HomeMy WebLinkAbout1998-009998 - demo PERMIT
CITY OF ORONO PERMIT TYPE:
27� KeJl�y Parkway- P.O. Box 66 k��_�I�.C�I i���
Cry�tal Bay, Minnesota 55323 Permit Number: � -,
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(612) 473-7357 Date Issued: - - • � �„,
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNAT E
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�CIT�' OF ORONO APPLICATION FOR DEMOLITION PER�tiiIT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, ivlN 5�323
SPECLAL CONDITIONS & HOLD HARtiTI.ESS AGREEI�IE\TT
General Instructions
1. You may be required to obtain other permits, i.e. burnin�, well abandonmment, etc.
2. �7ork must not be�in unless the permit card is available on the job site.
3. A 24 hour notice is required for all inspeccions. Call 473-7357.
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JOB SITE ADDRESS: ��f 3 <�- �ti� � '' �_ `� �=�
Occupancy Type: �_Residential Commercial
Oti�'ER'S NQutiIE: \' ei �.� �.�z Phone: �/ 7��" ��Y(
Mailin� Address: ��y�°; �� .�h..�r� �v� Ciry: �^�:r�L'
CONT'KACTOR'S NAl1�• Bus. No.:
Mailing Address: City:
Demolition if planned by means of: � manual disassembly
heavy equipment
burnin� (by fire department)
Permits Issued:
# Bunung Fire Department
# N� Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner hereby a?rees as
follows:
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 writin� for temporary use thereof.
3. r . i� .L.v �.,. _t�,.,.�, ...r..�arl frnrn thP v_r1111IId; �t'- F�)t-4-j"��Llv�, r�l'� �3/ .
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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 re?ulations.
6. Inspection required when all debris has been removed, before bacl�"�ilin�.
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7. Within 5 workin� 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 �vith the adjacent ground elevation (except when such excavation is to be used as
par[ of a new buildin� and such new buildin� is actually under construction).
8. The undersi�ned owner shall and hereby does indemnify and hold harmless the City of
� Orono, its aaents, employees and assigns from and a�ainst all claims, dama�es, losses
or espenses, incIudin� attorney fees, against the Ciry, its aQents, employees and assi�ns
arisin� out of or resultin� from the demolition described herein as performed by the
propeny owner, his employees, ajents, subcontractors or assigns.
PERII�IIT TYPE AND FEE CALCULATION
_�c �50.00 =�Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $
2. State Surchar?e $ .50
3. TOTAL PERi�1IT FEE (add Iines 1-2 above) �
The undersigned hereby applies to the City of Orono for issuance of a Demolition Permit, agrees
to do all work in stric[ accordance with the ordinances of the City and the regulations of the
State of Miruiesota, and certifies that all statements made on this application are complete, true
and correct.
APPLICAN'f'S SIG�'AT'CTRE: Date:
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Oti�iYER'S SIGNATCTRE: ����'�-� ' % �� Date: "� i.��, ;� ,��
APPROVED BY: Date: � - �-r t�
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