HomeMy WebLinkAbout2018-00316 - demo City of Orono FOR CITY USE ONLY
VLO ,/�\ P.O.Box 66 Date Received:^/►IS Permit#Igalif(LQk�)
O \ 2750 Kelley Parkway
f� 1 Crystal Bay,MN 55323 Amount: $747,4p SAC Credit:
(952)249-4600
1 h / Homeowner(s)Signed: ❑Yes
",r �� Resolutions(if any)Signed:0 Yes 0 None Required
NSR, t S HOS@ Zoning 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)
Job Site/Owner Information:
Type: 0 Residential ❑ Commercial
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Site Address: � � 5- s Qy� t-* LV=. L
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AQ�c \ � Mailing Address: --?g- W +h AL\ ( v) "C?
City: lci)c1\O`--t 11^1 Zip: e 41
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Phone: \ _'(U ` 3� -I Email c�JYI+AL� C�g 2\Vne k-40 M Q Cal
Contractor t Applicant Information
Contractor/App.: 0--L-KB \ Q Contact Person: QC)MA n 7_h (
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Address: C k \PV\ Y" ,9 State License#: BC 6 cO' 2-3
City: ky(Y\ -k Zip:CS-`t`"1 1 Expiration Date:
Phone: C S \ 2-70 '3 I 9 1 Email:CCI.APC...\ .'" C(..12:. MC k--t OM e.COM
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 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
$75.00— Principal Structure $
❑ $50.00 —Accessory Structure x (how many)
1. Subtotal of above permit requested $ 7 5 00
2. State Surcharge 1.00
7
3. TOTAL PERMIT FEE (add lines 1-2 above) $ 6 ' }
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.
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Applicant's Signature: G- Date: J_. //s/e
Owner's Signature: Date:
Approved By: 67' r�/ j Date: g"-/////b f/
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*Zoning Disclosure Required? ❑ YES SUNO
*This must be filled out by Zoning Department—For e er answer, a Zoning Official must sign5-2.0
all applications.
*Approved By: Ir�oviY�` Date: J'2 O'
(Zoning Official)
lblen& 420t .. 03517
Form Last Updated: July 2015
150784