HomeMy WebLinkAbout1998-01038 - demo • �'ERMIT
'� CIT'���� ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 �-�;��i�;,i;yt_
Crystal Bay, Minnesota 55323 Permit Number: ���;,._�`;�:,
(612)473-7357 Date Issued: - -
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APPLICANTiPERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO APPLICATION FOR DEMOLITION PER�ti1IT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 5�323
SPECL�L CONDITIONS & HOLD HA.Ril�1LESS AGREEIZEN�T'
General Instructions
1. You may be required to obtain other permits, i.e. burnin�, well abandonmaient, etc.
2. �Iork must not be�in unless the permit card is available on the job site.
;. A 24 hour nocice is required for all inspec�ions. Call 473-7357.
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JOB SIfiE ADDRESS: ;� =.=5-" �' �`��- �'.
Occupancy Type: �_Residential Commercial
Otii�'ER'S NQ1.itiIE: ,,� ,���, �. �. �
�_ ,��� ,i Phone: �/ %'� � 3 I%�
Mailin� �ddress._ j�:��, C�'N'�,r G�r'°,,�T l<� � —
Ciry: n,�'G^���,~,
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COi�1'T'RACTOR'S �'A112E. _ -' , ,f'" `- ` BuS. NO. ��I - I� < �
� • � City: �� �'c,b-,; k�rkK
Mailing Address: •- ;'� ;�,��%�'�k' S�" '1 T� `- -
Demolition if planned by means of: manual disassembly
� heavy equipment
burnin� (by fire department)
Permits Issued:
# )3urning Fire Department
# Well Abandonment
In return for issuance of said Demolition Permit, the undersi�ned 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 kep[ off adjouun� property and/or the public rights-of-way
unless specific prior approval is obtained in writin° for temporary use thereof.
3. Foundations shall be completely removed from the ground.
4, AlI 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 reo lations.
. 6, Inspection required when all debris has been removed, before bac�'�llin�.
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7• Within 5 workin� days of superscructure removal, a final inspection shall be requested.
The site shall be left clean and clear of all debris, wi t h any excavation filled with earth
level �vith the adjacent around elevation (except when such excavation is to be used as
part of a new buiIdin� and such new buildin� is actually under construction).
8. The undersigned owner shall and hereby does indemnify and hold harmless the City of
� Orono, ics aaents, employees and assi�ns from and aQainst all claims, dama?es, losses
or erpenses, includin� attorney fees, against the Ciry, its aaents, employees and assi�ns
arisin� out of or resultin� from the demolition described herein as performed by the
property ocvner, his employees, a�ents, subcontractors or assijns.
PERI�IIT TYPE AND FEE CALCULATION
�50.00 ='Principal Structure
�30.00 - Accessory Scructure
1. Subtotal of above permit requested �
2. State Surcharge $ .50
3. TOTAL PERiv1IT FEE (add lines 1-2 above) �
The undersigned hereby applies to the City of Orono for issuance of a Demolition Permit, agrees
to do aIl work in strict accordance with the ordinances of the City and the re;�ulations of the
Sta.te of Minnesota, and cercifies that all statements made on this applieation are complete, true
and correc[.
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APPLICANr S SiGi�'ATURE: y,.� �- Date: -; - F"? -- ��
OtiYNER'S SIGNATURE: ,�'�< < :.<<t.. � >>lt � c; , .-'
- � ��-� Date: �r r-/�' —l,�.
A.PPROVED BY• � , Date: Ca _ � � � ��