HomeMy WebLinkAboutDemolition Permit 06-0096
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED d-k
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,e;ue,e W~y
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CONTR.
ADDRESS
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OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
d~o
6'9C
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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o CORRECT ACTION AND PROCEED
o CORRECT WORK, CA;~"; REINSPECTIQ
Inspector: $7 ~ Owner/Contr:
, -
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/NSNOTl
CITY OF PRIOR LAKE
DEMOLITION PERMIT
Date Rec' d
FE9 0 9 2006
"I
I PERMIT NO. {)G. 001 (p I
(Please type or print and si~ at bottom)
ADDRESS
ZONING (office use)
I 7 {9 'c3(n
lZev~ LI\/Io/
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID2.5. tJt2.- ('C7. 0
OWNER r'\
(Name) yul.. ~
~.....eS
o,c "'-'-'V
~~
(Phone) G::>-, C(~ z.. s-z,oo
(Address) c& 'S- Nc.IV p~ '-'""'+)' tF /<.10 .e:~ ,...,.,-v >~'-z..z..
CONTRACTOR
(Company Name) ~~A-.I ~~A.4.~
(Contact Name) -1fI\AL~ \\ "3l.v..lNS<>""
(Address) ~; CI~ I~ fK ,A-...€ ~.s.'r
(Phone)
(Phone)
~oP.c- ~ S":S""~,~
C\ 5, CO' '-I 1 'ZOc:.
~ I 'Z.. 'Z. 8 'L. 'Z. 53 ~
. Use of Building:
INTERNATIONAL BUfi.,DING CODE
Type of Construction: I II ill IV
Occupancy Group: A B E F H I
\ Division: 1 2 3
~MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
!r R, c ,
V A B
M R S U
4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that
I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I her~~ CYlal or a designee may enter upon the property to perform needed inspections. ~ \ I z,-JcG:.
- I . Signature . · Date
This Application Becomes Your Demolition
(jji;;t ;;;;:Pro~;~~~ ~
l\1LhTKq~CES) .
DE'l.hKMINATI
/2e;CO (l)$Jqt\(l(J.(IO C.lrEC...c FR~!1f
/Gtj/lN <!,()NTlC-, (2.1 CJe)
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. to certify that the request in the above application and accompanying documents is in accordance With the City Zoning Ordinance and may proceed as requested.
~O~ate
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:
12fjl1;J C!)/vl7~ Alq
/ 7c., E(;' luYuc/c vV/tV
I
Address:
Check boxes below:
"I Fill Excavation to grade
~ Sod or seed all bare soils
r Erosion control (see handout). Maintain erosion control until turf is established.
9-- 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.
If- Cap gas line. * (By gas company)
~ Disconnect electric at meter. (By electric company)
va Pump and fill cesspool/septic tanle Certified contractor required.
'fI Abandon well. Certified contractor required. Existing well
,. Remove existing structure foundation and footings, materials, and debris. * *
If 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),... . . .-if n
p)~ ~#j ~~, ~~r~^ OJ ~
~ Yo--J.- ~ -Ar~ ~. ~. ,:~ /~.~~ ~
~o-J -f4 · ~ r ~.
*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
'-- -l4 nJ)~
SIgnature
7.,,/1 J ()(.,
Date' .
J: \B UILDING\HANDOUTS\Demolition Restoration.doc
MINNESOTA DEPARTMENT OF HEALTH
WELL AND BORING SEALING RECORD
Minnesota Well and Boring
Sealing No.
Minnesota Unique Well No.
or W-series No.
(leave bWlk it not 1rn:Iwn)
1H244-4Q2
I ,~ 7/~f:f:I:
Minnesota Statutes, Chapter 103/
Township No. Range No. Secnon No. Fraction (sm.. Ig) Date Sealed
. Date Well or Boring Constructed
?_ L/ _ ~f.o
Sp.~ ~e 114 22 12 'I. 'I. 't.. ~~e C)(.-?
