HomeMy WebLinkAbout1999-011159 - demo PERMIT
�1TY OF ORONO PERMIT TYPE:
���0 Kelley Parkway- P.O. Box 66 `.;''�`�_;.:: ; ""�:
Crystal Bay, Minnesota 55323 Permit Number: :,�_ �_��..��v�
(612) 473-7357 Date Issued: - - -. ��--
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APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE -�'" �
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CITY OF ORONO APPLICATION FOR DEMOLITION PER�tiiIT �
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, �IN 5�323 -
SPECL4L CO�tDITIONS & HOLD HARi�ILESS AGREE_l�\TT ,
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General Instructions �
1. You may be required to obtain other permits, i.e. burning, well abandonmment, etc.
2. `Vork 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.
JOB SITE ADDRESS: 'J� r �l l v ��-� �l. � v r V1� �
Occu anc T e: Residential ommercial `7� 3��
P Y YP �,�
Oti��ER'S NQu�1E:��D r�.�� a � C_ I,t�r,��� ���� 1� �c�-�e�: Phone:
Mailin� Address: ��S t� k -� ���, 1��� _ City: � � � � t�„ �� r- V1�� .
�5 �-� 33I
� Bus. No.: �,��� �l -���p t��
COr"ITR.ACTOR S NANIE: �, E°�-�5� .; �Y� -���� ; � ,._
Nlailing Address: City: -�; ;,;�, ,� ��_
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Demolition if planned by means of: manual disassembly �
heavy equipment '
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�burnin� (by fire department) �
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Permits Issued: �i
# Burnina Fire Department (
# Well Abandonment �
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as
follows:
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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 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 wi� ali �
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 backf'�lling.
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' 7. Within � workin� days of superstructure removal, a final inspection shall be requested.
The site shall be lef[ clean and clear of all debris, with any excavation filled with earth =
level with the adjacent Qround 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 undersi�ned owner shall and hereby does indemnify and hold harmless the Ciry of
Orono, its agents, employees and assigns from and a�ainst all claims, damages, losses
or expenses, including attorney fees, against the City, its a�ents, employees and assi�ns
arisin� out of or resultin' from the demolition described herein as performed by the
property owner, his employees, ajents, subcontractors or assigns.
PER�tiIIT TYPE AND FEE CALCULATION
�� �50.00 =�Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $
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 rewlations of the
State of Minnesota, and certifies that all statements made on this application are complete, true
and correct.
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APPLICANT'S SIGi�'ATU�ZE: ,` , ,�`.�,� ���-,� _ z, Date: � -j�- t 9'-
OWNER'S SIGNATLTRE� � - "
C 2 C� �✓.,���'�-� Date: �-/� - l �i
APPROVED BY: Date: ! - � Z �`j