HomeMy WebLinkAbout1995-007322 - demo gas sttion � , � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _ �;��;_;���_:-
Crystal Bay, Minnesota 55323 Permit Number: _ ,
(612)473-7357 Date Issued: ;_�:r�:;;-;;;.i.a=
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE �'� ISSUED BY:SIGNATURE
I � � , I eer�i�s ie:e� THE CITY OF OROFJO 612-473-'T357 e02
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CITY OF URONO A�'PLICAT�UN FOR DEMOI.iTinN PERMIT
P.O. Box 66 (2750 Kclley Parkway)
Crystal Bay, MN 55323
SPECIAL COND�'TiONS & HOLD I�[A�tMLFSS AGREEMENT
General Instructions well abandonmment, etc.
i. You may be requircd to vbtain othcr pernilcs, i.e. burning,
2, Work must nOt begin unless the permit card is availabte on the jab site.
3. A 24 hour notice Is reyuired for all inspections. Cail 473-7357.
JOB SITE ADDItESS: 3�!$ `1(_ ►�.�7n S H��
Occupancy '�'ype: �Kesidential �,�Commercial �
OWNER'S NAME: `��2 • Pho�: 297—Z4'!� . �
Mailuig�Address: k�*— �
,,o,� City: .Sr•-P � w�h -r�5/bto �
CONTRAG70R'S NAME:, ��rr r� ���`� Bus. Na 928?.?��--
Mailir►g; Addmss:�{ �000 ll�+' �1.4'c� - City:�t�f,rt�,n 5 `/
Demvii�on if planned by mr,ui�s of: msnuai disassembly
heavy cquipment
; � burning (by fire department)
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Permitsj Issued:
� Burning Fire Aepartment .
� Wcil Abandonment
I In retucln for issuance of said Demolition Permit, the wndersigned owncr heraby agrees as
foIlows�
1. The swcture(s) shall be kept enclosed and/or securcd until such time �s demolition is
� compYete.
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2, Demolition debris will be kept off adJoining property and/or thc public rights-of-way
� . uniess specific prior approval is obtained 'w writin8 for tempvrury use thcreof.
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3. Foundatiuns sl�all bc comptctcly removed from the �round.
; 4. All demolition debris shatl be completeay disposed of off site in aecordaace with all
applicable PCA requircments.
I I� 5, Water wells must be abandoned in accordance w9th State Health Department regulations.
6. lnspection requircd whCn all debria has been removed, before backfilling. ;
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` � � ► 08i31 i95 10:07 TFE C I TY OF OftOrlO 612-473-'i 57 603
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7. Withiz� 5 working days of supersuuctun r�m�+s�+ a �� inspection shall be requested.
The site shall be left clean and clear of all debris, with any excavation�illed with eanh
1eve1 with rhe adjacent ground elevot�on (cxcept whcn Buch excavation �s to be used as
part nf a new building and such new building is actually under construchon).
$. Thc undersigned owner shail and hereby does indemnify and hold hart�iless the City of
Orono, its agents, employees and assigns from and against all claims, dama�es. losses
or expenses, including attorney fees, �gainst thc City, its agents, cmplo�ees and asaigns
arising out of or resulting from the demolition descrlbed herein as perfozmed by the
property �wner, his employees, agents, subcontractors or assigns. i
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pE�I1'1' TypE AND FF•E CALCULATION �
$50.00 - Principa! Structure '
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$30.00 - Accessory Structure '
f. Subtotal of above permit r�quested $
2. Srate Surcharge
$ ' -5�
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3. TO?AL P�ItMIT FEE (add lines 1-2 above) $ �
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The undecsigned hereby applies to the CIry of Orono for issuanc:�of a Demolitio Pcrimit, agrees j
to do all work in suict accordance with the ordinances of the City and thc regulations of the
State of Minz�esota, and ce�ti�es that aIl statements made on this applicadon are complete, true �
and correct.
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A.pPLICANT'S SIGNATU�tE• � Date:
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OWNE�t'S SICNATURE: Uate:., i
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APPROVED BY: Date: �
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