HomeMy WebLinkAbout2017-01110 - demo •
CITY OF ORONO 1 I 1111111111111111111111111111111111111111111
* 2 0 1 7 — 0 1 1 1 0 *
2750 KELLEY PARKWAY DATE ISSUED: 09/22/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 2625 KELLY AVE
PIN : 20-117-23-14-0026
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 000 BLOCK 005
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE
ACTIVITY : 645-SINGLE FAMILY HOUSES(ATT&DET
NOTE:
1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. INSPECTIONS DONE BEFORE BACKFILLING.
NOTE: A 24-48 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600.
SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUALIFIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. CHECK
TO MAKE SURE THIS PERMIT HAS BEEN PULLED BEFORE ISSUING THIS PERMIT.
APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 75.00
STATE SURCHARGE DEMO 1.00
J S STEWART COMPANIES,INC. TOTAL 76.00
11030 LAMONT AVE NE
Payment(s)
HANOVER,MN 55341 CHECK 7934 76.00
Minnesota State License#: sept-L703
OWNER
ELLEN REDMOND REVOC TRUST
2625 KELLY AVE
EXCELSIOR,MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
013 P-C)/( \
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Applicant Permitee Signature Date Issued 4ignature Date
A' City of Orono 4),,/f_T USEONLY�Of VPO.Box 66 Date Recei Permit#�/7-4/J/1)
0 2750 Kelley Parkway
Crystal Bay,MN 55323 Amount: $7‘9•117 SAC Credit:
(952)249-4600
.� �,
Homeowner(s)Signed: ❑Yes
yF �� Resolutions(if any)Signed:0 Yes 0 None Required
�gkESHOR� Zoning Disclosure Signed: 0 Yes 0 None Required
CITY OF ORONO - DEMOLITION PERMIT 0 -( - /11
(All permits must be approved by the Building Official and/or Zoning Department) _,,,e./�'
Cliit
Job Site I Owner Information: W
Type: [g] Residential J E] Commercial
Site Address: Z(v Z 5 )61/j 4 YL ZYbvtO
Owner: I(P.UI I<LyvtOY1,t Mailing Address: Z(v Z s J/ L i'7ve_
City: inOnD Zip: 5533i
Phone: (0 I Z. ?(oO 42-(c (c. Email: J I ekt @ -Q'.a (C.S S? ati , 66
Contractor tApplicant Information:
Contractor/App.: d S S1t vO- - £o. I etc_ Contact Person: •-r-retc-ei U4s� 1
Address: 1 ID o ketkvw r.& rkt VE State License#: J
City: 1Q,R01/e- Zip: SS 3L1 I Expiration Date:
•
Phone: `7(,'3 Ltl' ' D 30 Email: i AA-0,191 S -e t„)Gc.A-� I Cowin
SPECIAL CONDITIONS &HOLD HARMLESS AGREEMENT
General Instructions:
1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc.
2. Work must not begin unless the permit card is available on the job site.
3. A 24-48 hour notice is required for all inspections. Call (952)249-4600.
4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued.
Demolition by means of: ❑ Manual Disassembly DA Heavy Equipment ❑ Other
Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandonment#
In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to:
1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which structures are
to be demolished.
2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in accordance with
Chapter 79, Construction Site Runoff Control.
3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will
not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating
permit(s)are not required.
Form Last Updated: July 2015 ci
150784
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4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached). i
5. Keep all structure(s)enclosed and/or secured until such time as demolition is complete.
6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific prior
approval is obtained in writing for temporary use thereof.
7. Completely remove foundation(s)from the ground.
8. Completely dispose of all demolition debris off site in accordance with all applicable PCA requirements.
9. Abandon water wells in accordance with State Health Department regulations.
10. Call for an inspection when all debris has been removed, before backfilling.
11. Within 5 working 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 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).
12. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped, crushed
and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are
crushed and filled.
13. 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
n $75.00 — Principal Structure $ 7S---00
❑ $50.00 —Accessory Structure x (how many)
1. Subtotal of above permit requested $
2. State Surcharge 1.00
c1)
3. TOTAL PERMIT FEE (add lines 1-2 above) $ -7(P
The undersigned herby applies to the City of Orono for issuance of a Demolition Permit, agrees to do
all the work in a 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.
q_ _ ,
Applicant's Signature: AWA
_ Date:
lirOwner's Signature: arMu� /p Date: 9 - --. 1 7
Approved By: .dirl ,� , 9 Oficial)
i
irlir AtDate: ?/A `
=uildin "
*Zoning Disclosure Required? ❑ YES NO 201 . -O 10l 5
*This must be filled out by Zoning Department-For e' er answer, a Zoning Official must�sign all applications.
*Approved By: CA 1 Date: "t
on ng Official)
Form Last Updated: July 2015
150784
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