HomeMy WebLinkAbout1992-004594 - demo ,
PERMIT
� CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: �;tj������'
Crystal Bay, Minnesota 55323 Date Issued: iy:�;/iF,{��
(612) 473-7357
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT% ERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR DffiKOLITION Pffi2MIT
P.O. Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
� SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
**************��*�*�*�*******�**:****�*�******************�*�****::*******
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��*******:***:****:t**#****#�****�***:t**t*:::***t****:**:***�*t**
JOB SITS ADDRESS: / ,� .: � �-' l � Z� � �< ;,`���� /�z �'�
Occupancy Type: Residential Commercia
OWNER'S NAME: av �t�'�% Phone: ���v-- �l��S �
Mailing Address: i� e City: � ;�
/nh
CONTRACTOR'S NAME: C�/���'' Bus. No. :
Mailing Address: City:
**#**#t*�*�t*******:::***:t*��******:*�*******************:*:***:*f*****:**
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
pub 1 i c rights-of-way un 1 es s specif i c prior approva 1 i s 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 al 1 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 �Ieft 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
fees, against the City, its agents, employees and assigns arising out
of or resulting from the demolition described herein as performed by
the property owner, his employees, agents, subcontractors or assigns.
t**�*�t*�*�*********�**::*:::**:�*�*::�:**:*��***::***��**�::*:�*#:##:***:*
_ _ ..... PffitlrilT.�TYPB AND FSS� CALCQLATION- -.-.:.�.._ ::. .-:,.-_�..- :..,� -....-
' $50. 00 Principal Structure
$30.00 Accessory Structure
1. Subtotal of above permit requested S
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $
*:*********�*�*�****�*��*****�*:********��****�*t*�******::*************s**
the undersigned hereby applies to the City of Orono f or 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. �
` :8 2�� �
SIGNATURS OF APPLICANT: � Date l