HomeMy WebLinkAbout2011-01299 - demo - CITY OF ORONO PERMIT NO.: 2011-01299
� 2750 KELLEY PARKWAY
, ORONO, MN 55356- DATE [SSUED: 10/2U2011
(952) 249-4600 FAX: (952) 249-4616
ADDIZESS : 4099 HIGHWOOD RD
PIN : 07-117-23-44-0012
LEGAL DESC : H[GHWOOD LAKE MTKA
: LOT 014 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-ACCESSORY STRUCTURE
ACTIVITY : 649-ALL OTHER BUILDING& STRUCTURES
NOTF,:
l. FOUNDATIONS/ALL DEMO DGBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. INSPGCT[ONS DONE B�FOR�BACKFILLING.
DEMOLI��ION OF GARAGE
��
AI Seran �
GRACO
Sc�n�or Enqrnee�r
Cnnlrocto�Equipment Division
GRACO MINNESOTA INC.
David A Koch Center
Phone:612 623 6902 20500 David Koch Ave
Fax:612 378 3558 Rogers,Mn 55374
aseran@graco.com Graco Inc.&Subsidiaries
MAILWG ADDRESS: P.O.Box 1441 �Minneapolis,MN 55440-1441 USA
APPLICANT
DEMOLITION -ACCESSORY STRUCTURE 50.00
BOLLIG & SONS, INC. STATE SURCHARGE DEMO 5.00
1 1401 COUNTY ROAD 3
HOPKINS, MN TOTAL SS.OG
(612)938-4433
OWNER
SERAN ll[, ALONZO
4099 HIGHWOOD RD
MOUND, MN 55364-
AGREEMENT AND SWORN STATEMENT
The�vork for��hich this permit is issucd shall be performed according to
the approved plans and specifications,applicable City approvals,and the
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 governing this type of work
shall be compied H�ith whether or not specified herein.This permit will
expire and bccome null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the Sta[e Building Code.This permit may bc
revoked tin e • e.
� _. � '� / 2 / / I
pplicant Per �itee nature Date ��� � � ��
Is: d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
. ^
�`��� City of Orono �
1 FOR [TY CISE O:�I.Y
����`� P.O.Box 66 Date Received: � Permit# �U�����
0��
���_ � 2750 Kelley Parkti�ay
��� j` *� � Crystal Bay,MN�5323 Amount: $� SAC Credit:
�
' �r�..;.c� (952)249-4600
"������ Homeowner(s)Signed: ❑ Yes
� Resolutions(if any)Signed:❑ Yes ❑None Required
"Lonin�Disclosure SiQned: ❑Yes ❑None Re uired
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Ofticial and/or Zonine Dcpartment)
Job Site/Owner Infornlation:
Type: [,� Residential ❑ Commercial
Site Address: � � �'I�l �//�f��aa� �� �'�'��� � /� �5`�� y
Owner: � L- �� ��f�/tJ Mailing Address: 5�! �
City: 0�1'�� Zip: �� ���
'L- - 2o `.� a l� IZ, �23 _ Gq� 2w
Home Phone: ��Z� �� Alternate Phone:
�'f S L ��o`� �--`7 O y��` �
Contractor/Applicant lnfonnation:
�- �
Contractor/App.: �0 I—(�t G- �; � B�'l6� Contact Person: '� R �'I �VG {-�-
Address: � � �-�' 0 ` Gov�,fL� �j State License #: �� � g`� � � �S
City: � 5 Zip: ��3�� Expiration Date:
Phone: ��� � �� g � °� 1 � _� Alternate Phone: � ( 'L � ��"1 — �O e `7
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions:
L 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 �Heavy 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
aecordance with Chapter 79, Construction Site Runoff Control.
3. Subinit a$2,000 escrow and an escrow agreement signed by the property owner.
4. Keep all structure(s) enclosed and/or secured until such time as demolition is coinplete.
5. 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.
6. Completely remove foundation(s) from the ground.
7. Completely dispose of all demolition debris off site in accordance with all applicable PCA
requirements.
8. Abandon water wells in accordance with State Health Department regulations.
9. Call for an inspection when all debris has been removed, before backfilling.
10. 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 actual�y under construction).
1l. 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.
12. 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 perforn�d by the property owner, his
employees, agents, subcontractors or assigns.
, PERMIT TYPE AND FEE CALCULATION
❑ $75.00—Principal Structure $
[�$50.00—Acc ssory Structure x�(how many)� �(�;
�
1. Subtotal of above permit requeste�l M�'� $
2. State Surcharge 5.00
''.i�c;
3. TOTAL PERMIT FEE (add lines 1-2 above) $ �_7
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.
� _� ,��
_-� �.�
Applicant's Signature: �'� Date: �O 2
Owner's Signature: � Date:
Approved By: Date: !� � Z� � � '
( ilding Official)
x Zoning Disclosure Required? ❑ YES �.NO
*This must be filled out by Zoning Department—For either answer, a Zoning Official must sign all applications.
;
* Approved By: ��/� � Date: �� �
� (Zoning Official)
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