HomeMy WebLinkAbout1999-011191 - demo Y�KMl'1'
�ITY OF ORONO PERMIT TYPE:
275L�.K�Iley#'arkway- P.O. Box 66 '� `�`������
Permit Number: "'' ��'`'`'`��'
Crystal Bay, Minnesota 55323 _ _ _ _ .. _
,(612)473-7357 Date Issued: - - _
ITE ADDRESS:
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CITY OF ORO�'O APPLICATION FOR DEMOLITION PER�titIT
� P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, �iN 5�323 =
SPECIAL COiVDITIONS & HOLD HAR�I�TI.ESS AGREEMENT'
General Instructions
1. You may be required to obtain other permits, i.e. burning, well abandonaiment, etc.
2. Work 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 473-7357.
JOB SITE ADDRESS: 6� o �� �-�
Occupancy Type: Residential Commercial
O`�'ER'S NQu�IE: � b�- �/�/QT�'L�Ll�R Phone: �'�J�'�.5�
Mailin� Address: f �o .,2rNT'�Re._.�4c.l�ElY Ll� CitY�T nr/ri4- AY, k
'SS33/
? CONTRACTOR'S NAIVIE: Bus. No.:
' Mailing Address: City:
Demolition if planned by means of: � manual disassembly
heavy equipment
�_ burnin� (by fire department)
Permits Issued:
# Burning Fire Department
# Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as
follows: �..
1. The sttucture(s) shall be kept e�closed and/or seeured until such time as demolition is
c.omplete. .
2. Demolition debris will be kept off adjoinin� property�'�ancUor the public rights-of-way
unless specific prior approval is obtained in writing for temporary use thereof.
3. Foundatians shall be completely removed from the ground.
4. All demolition debris shall be completely disposed of off site in accordance with all
applicable P�A requirements. .
5. Water wells must be abandoned in accordance with State Health Department re;ulations.
6. Inspection required when all debris has been removed, before bac�illing.
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7. Within � workin� 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 around 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 a�ainst all claims, damages, losses
or expenses,yincluding attorney fees, a�ainst the Ciry, its a�ents, employees and assijns
arisin� out of or resultin� from the demolition described herein as performed by the
property owner, his employees, a;ents, subcontractors or assigns.
PER:�IIT TYPE AND FEE CALCULATION
$50.04;-�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) $
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 Minnesota, and certifies that all statements made on this application are complete, true
and correct.
APPLICANT'S SIGNA'TURE. Date: ?�
O�Wi ER'S SIGNATURE: Date: Z
APPROVED BY: Date:
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