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Home My WebLink About2017-00331/00332-VOIDED PERMITS �" � CI'h/Of�fOf10 FO�t CIZY tiSE O'_�ZY ��`�, P.O Bax 66 Date fteceived ' � Pernut� _ �� ` ( �; �'� ; f �i 2750 Ke#IeyParkway �-J � ; CrysEal Bay,MN 55323 P,mount: $ SAC Credit: 4 � �; � (952}249-460� �"`.r �� Homeonmer(s)Signe�_ Q Yes '��sh =,`` Resolutions(ifany}3ignetl ❑`i es Q N�s Reyuir� �.��ST ��y-�g,�� j ZouingDisclosurs3rgped �Yes Ql�oneitec�uired � � . ' _ i t_ , - �,�� i "�j�t,��;r"i(<� C -. -i - -�� ., �. . �.._ i f I l_ Wl C f,e._Y"I�,1 1 t C[TY OF ORONO - DEMOLfTION PERMlT {All pertnits must beapproved b�ths Buitding Offiaai andJorZoning Departmenf} _ . _ . . __ J�b 5tte f C.�wrter IntOrma��ot1 Type: �Residential ❑ Commercial Site Address: ��7C�C- ,��fic�,��- ,}�� r- OWCEBt": �1'7,v/1� �.��t-r�.l�_S Mailing Address: i7�>� �«:ro,/'.s+P ��" CI�/: (�l-�.r� �, Zlp: ..�� `j / Phone: Email: �� _.....___...._....__.....................__......_,.......�_..___ ..._Lor�tractor i 1�p�1�c��t Ir�to�r�twr�: �� Contractor/App.: �-/,�,��ri,,�r� c,� c' Contact Person: �.�},�� '�tate License#: C 3 Add�2SS_ �C'�� 't�'�- ��.Uf:r'r �t �.��`l�-' � City: C��;r�w�� Zip: -S3�i/ Expiration Date: 3-3/-- Zo/� Phone: �f S`f� ? c; � �`�(,. Email:�� /�r�/1 -/ra=��--� . <os�� . ...___. ... ..._.. _ _ __. _�. ��..._...�._.� _ � - �'��'/ �,.. _____�.�._ SPECI�IC CON['}�T�ON�� Ht)L[3 #�A►RMLESS AGR��;��NT ,�///////, General I nstructions: 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 2448 hour notice is required for all inspections. Call (952}249-4600. 4. Sewer m usf be discontinued at the Ci#y service by qualified contractor before demo permit is issued. Demol�ion by means of: ❑ Manual Disassembly �Heavy Equipment ❑ Other � Permi#(s) Issued: �❑ Sewer aisconnection �� ❑Well Abandonment# i��,� , '� `�`- ,, i�%�� i��. _ " ', �r In retum for issuance ofi said Demolition Permit, the undersigned owner hereby agrees to: 1. Submit a survey, aerial photo or sketch showing all strudures on the property. Note which structures are to be dem�lished. 2. Submit a survey, aerial photo or ske#ch showing proposed erosion contr-ol measures in accordance with Chap#er 79, Canstr�.�ction Site Runoff Control. 3. Submit a copy of permit apprvval from the Minnehaha Creek Watershed District (MCVN�). The City will not issue a demol�ion permit without a copy of the permit(s) from the MCWD or documentation stating permit(s)are not required. Form tast Updafed Jufy 2095 1507&3 . --.---� ,J`�_c�- C �� ci� � � ��_S C� �� C'� C�� s � ��-� �� l `-( �ss �,� ; �� . � �" � � � , �r. �;� C� �� ,�;9 � � �c.� — I�ciu.� �� CiL-� C�C� �_�-%/ / �� 1�-�— '� � V� �� '�l��e��.� /�e� �`L`--�-�--� o� p�m�� r C�rc I�K� I'�u�-- 4. Submit a ;�2,500 escrow and an escrvw agreement signed by the property owner(copy attached). 5. Keep all structure(s) enclosed and/or secureri until such time as demolition is complete. 6. Keep all demolition debris off adjaning properfy and/or the public rights-of way unless speafic prior approval is obtarned 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 w�#h all applicable PCA requirements. 9. Abandon water wells in aocordance with State Health Department regulations. 10. Call for an inspec6on when all debris has been removed, before badc�lling. 11. Within 5 working days of superstrudure removal, a final inspection shall be requested. The site shall be left clean and clear of all debris, with any excavation filled w�#h earth level with the adjacent ground elevation (except when suc� 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 mus# be pumped, a-ushed and ftlled with native soils. An inspection is required after the tanks are pumped and before the tanks are cxushed 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 daims, 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 bythe property owner, his employees, agents, subcontractors or assigns. PERMIT TYPE AND.FEE CALCULAl10N ,-, ,� �� .f �� r ��r,:�ti� , � �� ' � � $ �s, r.