HomeMy WebLinkAbout1999-011592 - principal structure demo PERMIT
CITY OF ORONO PERMIT TYPE:
�/�0 Kelley Parkway- P.O. Box 66 w:;;;�L;:;��:;
- Crystal Bay, Minnesota 55323 Permit Number: ::s� i��:-��
� (612) 473-7357 Date Issued: �yj�. _ . _ _
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APPLICANTPERMITEESIGNATURE ISSUEDBY SIGNATURE
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' CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT
P.O. Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
General Instructions
1. You may be required to obtain other permits, i.e. 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 (612) 249-4600.
JOB srrE anv�ss: ��� �►� L,�d� AUe..
Occupancy Type: �Residential Commercial
OWNER'S NAME: �; �;aw� �./. $oclC,mnr, Phone: �17L- �//��
Mailing Address: /29d Low�a L�K Avt. City: /1'Jound
CONTRACTOR'SNAME: wo d���,fs �kcr.���c,� Bus. No.: 6(a�36 -QS 3
Mailing Address: 8�3 6 (C�n,,(o�(( �. City.�'�e� �;�;e ,M•�
Demolition if planned by means of: manual disassembly
�_heavy equipment
Permits Issued:
# � 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 public rights-of-way unless
specific prior approval is 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 all
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.
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7. Within 5 working days of superstructure removal, a final inspection shall be requested. The
site sha11 be left clean and clear of a11 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.
PERMIT TYPE AND FEE CALCULATION
� $50.00 -Principal Structure
$30.00 - Accessory Structure
1. Subtotal of above permit requested $ 5�'
2. State Surcharge $ .50
3. TOTAL PERMIT FEE (add lines 1-2 above) $ SO• Sv
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 conect.
APPLICANT'S SIGNATURE: Date:�—a 3��
OWNER'S SIGNATLTRE:���?�' Date: ��Z��`�
APPROVED BY: Date: 6 • Z 3 "�5