HomeMy WebLinkAbout1995-006671 - demo PERMIT
CITY OF ORONO PERMIT TYPE:
! 2750�elley Parkway- P.O. Box 66 Permit Number: - � �
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Crystal Bay, Minnesota 55323 _ y. . �
(612) 473-7357 Date Issued: .°`#-_'��i
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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FOUNDATIONSI� DEMO DEBRIS TO BE REMOVED FROM GROUND AND DISPOSED OF OFF SITE PER PCA
REGULATIONS. WE.LLS MUST BE ABANDONID. YNSPECTION BEFORE BACKFIL�,ING.
CONTRACTOR: — ��;t-:;-�? _ _�., _ - OWNER:
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A PLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATUflE ��iC-
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CxTY QF ORQNQ APPLICATYGIN �'QR D$liOLITiQN PSRI�LIT
P.O.. Box 66
-Crystal. B�y, MN 55323
SPECZAL CONDITIONS & HOI�D HARMLESS AGREEMENT
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Gener�I Instructivns ��i� �
1- You may be required to obtain other pErmi�s� i.e. hurn�ng, well,
abandonmment, etc.
2 . Work must not begin unless �he permit card is availahle on th2 ]Ob
site.
3. A 24 hpur natice is required it�r a�J. insper.ti .nn�3. C.all 473-7357.
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Jo� s�� �vn�ss: �Z G v��� 'hvRC. /��
Occupancy Types ��_Residential Commercial '- -
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�WNER'S NAMR: (l�Il� �(V� ' � i Phone: � z �_ �-f ��
Mai�.a.ng Address: ' > C ty;__j`7'J-Q,e,� ��
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CONTRAC`.['b�'S Nl1ME; r • � ��'n Bus. No. ! (,p�"LI�-I Z�{JSI�o
Mailfng Address: � � ,� J City: ��,;��, �(� m S !1 j
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Demolition it plannecl by means of: manual disassembly �heavy equipment
^burn�ng (by fire department?
Permi�s Issued:
�# Burning I'ire Depar�ment
� WeZl Abandonment
zn xeturn for issuance of �aid i7emolition �ermit, the undersigned owner
hereby aqrees as �oliows:
l. The structure(s} shal]. be kep� enclased and/or secured un�il such tim�
as demo3ition is compiete.
2. Demol�t�oi1 debris will be kep� off ac��oining property and/or the
pub�i.c xights�of-way unless speca.f�.c pri�ar appraval. is ob�ain�d �.n
writing for temporary use thezeo�.
3. Foundat�ons shall be completely removed from the ground.
4. AZ 1 demolition debris shal. l be compl.etelX dispased af o�£ sit� in
accordance with aIl appl.�.cable PCA r�quirements.
5. water weils mus� be abandoned in accardanc� with State HeaZth
Department regulations.
6. Inspection required when all debx�.s has been xem�ved, be�c�ze
backfilling.
7. Wi�hfn 5 working days v� sup�rstruc�ure remova]. { a �inal. inspection
shall be requested. The sitie shall be left clean and clear of aI. l
debris, witr� any excava�ion �il.l.ed with eartih level wi�h �he adjacent
ground eleva�ion (except when such excavation is to be used as part of
a new bu�lding and such new building is actually under cons�ruction).
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8. The undersigned ownes ah�li and hezeby doe� �nc3emn�.fy and hold
, ltarm].ess th� CitX vf �zono� its a5ents� emp�.�Yees and �ss� gnR frc�m and
agains� a�1. claimsr damage�r Z��s�� or expenses, i.naluding a�torney
Fees, against the City, itfi agents. employeea and assigns ariR3.ng out
dt Oz' resu�ting from the demolit�on described herein as pezform�d hy
the prop�rtiy owner, his employ��s, agant�, suh�ontr.ac�ors or ass�.gns.
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PERMYT TY�'S AND FSE CALCULATION
$50.00 Principal structuxe x
$30. 00 Accessory Stxucture
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l. Subtotal of ahove permit x'equested $ �U�•
2 , Sta�e $urcharge $ '��
3 . TOTAL PERMZT FEE (ddd lfries 1-2 €tbOve} $ �U � ��
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the unders3.gn�d hereby appli.es ta the City o� Urona �or issuance o� a
D�mo].ition Permit, agxees to do all. work in s�rfc� sccordance with �he
o�dinances of the Gity and the regulations of the State of Minnesota, and
certifies that ali s�atemen�s m�de on this app�ication axe complet�, true
and �oxzect.
SIGNATIIRE OF AFP7��CANT ;1Lt� b a t e : (�( a
p.�� .�l(�� 11. 2�- 5Y
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