HomeMy WebLinkAbout1995-007100 - demo -
P�,R�VIIT
�ITY OF ORONO PERMIT TYPE:
2�50 Kelley Parkway- P.O. Box 66 - -
Crystal Bay, Minnesota 55323 Permit Number: _
(E12) 473-7357 Date Issued: ,
51TE ADDRESS:
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DESCRIPTION:
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F�PPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
•�r •
CITY OF ORONO �' � APPLICATION FOR DEMOLITION PERMIT
P.O. Box 66
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
**********�t***#***********�*****�**�***********���*�****t�***t���*****�**
General Instructions
1. You may be required to obtain other permits, i.e. burning, well.
abandonmment, etc.
2 . Work must not begin unless the permit card is available on the job
site.
3. A 24 hour notice is required for all inspections. Call 473-7357.
***�*�**#**:***********#*�**********t******�*******�*�**�*****�****���*�***
JOB SIT$ ADDRESS:
Occupancy Type: Residential Commercial
OWNER'S NAME: �L s�Rr4-A/ Phone: �f 7l-�7 ° , SS7-y�0
Mailing Address: o9g �{����✓op� City: hra�•�✓,� �r.J
CONTRACTOR'S NAME: $oLT �✓t.�� ���-y�o[,iT/s�./ Bus. No. : �/yg -y7��
Mailing Address: i�,r�s C�,r,-�, ,ZjJ �{� City: �it,L,/�- •yr SS.3/�'
*******��***��:**:*:******* *�**�r*****�***�********�**�*�**:**���****�***�*
Demolition if planned by means of: �manual disassembly �heavy equipment
burning (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:
l. The structure(s) shall be kept enclosed and/or secured until such time
as demolition is complete.
2 . Demolition debris will be kept off adjoining 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
f ees, against the City, its agents, employees and assigns arising out
of or resulting f rom the demolition described herein as performed by
the property owner, his employees, agents, subcontractors or assigns.
�**:*****�***�******t****�*****�*t���t�***�**�***�**�*�***�*����***t**:****
PERMIT TYPE AND FEE CALCIILATION
$50 . 00 Principal Structure .�
$30 .00 Accessory Structure
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l. Subtotal of above permit requested $ v
2. State Surcharge $ .50
O `_�
3. TOTAL PERMIT FEE (add lines 1-2 above) $ �
***********�*�*******�**�***********�*:*****�***�**�****�**�***�****�****t*
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.
SIGNATURE OF APPLICANT: �
� Date: (% � / S
� '� ~`� �
�,<< � �ss U-e-
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DATE �'
}71ME
CITY OF ORONO CALLED IN j — — __
INSPECTION N TICE sCHE�u�Eb t
PERMIT NO. v� COMPLETED _—��1=�Q
ADDRESS �� � � W� �� ^`� �
OWNER CONTR.
TELEPHONE NO.
� FOOTING ❑ PLUMBING Fil ❑ SITE INSPECTION
J FRAMING ❑ PLUMBING FINAL ❑ EXCAV./GRADING/FILLING
� ❑ INSULATION ❑ MECHANICAL ❑ LAKESHORE/WETLANDS
� ❑ WALL 8D. ❑ WATER HOOKUP ❑ LICENSING
lt� ❑ FINAL ❑ METER SET/TURN ON O COMPLAINT
� � PROGRESS t7 SEWER HOOKUP ❑ FOLLOW-UP
� ❑ DEMOL. ❑ SEPTIC INSTALL. ❑ SEPTIC FINAL
Q O FIRE PREV. ❑ SEPTIC MAINT. ❑ FIREPLACE/WOOD BURNER
� ❑ WELL TEST PUMP ❑
� COMMENTS:
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W � WORK SATISFACTORY:PROCEED O PHOTO TAKEN
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p ❑ CORRECT WORK 8 PROCEED
V , CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
- CORRECT UNSAFE CONDITION WITHIN HOURS INSPECTOR WILL RETURN.
�STOP ORDER POSTED.CALL INSPECTOR.
INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
Owner/Contr. on site
Inspector `�u� � 473-7357
White llnspector's File Canary/Site Notice