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Permits - Permit# 10-15B - 4341 Channel Road - 1/1/2010CITY OF SPRING PARK 4349 Warren Avenue Spring Park, MN 55384 Phone (952) 471-9051 Fax (952) 471-9160 BUILDING PERMIT Noise Ordinance In Effect: -� O m c ;a r- C/) 3 z �p "� O Monday - Friday before 7 a.m. and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m. DATE - CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL SITE ADDRESS CA „4A/6 L / . 9 n, PI v0-V Name / Address / Zip CONTACT NAME - PHONE - EMAIL - FAX ARCHITECT f R uir / Address / itv State / Zio/Phone CONTRACTOR Name State /Zip/ Phone �/City/ /0c, L-a-Ae -JT- 5?--? q6 I s — to 3cx) CONTACT NAME - PHONE - EMAIL - FAX jrt -e// i0/- L (o B CONTRACTOR LICENSE # / TYPE OF WORK A New Home ❑ Deck ❑ Re -Roof ❑ Commercial R Residential ❑ Addition ❑ Fence Height: ❑ Re -Side EST. VALUATION OF WORK ❑ Remodel ❑ Pool ❑ Ret. Wall Height: $ 006— ❑ Finish Basement ❑ Stucco Demo ❑ Window Replacement Building Height: o ' Feet ❑ Accessory Structure ❑ Stucco ❑ Other: # of Stories: It SCOPE OF WORK: Cu T/lv 3w e e!L Use of Building: 14e.OF Signature of this application by the legal property owner or a licensed contractor, as the owner's representative is required and authorizes the City Zoning Administrator or designee and the City Building Official or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and state that all information is true and correct to the best of my knowledge. I further agree that all work performed will be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the City and the laws of the State of Minnesota regarding actions taken pursuant to this permit. I agree to pay all plan review fees even If I choose not to proceed with the work. Permit expires when work is not commenced with 180 days from sate of permit issued, or if building and work is suspended, abandoned or not inspected for 180 days. Work beyond or without a permit or inspection will be subject to a penalty. Call MNSPECT for inspections at (952) 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m. SIGNATURE OF APPLICANT: DATE: d PRINTED NAME: / v.iS DATE: -1 --------------------------- OFFICE USE ONLY BELOW THIS LINE ------------------------- LEGAL DESCRIPTION: Lot L Block Addition Zoning Valuation of Permit: $ Lot Area: J& O a S < OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED Yes No SETBACKS: REQUIRED (ft) ACTUAL (ft) NOTE: The applicant is required to submit commercial plans to Met Council Environmental Services for Sewer Availability Charge (SAC) determination. Contact Jessica Nye @ 651-602-1378 for submittal requirements. Permit will not be issued until a determination letter is provided. TOTAL DUE: Permit Fee:$ _ Front (ROW) Plan Check Fee:$ Rear State Surcharge:$ Side Site Insp. Fee.$ Side SE/WA Fee:$ Corner - — S.E Fee:$ — Lakeshore - _ _ h SAC Charge:$ Wetland wAc cnarge:$ Other _ _ Sewer Hook -Up:$ Water Hook -Up:$ __ Water Meter:$ Paid_ _ Receipt No. Other:$ Date _ By I BUILDING APPROVAL BY: DATE: TIME: CITYAPPROVAL BY: DATE: TIME: All new construction and/or dwelling expansion shall require a certified survey dated within five years of application. All new construction and/or dwelling expansion will be subject to contracted planner review and may add to the application time period, somewhat. Poor Quality Document Disclaimer The original or copy of a document or page of a document presented at the time of digital scanning contained within this digital file may be of substandard quality for viewing, printing or faxing needs. LB Legal Name: :EMCOR ENTERPRISE INC DBA: Business.Structure: CORPORATION Date Received ;,•„�; at City Hall: Name: [CO VJ -\ Address: Ay z C-` / Application For Demolition Permit Permit #: City of Spring Park, Minnesota �JJu� 0 Telephone No.: Fee: $40 Demolition Property Address: _ 1-'/ 3 q l C Q Type Of Structure: 7�0US cz.. --4- 7!h r Approx Date To Begin: �� (S O Estimmated Completion Date: Lc� 1(� /o1 C - Z0 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- �AJS Telephone No. ?S L ` 7.3 Address: l� �(O 0 6 C-1 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. I 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 tr and correct statement of my intentions. Signed By Applicant: �� �'� Date: e-->— G _ 110 Permit Approved By: Title: Date: 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 Page 1 of 2 All of the foregoing requests must be completed and signed -off PRIOR to the start of any demolition. The undersigned owner/contractor hereby agrees as follows: l . The structure shall be kept enclosed and/or secured until such time as demolition is complete. 