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HomeMy WebLinkAboutExcavating & Grading Permit 14-G-22 (2) • "EXHIBIT A" air nod FOR CITY USE ONLY PERMIT# bi- 6-'27 DATE /f-19/y EXCAVATING & GRADING PERMIT 00(0 74,/9 , Applicant: A Cof\c-c ct t 131-1c k 1oA1in Phone: °I.S2-ZZO -Zfocci Project/Development Name if Applicable: Address: --Zz0 )-1-rpe S^� �� �t ibr Q /''�N S5 ' V Property Owner: /Troy/! Pe \ afti Phone: q O3OS Address: 5?-Lc Bice S� g'G Contractor: 1?eAi5 ,YACs! 1-Z-, i k "k7CtA)\'nS Phone: `C5-Z-555--0393 Address: Sal l la FSI\.c' XC1 e S BIc \vl\m yV\t 3-57-i7 6 Consultant Engineer/Surveyor: J-Tr Ian c Phone: 320- Z53- Address: 3-7 -37 31- Av.e - \u s- Po,r I AAA S Emergency Contact(24 HR): / \i Phone: Z- ZZO -z lQ 0 1 Location of the Property: Legal Description: ColYinAS 00ork L �S� actS.A 1 o' 3 U )is to n cOk bS 0 1?/O 7._61 60- + lv2,oav Will the excavation or filling be in a: Watercourse Wetland Upland ›p Purpose for the proposed excavating or filling: Concrtlu ins k10-tA Estimated start date: Completion date: What is the type of material to be removed or deposited? What is the quantity of material to be removed or deposited? What is the total area disturbed for excavation or filling? 3oib0 ,51:4 In what manner will the material be removed and/or deposited? IV- What highway,street or other public-way will material for removal or deposition be hauled or carried? What,if any,street,avenue, lane,alley, highway, right-of-way,thoroughfare or public ground will be obstructed? _ IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION 01:THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL CITY OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER. Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan?Yes No If yes,explain proposed effect "EXHIBIT A" SUBMISSION REQUIREMENTS: A. Completed application form B. Map or plat of the proposed filling or excavating showing location and amount of material proposed to be removed or deposited,with a description of the area C. The depth or heights to which such removal or deposition is proposed throughout the area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1"=50' or larger. The proposed and original contours shall be shown including all property within 200' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of Minnesota D. Erosion control plan E. Effect on existing utilities F. Application fee G. Amount of Letter of Credit,or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra ordinary costs of repairing, highways, streets or other public ways along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything required to be done H. Public liability insurance CONDITIONS OF APPROVAL: A. Applicant must call the Engineering Department for erosion control inspection at (952)447-9830 prior to earth moving activities. B. Maximum 4:1 slopes are allowed in "maintained" areas except approved by City Engineer. Maximum 3:1 slopes are allowed adjacent natural resources. C. Slopes greater than or equal to 3:1 shall have approved erosion control Best Management Practices installed immediately after finished grading. D. Minimum grade for drainage swales shall be 2%or greater. E. Removal or depositing of material greater than 400 cubic yards requires a conditional use permit,unless it is part of a preliminary plat application. F. Applicant is responsible for obtaining and meeting the conditions outlined by other permitting agencies including but not limited to the following: DNR,Corps of Engineer,Prior Lake/Spring Lake Watershed District,Scott County, Mn/DOT, MPCA. G. Applicant is responsible for all damages to other property or facilities as a result of work covered by this permit. H. Applicant must call the Engineering Department for final grading inspection at(952)447-9830 prior to release of grading security. I. Additional Conditions: THE UNDERSIGNED HEREIN CERTIFY THAT THEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEPT THE TERMS AND CONDITIONS TO THE ISSUANCE OF THIS PERMIT A AGREE a FULLY COMPLY THEREWITH TO THE SATISFACTION OF THE CITY OF PRIOR LAKE EN ! ' ' MENT •R ITS D IG ..0? ` -)/Applicant: �' - Date/ 9 Property Owner: _ .r r, - Date I6-31-1'1 • "EXHIBIT A" IMPORTANT— BEFORE STARTING WORK EXCAVATOR AND OPERATOR'S NOTICE This notice is to inform excavators and operators they must comply with Sections 2160.03 to 2160.07 of MINNESOTA STATUTES Call Gopher State One Call (800) 252-1166 or 651-454-0002 Or go to www.gopherstateonecall.org Smart Phone: http://mnticketentrv.korterraweb.com FOR CITY USE ONLY. AUTHORIZATION OF PERMIT Financial Guarantee