-I~
GPS Latitude degrees minutes seconds .1.:::::4::
LOCATION: Depth Before Sealing
Longitude degrees minutes .econds
, Numerical Street Address or Rre Number and City of Well or Boring Location
l1686 "R~"...., p l,,~}'":
Show exact location of well or bonng
in section grid with "X"
N
J5~
ft.
ft. Original Depth
AQUIFER(S)
\Zf Single Aquifer 0 Multiaquifer
WELUBORING
o Water Supply Well
STATIC WATER LEVEL
~ Measured
,
/,.-1')
o Estimated
Pd or T ~kp ~-r:;~J?
Sketch map of well of boring
location, showing prr Jerty
lines, roads, and buH lings.
. t' 't. ~
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--,- -,--' --.,-- -,--
, I I I
, I . ,
; I; ; j ; j
w ---~-~ '-~----~--T-~--l E
-t--t--t--t-T
~-+_. --+----{-----+--
++++ lk-.
---r--- n~_'--~ur~n.ll
---.L...----.L...- I I
S
''''''''
f
+
:;'
PROPERTY OWNER'S NAME/COMPANY NAME
,R:-van Contraetipg
Property owner's mailing address if different than well location address indicated above
8700 13th Ave S
Shakopee, MN 55379
WELL OWNER'S NAME/COMPANY NAME
Well owner's mailing address if different than property owner's address indicated above
GEOLOGICAL MATERIAL
COLOR
I HARDNESS ORI FROM I TO
FORMATION
If not known, indicate estimated fonnation log from nearby well or boring
.-1 ^ "~~+
L, ~. lj~~
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REMARKS, SOURCE OF DATA, D1FACULTlES IN SEALING
IMPORTANT-FILE WITH PROPERTY
PAPERS-WELL OWNER COPY
H
I) AA A IV)
10
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o Env. Bore Hole
o Monit. Well
o Other
ft. Ji( below
o above land surface
CASING TYPE(S)
~ (l Steel 0 Plastic ,0 Tile
~ ) WELLHEAO COMPLETION
..::::> Outside: 0 Well House
J
,
o Othe"
2G06
Inside: 0 Basement Offset
:>e Pitless Adapter/Unit
o Well Pit
o Well Pit
o Buried
o Buried
.....------- -------~-----;,--
Set in oversize hole? Annular space initially grouted?
DYes )(NO DYes o No o Unknown
DYes o No DYes o No o Unknown
o Yes o No DYes o No o Unknown
CASING(S)
D~aJe~e, (
4 in. frorp/)
Depth ,
to!?')
ft.
in. from
to
ft.
in. from
to
ft.
SCREEN/OPEN HOLE
Screen from
ft. Open Hole fromt2::i
,
to/55 ft.
to
OBSTRUCTIONS
~ Rods/Drop Pipe 0 Check Valve(s) 0 Debris 0 Fill
Type of Obstructions (DeSCribeLh/.JV I~ cz..
o No Obstruction
la~y
Obstructions removed? Y Yes 0 No
rUMP ., "
I Type <"@ ~
I:' ~ ~ Remov~d 0 ~o; Pr~fent 0 Other
U~ METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
I ;s(' No Annular Space Exists 0 Annular space grouted with tremie pipe 0 Casing Perforation/Removal
I in. from to ft. 0 Perforated 0 Removed
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Descrihe
in. from
o Perforated
to
ft.
o Removed
Type of perforator
o Other
GROUTING MATERIAL(S)
(One bag of cement = 94 Ibs., one bag of bentonite = 50 Ibs.)
f f
Grouting Materia~T ~~~rom/:" to -/5-0 ft.
-/8
yards
bags
frorr
to
ft.
yards
bags
from
ft.
to
yards
bags
OTHER WELLS AND BORINGS
Other unsealed and unused well or boring on property? 0 Yes \V No How many?
LICENSED OR REGISTERED CONTIl,o,CTQR CEI'!TlRCATlONc( '1' '0'..
This well or boring was sealed in accordance w~h'M'innesota.i=!l)I"";'Chapter 4725..,Tbe iiitoiination contained in this report is
true to the best of my knowledge. .
Don Storlol~ Wpll nrilli~.,.." r.n.,
l::) ~
contractorB, USineS2Name,. . _C/". '. "~ ' ".
4// ~~
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Tr>'" -
Tl1..7?:
Ucense orJ~.egistration No.
3-d-OtD
Date
~
. Name of PersDn Sealina Well Dr Rnrinn