HomeMy WebLinkAbout1991-003524 - demo I �'ERMI�'
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` Crystal Bay, Minnesota 55323 Date Issued: i:i�.i 1 c��'�1
;�12) 473-7357
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AP LICANT/PERMIT SIGNATURE ISSUED BY:SIGNATURE ,.
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CITY OF ORONO APPLICATION FOR D$MOLITION PERMIT
P.O. Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
**************�**##****:*:#t***:�*******#***:******t*�#:#:****�**##:�*�*#�
General Instructions
1. You may be required to obtain other permits, i.e. burning, we 11
abandonmment, etc.
2. Work must not begin unless the permit card is available on the job
site.
3. All work must be inspected before it is covered. Call 473-7357.
- 24 HODR NOTICB IS RBQIIIRED -
�**********�****:*****t*******#****�*: **** *�#*********�:********#*�******
JOB SITE ADDRESS: „2� �6 /Y� �K.,�p ��t.�..i
Occupancy Type: A(' Residential Commercial
OWNER'S NAI�Il�: �Q s; .�..,. Q �.,Ir� �G,�,(�C, Phone:
Mailing Address: City:
CONTRACTOR'S NAI�: S� Bus. No. : �- 7� 7
Mailing Address: "' '� City: S"1:?l�
*�********#****** ***�***: :********��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:
1. The structure(s) shall be kept enclosed and 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. All demolition debris will be completely disposed of of£ site in an
approved landfill and in accordance with all applicable PCA
requirements (including foundation).
4. Upon completion, and within 5 working days of superstructure removal,
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.
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5. The undersigned owner shall and hereby does indemnify and hold
harmless the City of Orono, the City Council , and the agents and
employees of the City from and against all claims, damages, losses or
expenses, including attorney fees, which the City, City Council and
agents and employees of the City may suffer or for which it amy be
held liable arising out of or resulting from the assertion against
them of any claims, debts or obligations in consequence of the
demolition described herein as performed by the property owner, his
emp loyees, agents or subcontractors, whether or not caused in part by
a part indemnified hereunder.
**�*:*:**:*�***t**::*:�***�*�******�************:*****:�*:#****�*�:********
PERMIT TYPE AND FEE CAI.CULATION
$50.00 Principal Structure
$30. 00 Accessory Structure
l. Subtotal of above permit requested S
2. State Surcharge $ .50
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.
SIGNATIIRB OF APPLICANT: � Date: � ���7�0