Amount$ /() Financial Guarantee Type (Letter of Credit,Bond or Cash) Permit Fee$ '-0;J' Liability Insurance provided? Yes 0 No (Insurance Certificate must name the City of Prior Lake as an additional insured party) In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations,and pursuant to authorization duly given by said City of Prior Lake, permission is hereby granted for the work to be done as described in the above application and submitted drawings,said work to be done in accordance with this application and submitte gs. ENGINEERING OFFICIAL Date //417/1 Per alid if signe by City Official PERMIT EXPIRATION DATE(90 days from approval date) LA'l'7' /fir Planning Dept.Initials , AL• "EXHIBIT A" o* ruto FOR CITY USE ONLY .�' PERMIT# y .�!fhRt5C. . 1\JA DATE .572 /41 EXCAVATI\ G & GRADING PERMIT A ' - ZZ0--Zco0 Applicant: %t� � � S COCaY�Cf Phone: olS q Project/Development e if Applicable: Address: 52-1-0 1k6 . 5k St TT\c 1.--Ake VIA-A) 5537-Z Property Owner: \ x\ xcetr)---c- \t- Ac o\ ?e \< . Phone: 2-3 -_p-c0 Address: SLZ0 ""VO C?e S r?kt�or Contractor: A. ? cj cops Phone: c(c2- 513 1-0':( Address: 611ln FA09orti Ails S� 1 7>1aVAAra15Vbt\, C-1.nI 55-`CZd Consultant Engineer/Surveyor: ZIT- \JCC Phone: 320 .-253- c(35 Address: .337 ;I ' kre__ 5 , IA) IMF\ S6 38 ? Emergency Contact(24 HR): ?pec-S Phone: 115Z- 2-2-o -Z(o®`� Location of the Property: l Legal Description: Cov' ,A' L CCAA.\e \?r Pv'toL\ L-8k H SU O\5P4\ a 15- `�/n Zai Air I WG Will the excavation or filling be in a: Watercourse Wetland Upland Purpose for the proposed excavating or filling: Co; -eA- re ,u.ns, to A k Estimated start date: Completion d. e: What is the type of material to be removed or deposited? What is the quantity of material to be removed or deposited? 'Atte What is the total area disturbed for excavation or filling? 30 In what manner will the material be removed and/or deposited? 6''x What highway, street or other public-way will material for removal or deposition be hau =d or carried? 1-1-wy \3 What, if any, street, avenue, lane, alley, highway, right-of-way,thoroughfare or public grou d will be obstructed? e\uv o IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL CITY OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER. Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan?Yes No If yes,explain proposed effect "EXHIBIT A" SUBMISSION REQUIREMENTS: A. Completed application form B. Map or plat of the proposed filling or excavating showing location and amount of material proposed to be removed or deposited,with a description of the area C. The depth or heights to which such removal or deposition is proposed throughout the area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1"=50' or larger. The proposed and original contours shall be shown including all property within 200' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of Minnesota D. Erosion control plan E. Effect on existing utilities F. Application fee G. Amount of Letter of Credit,or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra ordinary costs of repairing, highways, streets or other public ways along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything required to be done H. Public liability insurance CONDITIONS OF APPROVAL: A. Applicant must call the Engineering Department for erosion control inspection at (952) 447-9830 prior to earth moving activities. B. Maximum 4:1 slopes are allowed in "maintained" areas except approved by City Engineer. Maximum 3:15lopes are allowed adjacent natural resources. C. Slopes greater than or equal to 3:1 shall have approved erosion control Best Management Practices installed immediately after finished grading. D. Minimum grade for drainage swales shall be 2%or greater. E. Removal or depositing of material greater than 400 cubic yards requires a conditional use permit, unless it is part of a preliminary plat application. F. Applicant is responsible for obtaining and meeting the conditions outlined by other permitting agencies including but not limited to the following: DNR,Corps of Engineer, Prior Lake/Spring Lake Watershed District,Scott County, Mn/DOT, MPCA. G. Applicant is responsible for all damages to other property or facilities as a result of work covered by this permit. H. Applicant must call the Engineering Department for final grading inspection at(952)447-9830 prior to release of grading security. I. Additional Conditions: THE UNDERSIGNED HEREIN CERTIFY THATTHEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEPT THE TERMS AND CONDITIONS TO THE ISSUANCE OF THIS PERMIT AND AGREE TO FULLY COMPLY THEREWITH