HomeMy WebLinkAbout1996-008639 - demo ' PERMIT
' CITY OF ORONO
2750 Kelley Parkway- P.O. Box 66 PERMIT TYPE: . , ,
Permit Number: � �� -��'�:!'"`�
Crystal Bay, Minnesota 55323 �_°��Y'�:�����;.:��'
(612)473-7357 Date Issued: :_. :.
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REMARKS:
FEE SUMMARY:
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APPLI ANT�PERMITEE SIGNATURE � ISSUED BY:SIGNATURE ��.
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CITY OF ORO�'O APPLICATION FOR DEMOLITION PER1tiIIT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, �IN 5�323
SPECL�,I. CO�'DITIOtirS & HOLD HARiti1LESS AGREEl�1E\TT
General Instructions
1. You may be required to obtain other permits, i.e. burninQ, well abandonmment, etc.
2. `�ork 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 473-735 .
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JOB SITE �DDRESS: ��� ,� C� C�c� t � ? .
Occupancy Type: �_Residential Commercial
OWNER'S NQ��IE• �, ,� �� � � Phone: =-�� '�--`�/(}�]
Mailin� Address: � << � � �• C1�'� ��'r� •� � "
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CONI'RACTOR'S NA11'IE:�ci v� �X�c � Bus. No.: �f 7I'C 5 ��
Nlailing Address: �,��' ��r � ,�y5 City: S�n,- �`�� �'«r- IC
Demolition if planned by means of: � manual disassembly
_� 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
complete.
2. Demolition debris will be kept off adjoinin� 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 reb lations.
6. Inspection required when all debris has been removed, before bacl�"�lling.
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7. Within � workin� days of superstructure removal, a final inspection shall be requested.
The si[e shall be lef[ 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 buildin� and such new building is actually under construction).
8. The undersi�ned owner shall and hereby does indemnify and hold harmless the City of
Orono, its a�ents, employees and assigns from and against all clauns, damages, losses
or expenses, includin� attorney fees, aQai.nst the Ciry, its a�ents, employees and assi�ns
arisin� ou[ of or resultin� from the demolition described herein as performed by the
property owner, his employees, ajen[s, subcontractors or assiQns.
PER�IIT TYPE AIVD FEE CALCULATION
} �50.00 ��Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surcharje $ .50
3. TOTAL PERIv1IT FEE (add lines 1-2 above) $
The undersigned hereby applies to the Ciry of Orono for issuance of a Demolition Permit, agrees
to do all work in strict accordance with the ordinances of the Ciry and the regulations of the
State of Min.nesota, and certifies that all statements made on this application are complete, true
and correct.
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APPLICANT'S SIG�'AT'IJRE:' �:G� Date: %t�, - f j -'7�
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OtiWi ER'S SIGNATLTRE: �-t ��� -� ` ,�%� �f
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APPROVED BY: � . � - .,,_ Date: 1 Z s 1� -�C i