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HomeMy WebLinkAbout2006-P10560 - demo PERMIT CITY O RONO 2750 Kelley Parkway- PO Box 66 Permit Number: p10560 Crystal Bay, Minnesota 55323 Permit Type: Demolition (952) 249-4600 Date Issued: 11/14/2006 SITE ADDRESS: 95 Leaf St Unit# Long Lake,MN 55356 PID: OS-117-23-11-0005 DESCRIPTION: Proposed Use: Residenrial Census Code 649 Permit Class: Building Permit Type: Demolirion Permit Sub-type(s): Demo-Accessory Structure DETAILS: Approved per resolution#: ` Separate permits required: NOTICES/REMARKS: Foundations/all demo debris to be removed from ground&disposed of off site per PCA regularions. Wells must be abondoned. Inspection before bac�lling. FEE SUMMARY: Permit Fee: $ 30.00 valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 30.50 APPLICANT: Owner/Self OWNER: E C Graham 7r MN 95 Leaf St Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � ���� . APPLICANT PERMITEE SIGNATURE UED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, I-Assessing,(If Septic, 1-Septic) Page 1 � l CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT P.O. Box 66 (2750 Kelley Parkway) Crystal Bay,MN 55323 SPECIAL CONDITIONS &HOLD HARMLESS AGREEMENT General Instructions 1. You may be required to obtaiu other permits, i.e. well abandonment, etc. 2. Work must not begin unless the permit card is available oii the job site. 3. A 24 hour notice is required for all inspections. Call(952) 249-4600. JOB SITE ADDRESS: � -S �-e'� � S �- Occupancy Type: � Resideiitial Commercial OWNER'SNAME: Ed ►'h u n�l Gra ��m Phone: � I 2- � 6�.-��`�O Mailing Address: �9 0 9 R �u ce ��e City: �d��4 CDI�TRAC'TOR'S NAIVIE: 6 �✓ h e r' Bus.No.: Mailing Address: City: Demolition if planned by means of: � manual disassembly heavy equipment Pemiits Issued: # Well Abandonment In return for issuance of said Demolition Peimit,the undersigned owner hereby agrees as follows: 1. The struciure(s) shall be kept enclosed aiid/or sectued until such time as demolition is complete. 2. Demolition debris�vill be kept off adjoiizing 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 witli State Health Department regulations. 6. Se�ver and water nrust be discomiected at the services at the street by qualified contractors. 7. Inspection required when all debris has been removed,before backfillin�. � . ' 8. 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 iiew building and such new building is acti.ially under construction). 9. The undersigned owner sliall and hereby does indemnify and hold hannless the Ciry 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 perfonned by the property owner, his employees, agents, subcontractors or assigns. 10. Septic systems must be abandoned per Minnesota Rules Chapter 7080. All septic taiilcs inust be pumped,crushed and filled witl�native soils. An inspection is required after the taulcs are pumped and before the tanks are cnished and filled. PERMIT TYPE AND FEE CALCULATION $50.00 - Principal Structure x $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 Oroizo for issuance of a Demolitioii Permit,agrees to do all work in strict accordance with the ordiiiances of tlle City and the regulations of the State of Minnesota,and certifies that all statements made on this application are complete,true and correct. APPLICANT'SSIGNATURE: � Date: ��� !'f / OG OWNElZ'S SIGNA'I'U�: �-�"�,�,.J � Date:�! � � �� APPROVED�Y: Date: ��'�y 'v�6 ( uilding Ofticial) *ZONIIVG DISCLOS�JfltE 1�EQiJI1tEI)`? ❑ �'ES !�N� * This Must Be Filled Out By Zoning Department - For Either Answ�r, A Zoning Official Must Sign All Applications *APPRO�d)�Y: Date: (Zonin�Officialj Reset Form