TO THE SATISFACTION OF THE CITY OF PRIOR LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT. Applicant: Date 5- \`A Property Owner: Date 5-Z\-\Li "EXHIBIT A" IMPORTANT® BEFORE STARTING WORK EXCAVATOR AND OPERATOR'S NOTICE This notice is to inform excavators and operators they must comply with Sections 216D.03 to 216D.07 of MINNESOTA STATUTES Call Gopher State One Call (800)252-1166 or 651-454-0002 Or go to www.gopherstateonecall.org Smart Phone: http://mnticketentrv.korterraweb.com FOR CITY USE ONLY AUTHORIZATION OF PERMIT Financial Guarantee Amount$ Financial Guarantee Type (Letter of Credit, Bond or Cash) Permit Fee$ /00 ,(0 Liability Insurance provided?X.Yes 0 No (Insurance Certificate must name the City of Prior Lake as an additional insured party) In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations,and pursuant to authorization duly given by said City of Prior Lake, permission is hereby granted for the work to be done as described in the above application and submitted drawings,said work to be done in accordance with this application and submitted drawings. ENGINEERING OFFICIAL / Date Permi is valid if sired by C' 0 icial PERMIT EXPIRATION DATE(90 days from approval date) 9-21-/y Planning Dept.Initials 3 - I� 4 •. • "EXHIBIT A" 0-- . rur0% . U g A iFOR CITY USE ONLY alfnxt5 PERMIT# /11-.2-66 DATE .5/ /� EXCAVATING & GRADING PERMIT Applicant: A_ Pies Co r c xe.b.. Phone: °1 SZ- ZZ O-Z(007 Project/Development Name if Applicable: Address: 57-7-C) >kore_ 5k- S, 1 V7v-k6r` LS P W\AJ 553-2-z_ Property Owner: 13a.rare-A-c_r�c. )r- AS (O\ck ?e s\ Phone: 111 s Z3 -p'-O5 Address: 57_20I�U(-)Q S\-S.e , 17�f'‘or 1-41,.k-e. Contractor: A. PvelS Come -t_ Phone: 957.- 5150-(15P03q 3 Address: 6)1 le) Fik s\ /file. SN ` 1)1.6b1AVI.56\. /l4 5511ZO Consultant Engineer/Surveyor: STT \APhone: '37-0 —ZS-5- ( 33 X Address: 137 ;I s AvL 5 1 F 1Muk S 6 3o7 Emergency Contact(24 HR): +� Tit::-.\-‘ Phone: 15Z- 2-1© -Z(0 b`i Location of the Property: ll Legal Description: Cov pAS X e- ‘SN- P Lo 3� H ` Su \?ASPJ\ C� Z5 U t - IDI( Z�, C�1 ew Will the excavation or filling be in a: Watercourse Wetland Upland Purpose for the proposed excavating or filling: Co e . f .\b W ctiA Estimated start date: Completion date: What is the type of material to be removed or deposited? What is the quantity of material to be removed or deposited? What is the total area disturbed for excavation or filling? 3OcOt-+- In what manner will the material be removed and/or deposited? S' �f What highway, street or other public-way will material for removal or deposition be hauled or carried? ‘-k-k.ot \S What, if any, street,avenue, lane,alley, highway, right-of-way,thoroughfare or public ground will be obstructed? Nnc:vLD IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL CITY OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER. Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan?Yes__ No\C If yes,explain proposed effect • "EXHIBIT A" SUBMISSION REQUIREMENTS: A. Completed application form B. Map or plat of the proposed filling or excavating showing location and amount of material proposed to be removed or deposited,with a description of the area C. The depth or heights to which such removal or deposition is proposed throughout the area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1"=50' or larger. The proposed and original contours shall be shown including all property within 200' of proposed excavation or deposition and :than be signed by an engineer or surveyor registered in the State of Minnesota D. Erosion control plan E. Effect on existing utilities F. Application fee G. Amount of Letter of Credit, or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra ordinary costs of repairing, highways, streets or other public ways along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything required to be done H. Public liability insurance CONDITIONS OF APPROVAL: A. Applicant must call the Engineering Department for erosion control inspection at (952) 447-9830 prior to earth moving activities. B. Maximum 4:1 slopes are allowed in "maintained" areas except approved by City Engineer. Maximum 3:1 slopes are allowed adjacent natural resources. C. Slopes greater than or equal to 3:1 shall have approved erosion control Best Management Practices installed immediately after finished grading. D. Minimum grade for drainage swales shall be 2%or greater. E. Removal or depositing of material greater than 400 cubic yards requires a conditional use permit, unless it is part of a preliminary plat application. F. Applicant is responsible for obtaining and