HomeMy WebLinkAbout1997-009458 - partial demo --� PERMIT
�CITY OF �R�NO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 � -L._?��:'ai��
Crystal Bay, Minnesota 55323 Permit Number: ;�.��i_„_;
(612) 473-7357 Date Issued: ;^�,��};�;:;�,;_�;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE y�
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CITY OF ORONO APPLICATION FOR DEMOLITION PER�ti1IT
P.O. Box 66 (2750 Kelley Parkway) �
Crystal Bay, MN 5�323
SPECLAL CONDITIONS & HOLD HARti1LESS AGREE_1�NT'
General Instructions
1. You may be required to obtain other permits, i.e. burnin�, well abandonmment, etc.
2. Work must not be�in unless the permit card is available on the job site.
3. A 24 hour notice is required for all inspections. Call 473-7357.
JOB STTE ADDRESS: /'� �I S� �� L�,� � � �.
Occupancy Type: ✓ Residential Commercial
Oti�7ER'S NQutiIE: `T��( 1�' �� T�v Phone: �6���
Mailin� Address: �O `�7 7����/� � ' Ciry: �'L�� �
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CONTRACTOR'S NA3VIE: Bus. No.:
Mailing Address: City:
Demolition if planned by means of: � manual disassembly �-�ic�,'
�_ heavy equipment
burnin� (by fire department)
Permits Issued:
# Burnin; Fire Department
# Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as
follows:
1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is
comple[e.
2. Demolition debris will be kept off adjouun; property and/or the public rights-of-way
unless specific prior approval is obtained in writing for temporary use thereof.
3. Foundations shall be compietely 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 State Health Department rea lations.
6. Inspection required when all debris has been removed, before backfilling.
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7. Within � 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 Qround elevation (except when such excavation is to be used as
part of a new buildi.ng and such new building is actually under construction).
8. The undersi�ned owner shall and hereby does indemnify and hold harmless the Ciry of
Orono, its aaents, employees and assi�ns from and a�ainst all claims, dama�es, losses
or expenses,yi.ncludin� attorney fees, a�ainst the City, its aQents, employees and assians
arisin� out of or resultin� from the demolition described herein as performed by the
properry owner, his employees, a?ents, subcontractors or assigns.
PERII�IIT TYPE AND FEE CALCLTLATION
✓ �50.00 =�Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surchar�e $ .50
3. TOTAL PERi�1IT FEE (add lines 1-2 above) �
The undersigned hereby applies to the City of Orono for issuance of a Demolition Permit, agrees
to do all work in strict accordance with the ordinances of the City and the re;ulations of the
State of Minnesota, and certifies that all statements made on this application are complete, true
and correct.
APPLICANT'S SIG�'AT'URE: Date:
OSV�tER'S SIGNATURE: Date: �f� � �
A.PPROVED BY: ,/ _���� Date:
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