Permits - Permit# 10-02DEM - 4341 Channel Road - 1/1/2010Date Received
at City Hall:
Name: NO %(10'*,
G
Address: 3 C-i//
Demolition Property Address
Type Of Structure
Permit #. (Q - O a
Application For Demolition Permit
City of Spring Park, Minnesota
Fee: $40
Telephone No.:
C l� /�u �� s .0 t, AJ,2
4-1 3
M
l' +-OL- 10
Approx Date To Begin: Estimated Completion Date: �y �(o • /o� C - ZD
Utilities On Site: Check (✓) all that apply Sewer Water Electricy
Cable Gas Telephone
Note: It is the Owner's or Contractor's responsibility to contact GOPHER STATE ONE CALL at 1-800-252-1166 to notify of the
disconnect and to mark any underground utilities on the property..
Will Utilities Be Used For New Structure? .................. Yes V No
Note: If water and sewer services are never to be reused, the property owner is responsible for abandoning services according to
Minnesota State Plumbing Code and must be inspected by the City of Spring Park Pub 'c Works Department.
Is There a Water Well On Site? .................................... Yes No
Is There An Underground Fuel Tank? .......................... Yes No (/
Demolition Contractor: O l 4— �Sv� Telephone No. IS 2- - 7.3 8 - L `3 3
Address: 6'
Liability Insurance Co.
Policy No:
Policy Period From:
To:
Telephone No.
Coverage And Limits:
Note: In the event that any ASBESTOS is present in the structure, state approved methods must be followed.
1 hereby declare that I am the owner of the property or the demolition contractor of above described property. I agree to comply with
all state regulations and all materials from the demolition will be taken to a state approved demolition dumpsite. All the foregoing
information contained on thi.� permit is a trKand correct statement of my intentions.
Signed By Applicant:
Permit Approved By:
Title:
Date:
Date: G ��
The Following Section To Be Completed By City Officials
Total Fee:
Receipt No:
Received by:
The Following Section To Be Completed By Public Works / Operator
Water Service............ Disconnected Abandoned Sealed Signed
Sewer Service............ Disconnected Abandoned Sealed
Signed
Electrical Service ...... Disconnected Abandoned Removed
Signed
Gas Service ............... Disconnected Abandoned Removed
Signed
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XFRPHG PARK
Un Lake Mnnetonka
July 7, 2010
Jim Beuch
Bollig & Sons, Inc
11401 County Road 3
Hopkins, MN 55343-7423
Sent Via Fax: 952-938-9615
Dear Jim:
Thanks for dropping off your demolition permit application yesterday. As discussed, I
thought there might be some additional paperwork required from our building
inspections official at Mnspect. They sent over the attached two page permit submittal
checklist. Please complete this new document and forward it to my attention. Once I
receive this, I will forward your permit application and the two page checklist to Mnspect
for their review.
Sorry about the confusion. Obviously, our city doesn't do demolitions very often.
Sincerely,
Wendy Lewin
City Clerk
Ci� of Hinq Park
4349 WARREN AVENUE, SPRING PARK, MINNESOTA 55384-9711 (952) 471-9051 FAX (952) 471-9160
JUL-Oe-2010 08:32 BOLLIG AND SONS INC 95293e9615 P.03
rom:i+i i r ur --rni uu rnnn
Permit Submittal Checklist: Demolition Permits
Permits are required for all building structures and/or interior building demolition work. The permit fee
is based on valuation and must be submitted to the building inspection department for review.
• if a new structure will be built immediately following the demolition of the old structure, and
they are applying for the permits at the same time, then two permits are issued but the
valuation of the demolition work should be included in the valuation of the new permit.
• If a new structure will be built sometime in the future, and is not applied for at the same time,
then two permits will eventually be issued. Therefore the permits will be issued separately,
one for the demolition and then one for the new construction permit, after they are reviewed.
It is the responsibility of the owner and/or contractor to comply with the requirements and rules of all
authorities and government agencies having jurisdiction. The permittee shall be responsible for
contacting all of the proper State, County and Local authorities prior to the demolition commencing.
All asbestos and other prohibited materials shall be removed and disposed of in accordance with the
rules and regulations established by the Minnesota Pollution Control Agency. The Department of
Natural Resources, County Environmental Services Department, County Watershed, City Utilities and
Public Works Directors are examples of agencies and/or authorities that may be involved in any given
project and a demolition permit issued by the Building Inspections Department shall not be construed
as permission to proceed without approval from all appropriate agencies.
Submittal Requirements:
❑ ; Application
Q' Checklist for Demolition Permit with appropriate requested information attached
Required Inspections:
Prior to demolition the following items must be checked and remain in place throughout the
duration of the project:
❑ Traffic control
❑ Pedestrian protection
(Silt fence — dust control
❑ Owner/contractor must provide verification of proper clean-up and disposal of
contaminated soils, and all abatement issues, and disconnects
(see permit packet for requested documents)
❑ After the demolition project has taken place the following items must be checked during the
final inspection:
❑ Site properly cleaned up and appropriately graded
❑ Street cleaning
If you have any questions regarding the classification, removal, transport, disposal, or any questions
regarding asbestos rules, regulations, or standards, please feel free to contact the MPCA asbestos
team at the following numbers:
(651) 296-6300
(800)657-3864
Information is also available at the MPCA website: http://www.pca.state.mn.us
September 14, 2007 Dcrnoiition Page 1 of 2
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