meeting the conditions outlined by other permitting agencies including but not limited to the following: DNR,Corps of Engineer, Prior Lake/Spring Lake Watershed District,Scott County, Mn/DOT, MPCA. G. Applicant is responsible for all damages to other property or facilities as a result of work covered by this permit. H. Applicant must call the Engineering Department for final grading inspection at(952)447-9830 prior to release of grading security. I. Additional Conditions: THE UNDERSIGNED HEREIN CERTIFY THAT THEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEPTTHE TERMS AND CONDITIONS TO THE ISSUANCE OF THIS PERMIT AND AGREE TO FULLY COMPLY THEREWITH TO THE SATISFACTION OF THE CITY OF PRIOR LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT. Applicant: Date S Property Owner: - sir�� - Date 5--Z.\-V-1 w "EXHIBIT A" IMPORTANT— BEFORE STARTING WORK EXCAVATOR AND OPERATOR'S NOTICE This notice is to inform excavators and operators they must comply with Sections 216D.03 to 216D.07 of MINNESOTA STATUTES Call Gopher State One Call (800)252-1166 or 651-454-0002 Or go to www.gopherstateonecall.org Smart Phone: http://mnticketentrv.korterraweb.com FOR CITY USE ONLY AUTHORIZATION OF PERMIT Financial Guarantee Amount$ Financial Guarantee Type _ (Letter of Credit, Bond or Cash) Permit Fee$ /OO 406 Liability Insurance provided? `Yes 0 No (Insurance Certificate must name the City of Prior Lake as an additional insured party) In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations, and pursuant to authorization duly given by said City of Prior Lake, permission is hereby granted fo'the work to be done as described in the above application and submitted drawings,said work to be done in accordance with this application and submitted drawings. ENGINEERING OFFICIALi —: if„,.... .- 4 v---------Date ' Z i-/y — Pe mi is valid if si ed by C Official PERMIT EXPIRATION DATE(90 days from approval date) p-21-iy Planning Dept. Initials �/�'Ut'k- • . —_urruI, APIET-1 OP ID: BL ACCPRCP' DATE(MMpK)IYYYY) 4,....---- CERTIFICATE OF LIABILITY INSURANCE 05120/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCERPhone:952-996-8818 E CT Brenda Parker Mark Broom Fax:952-829-0482 rat 952.996-8866 FAX Northern Capital Insurance Gp EuU: (AIC,No;952'829-1)482 P.O.Box 9396 ADDRESS:brendaparkerrnortherncapital-mn.com Minneapolis,MN 55440-9396 Mark Bloom INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:Progressive Companies 24620 INSURED A. Pietig Concrete&Brick Inc INSURER B:General Casualty/QBE 24414 Attn: Andy Pietig INSURER C:SFM 11347 8116 Pillsbury Ave S Bloomington,MN 55420 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREOJ IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE INSR s/VDR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDDIYYI'Y) (MMIDDIYYYY), GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY CCX1040631 04/10/14 04/10/15 pREM SES(Ea oNccumance) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 BLANKET ADDL INSD WHEN PERSONAL&ADV INJURY $ 1,000,000 REQUIRED BY CONTRACT GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO JECT pi LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 100000 (Ea accident) $ A ANY AUTO 04650102-0 04/10/14 04/10/15 BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED I AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WSTATU- 0TH- AND EMPLOYERS'LIABILITY X TORFL ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N 060853.201 03/15/14 04/10/15 E L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Leased Equipment CCX1040631 04/10/14 04/10/15 Limit 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Re: Homeowner-Rich Peske, 5220 Hope St SE, Prior Lake, MN CERTIFICATE HOLDER CANCELLATION CITYOPR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Prior Lake THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4646 Dakota Street SE Prior Lake,MN 55372 AUTHORIZED REPRESENTATIVE 4 .vim-- >v-••‘_/I ©1988-2010 ACORD CORPORATION. All rights resiarved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • Nathan Briese �. From: Nathan Briese Sent: Thursday, September 11, 2014 2:46 PM To: 'Andy Pietig' Cc: Dale Stefanisko; Barbara C.Zerbe Subject: 5220 Hope St Andy, I am just wondering if you have a plan of attack for this property. I have granted you a 45 day extension do to the weather we had this summer. The Permit will now expire on October 7, 2014. That is 45 days from the previous expiration day!! Please let me know a time frame of completion for this project. Thanks, Nate Briese Engineering Tech City of Prior Lake, MN 952-447-9837 nbriese@cityofpriorlake.com