HomeMy WebLinkAbout1996-10-14 Permit, Demo Residence #008465PERMIT
CITY OF ORONO
2750 Kelley Parkway - P.O. Box 66
Crystal Bay, Minnesota 55323
(612) 473-7357
SITE ADDRESS:
1101
L'_;V
P. T tJ o*7-117-2?-dry-(020
DESCRIPTION:
PERMIT TYPE:
Permit Number:
Date Issued:
FERNDALE RD W
DEMC I RESIDENC:F
8uildirn3 Permit Type C�EMrI/PRINC: IPAL
Pui lding Wcirk: Type DEMO- PR I NC: J PAL,
Census Cede 645 DEMO 1-FAM.
BUILDING
() 68, 46 5
1.0/14/' F,
REMARKS: s
FOUNDATICINS/ALL DEMO DEPRI'S TO BE REMOVED FROM GROUND AND DISPOSED OF OFF
I TE PER PCA REGULATIONS. WELL'S MUST BE ABANDI"INED . INSPECTION BEFORE
FEE
Base Fee $50.0 I
Surcharge----------�y5i�
Tcit.a l Fee S() . So
CONTRACTOR: — App 1 i c -avi t. — '=;T . L— I C: OWNER:
LUNDGREN PROS C'0N13TRUGT I CIN 14 ;' 1 :::1 1 q 1 L.i 1NDGREN BROTHER' C ONL;T
13:35 WAYZATA BLVD E 9:3S E WAYZATA BLVD
WAYZATA MIN WAYZATA MN SS:=:91
('612) 473-1231 (61 '.)47:3-12:31
L
THE UNDERSIGNED HEREBY RE(-,1UE'3T'_; PERM I- ;' ; I I::IN TA MAk::E THE REAL I MPRFIVEMENTS
ANi) AGREES TO i Di ► ALL W� ►Rk:: IN '_;TR I C: i CI iMPL I ANCE WITH ALL CITY 17F
CIRCINI-I GIRD I NA . ' AND '=;TATE (IF . M I NNF c;'-'1 I A F:t t I LEA I NC; CCIDE REQ0I REMENT'
APPLICANT PERMITEE SIGNATURE
ISSUEDBv SIGNATURE
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CITY OF ORONO APPLICATION FOR DEd.IT) N' PERNfIT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions
1. You may be required to obtain other permits, i.e. burning, well abandonmment, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24 hour notice is requited for all inspections. Call 473-7357.
JOB SITE ADDRESS: r vi et i t'
Occupancy Type: Residential Commercial
OWNER'S NAME: �- ' . >
Mailing Address: C 7CAtbu4 L! << %, J City: i t
CONTRACTOR'S NAME: ��►y _t� h( u`2 Bus. No.:
Mailing Address: City'
Demolition if planned by means of:
Permits Issued:
manual disassembly
heavy equipment
burning (by fire department)
g Burning Fire Department
g 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
comPlew ar
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 acconhoce 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 baclt'filling.
0.
7. Within S 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. 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.
PERiNIIT TYPE AND FEE CALCULATION
$50.00 - Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surcharge $ .SO
3. TOTAL PERMIT 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 regulations of the
State of Minneseta, and certifies that all statements made on this application are complete, true
and correct.
APPLICANT'S SIGNATURE: 7� Date:
OWNER'S SIGNATURE: `
Dace: X
APPROVED BY: Date: 1 o - b . `t �,