HomeMy WebLinkAbout2004-P07931 - demo PERMIT
CITY OF ORONO Permit Number:
2750 Kelley parkway - PO Box 66 P07931
Crysta��3ay, Minnesota 55323 Permit Type: Demotition
(952) 249-4600 Date Issued: 9�1�i2oo4
SITE ADDRESS: 3407 Eastlake St
L.ong Lake,MN 55356
PID: OS-117-23-13-0035
DESCRIPTION:
Proposed Use: Residential
Pernut Class: Building Census Code 645
Permit Type: Demolition Permit Sub-type(s): Demo-Pnncipal Structure
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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m zst be abondoned. Insnecrion before backfilline.
FEE SUMMARY: Permit Fee: $ 80.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 80.50
APPLICANT: Rebecca Holzem OWNER: Rebecca Holzem
3407 Eastlake St 3407 Eastlake St
Long Lake MN 55356 Long Lake MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATU ISSUED BY SIGNATURE
Cooies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
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CIT 5�' OF ORONO APPLICATION FOR DEMOLITION PERMIT
r P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions
1. You may be required to obtain other permits, i.e. well abandonminent, etc.
2. Work inust not begin unless the perinit card is available on the job site.
3. A 24 hour notice is required for all inspections. Call (612) 249-4600.
JOB SITE ADDRESS: c���'� �C��� �c��ie_. ��''z�_f
Occupancy Type: ' Residential Commercial
OWNER'S NAME: 1`��-�-ec�c`� L � �-'�Z��'� Phone: �I a, . �O I - 1 I`�'C�
Mailing Address: 3�C.�1 CCc�S� �a-�e.- S-E-ve e f City: �C'��c�-� v
CONTRACTOR'SNAME: C�:.►'re--`'{"�-�v�f��+z���� I��cLs Bus.No.:
Mailing Address: City:
Demolition if planned by means of: manual disassembly
G� heavy equipment
Permits Issued:
# 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 adj oining 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. 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.
9. Septic systems must be abandoned per Minnesota Rules Chapter 7080. All septic tanks must
be puinped,crushed and filled with native soils. An inspection is required after the tanks are
pumped and before the tazzlcs are crushed and filled.
PERMIT TYPE AND FEE CALCULATION
`� $50.00 - Principal Structure
�� $30.00 - Accessory Structure
1. Subtotal of above pennit requested $ �U . � D
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 aUove) $ �� • � �
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.
APPLICANT'S SIGNATURE: ���-�-� ' � Date: �`�i � �� �C��'
OWNER'S SIGNATURE: �-�-�-cc�� . Date: a" � �� � C��—
APPROVED BY: ��,Po �)vt,a,,,_ Date: °► - � � - �`'