition
Applicant: ~l) ~I P;_ (Irtrk Cx' V f lepn If/rt
Address: 11'21&~' Vfn 1.0111
Check boxes below:
/Yill Excavation to grade
~ Sod or seed all bare soils
o Erosion control (see handout). Maintain erosion control until turf is established.
o Cap sewer below grade. * Mark location. Licensed contractor required.
o Cap water below grade. * Mark location. Licensed contractor required.
'" 0 Call City of Prior Lake Public Works Department for water meter removal.
o Cap gas line. * (By gas company)
o Disconnect electric at meter. (By electric company)
o Pump and fill cesspool/septic tank. Certified contractor required.
o Abandon well. Certified contractor required. Existing well
o Remove existing structure foundation and footings, materials, and debris. * *
o 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.
* * Final inspection and approval of restored site required.
approved finaJ)ns}r~:cnon.
~~----
\J .-:
Deposit will be returned after
~
y/ /?lA !~/
i DAte
/
(/
Signature
.hBUILDING\HA~00GTS\Demo Site Restor.doc