2. Demolition debris will be kept off adjoining property and/or the public rights -of -way unless specific, prior approval is obtained in writing for temporary use thereof. 3. Foundations shall be completely removed from the ground. 4. All demolition debris shall be completely disposed of off site in accordance with all applicable PCA requirements. 5. Water wells must be abandoned in accordance with the State Health Department regulations. 6. Inspection required when all debris has been removed — before backfilling. 7. Within five working days of superstructure removal, a final inspection shall be requested. The site shall be left clean and clear of all debris, with any excavation filled with earth level with the adjacent ground elevation (except when such excavation is to be used as part of a new building and such new building is actually under construction). 8. Septic systems must be abandoned per MN Rules Chapter 7080. All septic tanks must be pumped, crushed and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are crushed and filled. 9. The undersigned owner shall and hereby does indemnify and hold harmless the City of Spring Park, its agents, employees and assigns from and against all claims, damages, losses or expenses, including attorney fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition described herein as performed by the property owner, his employees, agents, subcontractors or assigns. The undersigned hereby applies to the City of Spring Park for issuance of a Demolition Permit, agrees to do all the work in a strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature Owner's Signature Approved By: CQJ— Page 2 of 2 JUL-0B-2010 08:31 BOLLIG AND SONS INC 95293e9615 P.02 'IU111. UI I I UI .;1111 Yu Init" CHECKLIST FOR DEMOLITION PERMIT Project Name: i 12- Date: 7- e -10 Address: �-(3 1�(k�J�tJ� City: S r Owner's Name: �b�-� k.'s L<c WO- Telephone Number: �/� / Z S S! Contractor's Name: l3a 11 a O U-f Telephone Number: 6^ Detailed explanation of work to be perfo ed: rr — 4 2 / r L, ., e . , A,L s n c . U�ccwb It's L ZZ�e_ 11 c- 11 o `v'� s1' Has the following been provided or completed Yes No NIA ❑ �3 ❑ Completed permit application submitted to the Municipality. [] V�l ❑ Two sets of site plans verifying the location and size of structure(s) being demolished. ❑ ® ❑ Two sets of plans showing area of interior demo work. ❑ ❑ Written verification and/or site plan identifying the type of pedestrian S �{-•e -Q-- protection being provided. Describe type, location and height of fencing to be used. ❑ Have all utilities been properly terminated. ❑ Has a "Notification of Intent to Perform a Demolition" (not required for single family dwellings) been submitted to the Minnesota Pollution Control Agency. Have all wells been properly abandoned in accordance with State Health Department regulations. ❑ g� ❑ Septic tanks pumped and removed. ❑ ❑ ❑ Written description of building demolition method provided. A— L] [] [& Are there any underground storage tanks to be removed. ❑ ❑ Performance bond, letter of credit escrow or securities provided in accordance with the Municipality policy. ❑ ❑ Have all hazardous materials been removed and disposed of in ordance Jth,eM,,in>,n,e.sota Pollution Control AgencySigned'Q'" Date: �— o ( 0 September, , 2007 Demolition Page 2 of 2 JIJL708-2010 08:32 BOLLIG AND SONS INC 9529389615 P.03 'romB L,l l l ur Jrnl Yu 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 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.oca.state.mn.us September 14, 2007 Demolition Pagc I of 2 TOTAL P.03