HomeMy WebLinkAbout2015-00069 - demo _ CITY OF ORONO * z 0 1 5 - 0 0 0 6 9 �
2750 KELLEY PARKWAY DATE ISSUED: OU29/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 3926 CHERRY AVE
PIN : OS-117-23-33-0019
LEGAL DESC : CRYSTAL BAY VIEW
: LOT 000 BLOCK 004
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE
ACTIVITY : 645-S[NGLE FAMILY HOUSES(ATT&DET
NOTE:
l. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. INSPECTIONS DONE BEFORE BACKFILLING.
NOTE: A 24-48 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600.
SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUALIPIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. CHECK
TO MAKE SURE TH[S PERMIT HAS BEEN PULLED BEFORE ISSUING THIS PEMIT.
DEMOLITION OF PRINCIPAL STRUCTURE ONLY.
APPLICANT DEMOLITION - PRINCIPAL STRUCTURE 75.00
SCHERBER COMPANIES STATE SURCHARGE DEMO 5.00
11415 VALLEY DRIVE MISC FEE 0.00
ROGERS, MN 55374- TOTAL 80.00
Payment(s)
CHECK 16296 80.00
OWNER
WASHUTA,KENNETH
3926 CHERRY AVE
MOUND, MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and [he
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction au[horized is not
commenced wi[hin 180 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked a[any time for due cause.
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Ap licant Permitee Sig ture Date Issu By Signature Date
I
�O� City of Orono F R C }�YJSE ONLY 5 /�
P.O. Box 66 Date Receive� Permit#4�� � l
� 2750 Kelley Parkway �r�,�/
Crystal Bay, MN 55323 C/" Amount: $ � � SAC Credit:
(952)249-4600 l/ JJ�/
� � �n Homeowner(s)Signed: ❑Yes
�' �,� � Resolutions(if any)Signed: ❑Yes ❑None Required
`�kFSH��� Zoning Disclosure Signed: ❑Yes ❑None Re uired
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
Site Address: \, �� ����� �" � U
Owner: ��� L ����� Mailing Address:
,
City: l '(G� l.�r�- Zip:
Phone: ��� ��<�'��� � 2- Email:
Contractor/Applicant Information:
,^ , �
Contractor/App.: `��V 1-z l�✓ �� Contact Person: �f`� � "�f���
Address: 1�L��1 �'���`�-y �/ State License #: L�j�' ��-� ��
City: �` j Zip: SS�� �/' Expiration Date: ��- / - � S
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Phone: �'f �- �2- 3 i �3 Email: -Jc ��-cY,�(,.�i �.Q,���'ut; `��'�1
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 �eavy Equipment ❑ Other
Permit(s) Issued: (�Sewer Disconnection ❑ Well Abandonment#
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to:
1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which
structures are to be demolished.
2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in
accordance with Chapter 79, Construction Site Runoff Control.
3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The
City will not issue a demolition permit without a copy of the permit(s) from the MCWD or
documentation stating permit(s) are not required.
4. Submit a $2,500 escrow and an escrow agreement signed by the property owner.
5. Keep all structure(s) enclosed and/or secured until such time as demolition is complete.
6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific
prior approval is obtained in writing for temporary use thereof.
7. Completely remove foundation(s) from the ground.
8. Completely dispose of all demolition debris off site in accordance with all applicable PCA
requirements.
9. Abandon water welis in accordance with State Health Department regulations.
10. Call for an inspection when all debris has been removed, before backfiliing.
11. Within 5 working days of superstructure removal, a final inspection shall be requested. The site
shall be left clean and ciear 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).
12. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped,
crushed and filled with native soils. An inspection is required after the tanks are pumped and
before the tanks are crushed and filled.
13. 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
�$75.00 — Principal Structure $ ���`�
t_
❑ $50.00 —Accessory Structure x (how many)
1. Subtotal of above permit requested $ � S �
2. State Surcharge 5.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $
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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.
ApplicanYs Signature: �-�--,` � Date: �— ���� 5�
�
Owner's Signature: Date:
Approved By: Date: �J Z6-?'O��
(Building Official)
, N��r� ' /� � j
* Zoning Disclosure Required? ❑ YES NO �� I ������' r'��j��1 i'"� � �"l —� �� ��
"This must be filled out by Zoning Department— Fo it�nswer, a Zoning Off i�ia�must si n all applications.
* Approved By: Date:
�1�� �
(Zoning Official)
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CHERR Y __ ___ - ,, �� ;,P ,95�5� P lJ 8-117-23-3�-0019
; ADDRESS
3926CHERRY AVENUE
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________----"-��`� a i' X 25% = 6100 SF HC ALLOWED Q� �
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TR sAN uH y^i��--, 'a'' SURVEY IS SUBJECT TO CHANGE PER � �U �
�E�E° = 9`i.s iO TITLE OR EASEMENT WFORMATION � � �
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� �/1/ � VERIFY A�l DIMENSIONS AND �
�� a2;�Y�a ELEVATIONS WITH HOUSE PLANS
I�.� �= - � �yg�
I ��9ti' ,,�5 VERIPY ALL SETBACKS WITH CITY � ��
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� SOME TREES ARE SHOWN FOR REFERENCE �P"�� �
� NOT ALL TREES ARE SHOWN � �5� g
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DATE TIME '"
CITY OF ORONO CALLED IN �
INSPECTION NOTICE q SCHEDULED -- —
PERMIT NO�O/�'��D / COMPL ED
ADDRESS 3�
OWNER TELEP�/f� NO.
CONTRACTO �iti�
� DESCRIPTION �L�-�t�
ll� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
� ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANJCAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREP�ACE ❑ COMPLAINT
J � FINAI ❑ WATER HpOK-UP ❑ FOLLOW-UP
w ❑ AS BUILT-SURVEY ❑ SEWER HpOK-UP ❑ HARD COVER REMOVAL
� �J DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
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2 OWNERfCONTRACTOR TO MEET YOU:_YES�NO
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W ,. �WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
�� �CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REtNSPECTiON TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WIIL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-46��
OwnedContractoron site: �-� %i t' i� 1 E'i (`C� � ;>%�/l
Inspector. `_�L' 6
White Copyllnspector's File Canary CopylSfte Notice