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CITY OF ORONO * 2 0 1 4 — 0 0 4 1 5
2750 KELLEY PARKWAY DATE ISSUED: 05/07/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS 1485 FOX ST
PIN 02-117-23-33-0001
LEGAL DESC UNPLATTED 02 117 23
LOT 000 BLOCK 000
PERMIT TYPE DEMOLITION
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE DEMO-ACCES ORY STRUCTURE
NOTE:
1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. INSPECTIONS DONE BEFORE BACKFILLING.
APPLICANT DEMOLITION-ACCESSORY STRUCTURE 50.00
STATE SURCHARGE DEMO 5.00
CANDLEWOOD CARPENTRY LLC TOTAL 55.00
5960 AFTON ROAD
SHOREWOOD, MN 55331- Payment(s)
CREDIT CARD 3708 55.00
Minnesota State License#: BUIL-BC443759
OWNER
HENNEMAN, W P&A B
1485 FOX ST
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
�— / /1
pp scant Permitee Signature Date Is ed By Signature Date
^' City of Orono R C USE ONLY
P.O.Box 66 Date Receive Permit#
2750 Kelley Parkway CrD
Crystal Bay,MN 55323 Amount: $.rS SAC Credit:
(952)249-4600
Homeowner(s)Signed: ❑Yes N A
/ Resolutions(if any)Signed: El Yes,None Required
4 f S H o � Zoning Disclosure Signed: ❑Yes wsone Required
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Job Site / Owner Information:
Type: Residential ❑ Commercial
Site Address: 149,S'- Fo K �S J_
Owner: �«'-� p��•�+ 1 -�✓ Mailing Address: I'-lffS' fvX 'sT
City: Zip: SS3
Phone: S-6 3 J Email:
Contractor/Applicant Information:
Contractor/App.: Coaoc crr,�r y,�� Contact Person: C fS �a.✓
Address: S-91,o State License#: QC g143 7671
City: 5lif91L6VA Zip: Expiration Date:
Phone: Email: Chris C <<' ���?�^may•Cow
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions:
1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24-48 hour notice is required for all inspections. Call (952) 249-4600.
4. Sewer must be discontinued at the City service by qualified contractor before demo permit is
issued.
Demolition by means of: g Manual Disassembly ❑ Heavy Equipment ❑ Other
Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandonment#
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to:
1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which
structures are to be demolished.
2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in
accordance with Chapter 79, Construction Site Runoff Control.
3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The
City will not issue a demolition permit without a copy of the permit(s) from the MCWD or
documentation stating permit(s) are not required.
4. Submit a $2,500 escrow and an escrow agreement signed by the property owner.
5. Keep all structure(s) enclosed and/or secured until such time as demolition is complete.
6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific
prior approval is obtained in writing for temporary use thereof.
7. Completely remove foundation(s) from the ground.
8. Completely dispose of all demolition debris off site in accordance with all applicable PCA
requirements.
9. Abandon water wells in accordance with State Health Department regulations.
10. Call for an inspection when all debris has been removed, before backfilling.
11. Within 5 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).
12. Abandon septic systems 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.
13. 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.
PERMIT TYPE AND FEE CALCULATION
❑ $75.00 — Principal Structure $
$50.00 —Accessory Structure x (how many)
1. Subtotal of above permit requested $
2. State Surcharge 5.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $
The undersigned herby applies to the City of Orono 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: `� --y Date: EA zJ`'
Owner's Signature: Date:
Approved By: Date: S
�8uilding Official)
*Zoning Disclosure Required? ❑ YES ONO
'This must be filled out by Zoning Department—For either answer, a Zoning Official must sign all applications.
* Approved By: /U f ("' Date:
(Zoning Official)
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. —40 945,— COMPLETED 9� _
ADDRESS ,��j' 'i /CGSC St.
OWNER TELEPHONE NO.
CONTRACTOR
DESCRIPTION ey
❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q Ll TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. OLLOW-UP
kul ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
Z OWNEWCONTRACTOR TO MEET YOU:_YES_NO
COMMENTS: �� ./lelD�✓ b .l .0cc
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W ❑WORK SATISFACTORY:PROCEED OJ ECT COMPLETE
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W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
C) ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
U BEFORE COVERING PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector. "� -
White Copy/Inspector's File Canary Copy/Site Notice