HomeMy WebLinkAbout1997-009434 - demo �, PERMIT
' CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 - _ --
Crystal Bay, Minnesota 55323 Permit Number:
(612)473-7357 Date Issued:
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: - , : _ - � OWNER:
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APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE �i�r-.l�C(
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CITY OF ORONO APPLICATION FOR DEI�iOLITTON P`ER�ti1IT
P.O. Box 66 (2750 Kelley Parkway) �
Crystal Bay, ivlN 5�323 ;.,v'r' I � �i��i
SPECLAL CONDITIONS & HOLD HAR�TLESS AGREEI�f��"T
General Instructions
l. You may be required to obtain other permits, i.e. burnin�, well abandonmment, 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.
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JOB SITE ADDRESS: L :�'�c:�'C.�� j ;'�%'t�r r''✓. I'r`����R�� �.G . —'C�f�,� ���/i
Occupancy Type: � Residential Commercial
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Oti"vitiTER'S N���• �N�� '�fic��G f��� , �'�. Phone: �;�'�t�� �`��,Y-
Mailin� Address:��7 �.� ��vi��4:f= �CG. Ciry: ;"-�Tu2� �� 3�%
CON'I'RACTOR'S NAi1�:
i,�ES gEN,�r�-t���r�� Bus. No.: `�ic"7'1 - ((�i' '\�
Mailing Address: l�?�0S /��Y tZ ,'�ni��p���F�+>(.� City: �n(���'f��`nr��
Demolition if planned by means of: manual disassembly
k' 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 structure(s) shall be kept enclosed and/or secured until such time as demolition is
complete.
2. Demolition debris will be kept off adjoinina 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 backfillin�.
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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 ear[h
level with the adjacent �round 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 Ciry of
Orono, its aQenu, employees and assi�ns from and agai.nst all claims, dama�es, losses
or erpenses,yincludin� attomey fees, against the Ciry, its agents, employees and assi�ns
arisin� out of or resulting from the demolition described herein as performed by the
properry owner, his employees, ajents, subcontractors or assi?ns.
PER1tiIIT TYPE AND FEE CALCULATION
�50.00 =�Principal Structure
x $30.00 - Accessory Structure
1. Subtotal of above permit requested � �� ,Q p
2. State Surcharge $ .50
3. TOTAL PERI�IIT FEE (add lines 1-2 above) � .jU. �v
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.
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APPLICAIVT'S SIG�'A � - Date: q 1`9 9�
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OWNER'S SIGNATURE: � " 7 , �. Date: '7//9��,
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A.PPROVED BY: ' Date: "1 - �`� -`i�
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