HomeMy WebLinkAbout1992-004283 - building .
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CITY OF ORONO PERMIT TYPE: E;�����I��
1335 Brown Rd. South • P.O. 8ox 66 Permit Number: �lt.l:�y.�a::
Crystal Bay, Minnesota 55323 Date Issued: C�t�/i[�./'a�?
(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY: ' �
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CONTRACTOR: WNER: — A�Pl ic�r�t. —
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� THE �jt�GE�t=:I Gh�EQ H��'-�EBY �Ess�t?E=T'=; �'E�t1 i _.,�I�ii`J T�i t�r�K:E TNE FiEA� I ht�`�;�tUEt�ENT';
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APPLICA PERMITEE SIGNATURE ISSUED BY:SIGNATURE G��i✓1
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CITY OF ORONO AP LICATION FOR DffiKOLITION PSRMIT
P.O. Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
� SPECIAL CONDITIONS & HOLD LESS AGREEMENT
t****�*:***�t�********:*********:#*****�*** ***:********�**t�#************
General Instructions
1. You may be required to obtain othe permits, i.e. burning, wel I
_ = abandonmment, etc. - __ ,_. _ ._ .._. . __. .�,. _ -:-,- �. -. _ -
2. Work must not begin unless the permi card is available on the job
site.
3. A 24 hour notice is required f or a11 i spections. Call 473-7357.
*******�***t*********:*:**:***********:*�*t �*f:****t:**********#*********�
JOB SITS ADDRESS: �;����S Y� , ��-:� � �� r=,- �
Occupancy Type: Residential Commercia
OWN$R'S NAME: ��I � c- � Phone: -��7,� - :.�,����
Mailing Address: 5 "' � � City: �'�Ty.,�Z� _
CONTRACTOR'S NAME: Bus. No. :
Mailing Address: City:
**s**�******�***t****:****t**:****:�:**#:** t****s:t*tt�*****t:*#�***:�****
Demolition if planned by means of: �manua disassembly �heavy equipment
_burni g (by fire department) �
Permits Issued: �►����`���
# Burning Fire Department
# Well Abandonment
In return for issuance of said Demolitio Permit, the undersigned owner
hereby agrees as follows:
1. The structure(s) shall be kept enclos d 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 speci�i prior approval is obtained in
writing for temporary use thereof.
3. Foundations shall be com letely remove from the ground.
4. All demolition debris shall be completely disposed of off site in
accordance with al 1 applicable PCA re uirements.
5 . Water wells must be abandoned in accordance with State Health
Department regulations.
6. Inspection required when all deb is has been removed , before
backfilling.
7. Within 5 working days of superstruct re removal , a final inspection
shall be requested. The site shall e left clean and clear of all
debris, with any excavation filled wi h earth level with the adjacent
_ ground elevation (except when such exc vation is to be used as part of
a new building and such new building ' s actually under construction).
- -- - ___ _. � - � _ _.. � � r �..
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.
****�*#:**********t**********�***********�**#*t***t*�******:*�*t****f*f****
_._._�.__ PFRMIT�-TYPS AND F$S CALCUI.ATION --.:�_:�- -.,-, :.:_ . _. ..-.
� $50. 00 Principal Structure
$30.00 Accessory Structure �
1. Subtotal of above permit requested $
2. State Surcharge $ .50
3 .. TOTAL PERMIT FEE (add lines 1-2 above) $
***�*******��******�*f*�***f*:***********�***t*****�**�**t*#**�*****���**�*
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 Minnesota, and
certifies that all statements made on this application are complete, true
and correct.
SIGNATIIRS OF APPLICANT:\ � � � �v'�-�� � Date: ��7�`��� �—
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