HomeMy WebLinkAbout2016-01346 - demo CITY OF ORONO * 20 1 6 - 0 1 346 *
2750 KELLEY PARKWAY DATE ISSUED: 10/25/2016
ORONO, MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 585 ORCHARD PARK RD
PIN : 31-118-23-14-0001
LEGAL DESC : UNPLATTED 31 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DEMO-ACCESSORY STRUCTURE
ACTIVITY : 649-ALL OTHER BUILDING&STRUCTURES
NOTE:
1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. INSPECTIONS DONE BEFORE BACKFILLING.
ORIGINAL HOUSE TO REMAIN DURING CONSTRUCTION. THIS DEMOLITION IS FOR TWO ACCESSORY BUIDLINGS.
APPLICANT DEMOLITION-ACCESSORY STRUCTURE 100.00
STATE SURCHARGE DEMO 1.00
TJB HOMES INC TOTAL 101.00
9100 BALTIMORE STREET NE Payment(s)
SUITE#102 CHECK 056603 101.00
BLAINE,MN 55449-
(763)780-2944
Minnesota State License#:BUIL-1845
OWNER
THOMAS,DONALL&HENRIETA
585 ORCHARD PARK RD
LONG LAKE,MN 55356-
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 ith the State Building Code.This permit may be
revoked at any time for e cause.
/6 //�
/plic Permitee Signature Date Issued By Signature Date
OCity. of Orono o c,�USE ONLY
P.O.Box 66 Date Receivedr!� /I /(� Permit it ��6,-6046
Q 2750 Kelley Parkway
Crystal Bay,MN 55323 Amount: $ l• DI' SAC Credit:
(952)249-4600 y
Homeowner(s)Signed: ❑Yes
�E Resolutions(if any)Signed:❑Yes ❑None Required
4��$HOZoning Disclosure Signed: 0 Yes 0 None Required
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Type: Residential ❑ Commercial
Site Address: 558-s Oreik -1 Pitill- aS
Owner: t;_ c. 4. Mailing Address: 555 Ot.6,42I-) -iiiitt Q.eht)
City: Cleo in Q Zip:
Phone: 163,22/2 -'1St Email:
Contractor/Applicant it formation
Contractor/App.: y ,,._ ,�.�-�_ Contact Person: ASY‘ tL11.
Address: L'ivrc. i (etState License#: 1 ESc/�j
City: Bictln t Zip: 5-. 1q1- Expiration Date: 03p/1'Z
Phone: '7(3 7k'O—ZR4-fy Email: jrnc .0, k-Scpha mGS.rrcw,
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 pd 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
150784
, 4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached).
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
El $75.00— Principal Structure $
®' $50.00—Accessory Structure x 2 (how many) %d. it
1. Subtotal of above permit requested $ /zt.ei n
2. State Surcharge 1.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $ f O i'.ori
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.
Applicant's Signature: / _Amor _ Date: /O-7—/4
Owner's Signature: 41, J 1`, Date: 10/14.1 /14
Approved By: dieffillirar� Date: 16 2..J •
( wilding Official)
*Zoning Disclosure Required? D YES NO NUI + ' ' 'Puma Su Ik fi &NW 01110
*This must be filled out by Zoning Department-For ei a nswer, a Zoning ifficial must sign all applications.
*Approved By: Date:
(Zoning Official)
Form Last Updated: y 2015 Ju! Rori9(MI lew � +0 r maw. &gal � ,v
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DATE TIMEV
CITY OF ORONO CALLED IN
INSPECTIONOT CE SCHEDULED
PERMIT NO.a9(00 '0/31/4 COMPLETED 3 '021- /If
ADDRESS 5�J` O/ -,4 Q 1a /a().
OWNER TELEPHONE NO.
CONTRACTOR
DESCRIPTION Oervt( ei;n4t
u 0 FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
• 0 FOUNDATION DRAIN TILE 0 PLUMBING FINAL 0 TREE REMOVAL
❑ LATHE ❑ MECHANICAL RI 0 SITE INSPECTION
• 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS
Z ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
4 0 FINAL 0 WATER HOOK-UP FsOLLOW-UP
• ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
J 0 DEMO-SITE 0 SEPTIC INSTALL
X OWNER/CONTRACTORT�O MEET YOU:_YES_NO
ei COMMENTS: ///�cfri. •t AldI e v c4./9.0 c f p r
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0 WORK SATISFACTORY:PROCEED ROJECT COMPLETE
• 0 CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
j ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
• BEFORE COVERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector. Ca
/�✓ �
White Coovllnsoector's File Canary Copy/Site Notice