HomeMy WebLinkAbout2002-P05874 - demo ' ` ' PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P05874
Crystal �ay, Minnesota 55323 Permit Type: Demolition
(952) 249-4600 Date issued: iii2�i2oo2
SITE ADDRESS: 4185 Sixth Ave N
Long Lake,MN 55356
PID: 31-118-23-11-0004
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Permit Class: Building Census Code 649
Permit Type: Demolirion Permit Sub-type(s): Demo-Accessory Struchue
DETAILS:
Approved per resolurion#:
Separate perxnits required:
NOTICES/REMARKS:
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m ist be abondoned. Insnection before backfillin¢.
FEE SUMMARY: Pernut Fee: $ 30.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 30.50
APPLICANT: Owner/Self OWNER: Steven 7acobson
M� 4185 Sixth Ave N
Long Lake MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT P ITEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Aunlicant 1-Monthlv Revorts, 1-Assessing, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR DEMOLITION PERNII �� �
P.O. Box 66 (2750 Kelley Pazkway) � 1 �Ib
C stal Ba , NIN 55323 �� 1�
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' SPECIAL CONDITIONS & HOLD H�iRMi,ESS AGREEMENT
General Instructions
1. You may be required to obtain other pernuts, i.e. well abandonmment, etc.
2. Work must not begin unless the permit cazd is available on the job site.
3. A 24 hour notice is required for all inspections. Call (612)249-4600.
JOB SITE ADDRESS: L � S (p �,, ,� �.3 -., ���{
Occupancy Type: ��esidential Commercial
OWNER'S NAME: � ��-�?�z ,�; ,:�A �..� � S � •� Phone: `� S� - y 7 � �- 3 G �
Mailing Address: �j// �' S � {--� ✓'�u� }�:r City: � ,� , ,�
CONTRACTOR'S NAME: Ci ,��, -.� r �'� Bus.No.:
Mailing Address: City:
Demolition if planned by means of: m ai disassembly
eavy equipment G c�; �t ' t
y
Permits Issued:
# 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
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 State Health Department regulations.
6. Inspection required when all debris has been removed, before backfilling.
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7. Within 5 working days of superstructure removal,a fmal 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
buiiding and such new building is actually under construction).
8. The undersigned owner shall and hereby does indemnify and hold harmless the City of
Orono, 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.
9. Septic systems must be abandoned per Minnesota 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.
PERMIT TYPE AND FEE CALCULATION
$50.00 -Principal Structure
_� $30.00 - Accessory Structure - `j �' ��` � �
1. Subtotal of above permit requested $ � E: . ` °
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $ �� � S �
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 regulations of the State of
l�tinnesota, and certifies that all statements made on this application are complete,true and conect.
APPLICANT'S SIGNATURE: � — Date: �� o �
O�VNER'S SIGNATURE: �� Date: � G�
APPROVED BY: �`� Date: 1( - 2� -c�'Z