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Home My WebLink About2011-00116 - demo CITY OF ORONO PERMIT NO.: 2011-00116 2750 KELLEY PARKWAY � ORONO, MN 55356- �ATE �ss[1E�: 02/18/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 100 BIG ISLAND PIN : 23-117-23-21-0001 LEGAL DESC : UNPLATTED 23 1 17 23 : LOT 000 BLOCK 000 PERMIT TYPE : DEMOLITION PROPERTY TYPE : OTHER CONSTRUCTION TYPE : DEMO-ACCESSORY STRUCTURE ACTIVITY : 649-ALL OTHER BUILDING& STRUCTURES NOTE: DEMOLI'I�ION OF(1)SMALL CA[31N,(2)CONCRETE BLOCK STORAGE BUILDINGS&(I) PICNIC SHELTGR CITY PROJEC"I�-FGG WAIVGD APNLICANT MINNETONKA PORTABLE DREDGING 500 WEST LAKE ST. TOTAL EXCELS[OR, MN 55531 PAID WITH CASH ' (952)474-9454 PAID WITH CC# RECEIPT NUMBER: OWNER City of Ocono PO BOX 66 CRYSTAL BAY, MN 55323-0066 AGREEMENT AND SWORN STATEMENT The�cork for wl�ich this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals.and the State Building Code. This permit is for only the work described and does not grant pennission for additional or related work�vhich requires separate permits. All provisions of laws and ordinances goveming this type of��ork shall be compied with whether or not specitied herein.This permit will expire and become null and void ifconstruclion authorized is not commenced within 180 days of Uie date of issuance,or it�construction is suspended for a period ot�180 days at any timc alter work has commenced. 'I'he applicant is responsible for assuring all required inspections are requested in confonnance with the State f3uilding Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitec Signature Date Issued L3y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . t ��/� � City of Orono FO CI USE ONLY ¢O� P.O.Box 66 Date Received: � /� Permit# O�j�—dU (O I� �, ; 11 2750 Kelley Parkway � + '� �-� k�� Crystal Bay,MN 55323 Amount: $� SAC Credit: �� '�r4 xti�� (952)249-4600 ��a'eg°�� Homeowner(s)Signed: ❑Yes Resolutions(if any)Signed:0 Yes ❑None Required Zoning Disclosure Signed: ❑Yes ❑None 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 ��Sn��Na"�— Site Address: �� /��L.�-n►D Owner: G t� Q E " RdIJO Mailing Address: �0� I�t�)C � �o city: �.��(s�-�s,+�'��,� �� zip: S�3 2 3 Home Phone: 9�2-2�/��G�_� Alternate Phone: Contractor formation: Contractor/App.: N'l.liv��'N1cQ �OR�f7�l.� Contact Person: G/iBQ1�bt--.-�A�8o+•2 Da-E.�.('s!N � Address: �� (ftl . L�A-J��S� State License#: City: �G�ZSlb2 Zip: S�" 3 � Expiration Date: — Phone: �S2^ �(�I�{ - ��l�y Alternate Phone: �(2� Sq`�' ?l�'�� ,�- c�e-�.c�� 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: [✓]�Manual Disassembly [✓�Heavy Equipment ❑ Other Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandonment# ��1�'/ In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as follows: 1. The structure(s) shall be kept enclosed andlor secured until such time as demolition is complete. a 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. 7. 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). 8. Septic systems must be abandoned per Minnesota Rules Chapter 7080. All septic tanks � �tl�PQ�1 must be pumped, crushed and filled with native soils. An inspection is required after the 1� 5('�'' tanks are pumped and before the tanks are crushed and filled. 9. 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 � 5►wkc.L C�16l� ❑ $75.00–Principal Structure Z, GaNc.. 6c�c� ST°'a�t-G� Rt�G� �'$50.00–Accessory Structure5� (how many) / ��uucc S�r��what) 1. Subtotal of above permit requested $ "` 2. State Surcharge $ 5.00 3. TOTAL PERMIT FEE (add lines 1-2 above) $ G ir��.o,��z'�'–��t Ve�D 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: v� Date: "— Owner's Signature: �%�� sD: � � . Date: 2 lg // l�c�2 G/.tr of OrlonrD Approved By: Date: (Building Official) . * Zoning Disclosure Required? ❑ YES ❑ NO *This must be filled out by Zoning Department—For either answer,a Zoning Official must sign all applications. * Approved By: Date: (Zoning Official) t� � M H E s o T A MinnesotaDepartmentofHealth SEALING NOTICE VERIFICATION � Well Management Section P.O.Box 64975 This is to verify that this office received a notification on 5/5/2006 that a well sc.Pa��,Minnesota 55164-0975 (Minnesota Unique Well No. H000247521) is to be sealed by DEPARTMENTmHEAITH (651)201-4600or 1-800-383-9808 DON STODOLAS WELL DRILLING CO., INC. at: Well or Boring Location Address: 100 BIG ISLAND ORONO Location: Township Name ORONO No. 117 Range 23 Section 23 This well must be sealed in accordance with the Minnesota Rules on Wells and Borings. MDH staff may be on site to inspect the welt sealing. ORONO, CITY OF PO BOX 66 CRYSTAL BAY, MN 55323 M I N N E S 0 T p Minnesota t�epartment of rlealth CONSTRUCTION NOTICE VERIFICATION � Well Manageme�t Section P.O.Box 64975 This is to verify that this office received a notification on 5/5/2006 that a well sc.Pa�i.M�nnesoca ss��a-o9�s (Minnesota Unique Well No. 0000739138) is to be constructed by DEPARTMFNtorHEAITH �GS])20]-4600or1-800-383-9808 DON STODOLAS WELL DRILLING CO., INC. at: Well or Boring Location Address: 100 BIG ISLAND ORONO Location: Township Name ORONO No. 117 Range 23 Section 23 Withdrawals exceeding 10,000 gal/day or 1 million gal/year require a MN DNR Appropriation Permit (651/259-5700). Any unused well must be sealed by a licensed well contractor. MDH staff may be on site for well inspection. Plans must still be approved for community public water supply wells. ORONO, CITY OF PO BOX 66 CRYSTAL BAY, MN 55323 -- - _.. .. . -- � ---�---. .__._.. .._—�--- .__._._ ._._. � ------- -- I