�, �' $75.00 – Prineipal Strueture �.'`�,, ��- ❑ �5U_UU –Accessory Structure x (how many) 1. 5ubtotal of above permit requested $ 1. 5tate 5urcharge 1.UU 3. TOTAL PERMIT FEE (add lines '[-2 above) $ �76- "— The undersigned herby applies to the City of Orono for issuance of a Demoli#ion Permit, agrees to do all the worK �n a stnct accordance w�th 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 S ignature: ��--�--=--"" Date: 3 3/�- j � Owner's Signature: Date: Appro�ed By: Date: (Building O�aal) " Zoning Disclosure Required? ❑ YES ❑ NO *"This must be filled out by Zoning Department—For either answer, a Zoning Official musf sign all applications. *Approved By: Date: (Zoning Offiaal) Form tasf Updafed Jvly 2015 1507&3 �_%_ � I'_(-; ��_>�% i c�� FI� Ct�"t�'F �,�-`,��!>, f- �' 1 'jb"��C�c� �-l—(p—��I -�o�L�7-UO �i3l liil�/ UI VfVIIU � �-�>i'r'; J,�• [Xt6�iPI��' auua�ng rermii N►pp��cauvn rvr �vew �iruciures or �t�vns __ MailP Bdox S6 ermii number: ,..,�( /_ I ( t � 3 Z- / � �� ,', Crystal Bay.MN 55323-0066 Oate receiv�: '�%� �� Sheet Address:' �° / Received by: � \1 275�Kelley Parkway� �� % ' :. _ Plan rewew fee: 3� . ��1,� Orono.MN 55356 ',," �( � ?k'rsrii�a� Main: 952-249-4600 -- __ _. Tota1Fee:----- —� " '""✓ Fax: 952-24�4616 www.ci.orono.mn us This applicafion form must be completed in full and all required infortnation must be submitted. Incomplete applicatio�u will be retumed. (Please print) GENERAL INFORMAl10N: Job Site Address: 7 � � ` 7�C ;� `� . ,��% Will this be a Parade of omes, Remodelers Showcase Home or other Display Home? Yes No M yes.a specia!event permrt�s raquired w2h Pol�ce DepaRmen!and City Counci!approva!60 days pnor to fhe event Shutl/e bus sernce wr be requued unless apptrcanf denronsfiafes suffiaent on-s�te parki�g rs availeble. fVon-permitted events wrlf not be aflowed. CONTRACTOR/APPLICANT INFORMATION: Name: > � L State License# p� �xpiration Date: ---ZL�/ Phone: (cell) Z office) Z � Mailing Address: C � e �' ' it : �,,'t LG.ya ZIP: ' ContactPerson: ��ti�/u �,�,.- �� Applicantis: ontra ,, / Homeowner �c��iea,.� Email andlor Fax: �--� jv-�,.�d u �% /�h/�_/i c,u�t. /.�i., PROPERTY OWNER INFORMIATION: /� �/�� ',,,,-^ UOi�� ` Name: ----�_�i;�---_�C��S I I�V2'i��S='� -------__.._......— Phone(day): Address: bC S/.-:_r1.rv- n,- CrtY: L�/'t"+Q�'� ZIP: S��/ ��--...__.._.__.._:... . _ _..... Email and/or Fax ARCHITECT/ENGINEER INF012MATION: Name: cl� � Phone(day): � .- Address: t�Cf , Crt : �' F_ ZIP:.�S Email andlor Fax: � ��-- " ` 1� �`i[-iL�• i-a'�CG'i-G. r�.z, (� �� ,�I ,� , PROJECTINFORMAl10N: Description of ro�ecf: �.r��-I�-�/u� � � �, � �1��L'�1L�� --................._—........................_...................____............... i 1.�ype oT Project 2.Proposed Use 3.Structure Tjpe 4.Sewage Disposal& i Water Supply ;�New Construdion �Single Family with ❑Accessory 81dg./Garage ; ❑Addition attached garege ❑Deck ❑Public Sewer ; ❑Accessory 8uilding ❑ Single Family with ❑OfficelCommeraal ' ❑Relocation detached garage Residence ❑Pnvate Sewer ❑Other(specify) ❑Muftiple Family I Condo ❑Retaining Wall(s) ❑Public 4feet or greater ❑Public Water *`Any eaRh movement may require ❑Commercial ❑Storage MCWD review&pertnits. ❑Industrial ❑Warehouse ❑Private Well i P.9innehaha Creek Watershed District(M19CVJD) ❑Other(specify) ❑Othe�(spedfy) ! 15320 Minnetonka BNd i P.linnetonka,61N 55345 ; Phone�. 952-071-0590 i Faz: 952-471-0682 � www.mmnehahaaeek.o $ � C�L�1 Estimated Construction Valuation(excluding land) ��- / Packef Last Updated-August 2015 Pege 21 l � � Shorc�6�''; C��h �Z Z � ��a�� _ J 1x� 3 , �� .� � S� - �r �►'�–�� y�,�;r`',�—' 5� — N�, �Q�► Q Irv� �O� V� �� —bvex�� R� � � � 0� � �}�✓� � � 3z�3� - lo�l �� — � � 3 �.�� IIIZ �� _ 23�L? ' (p�-1 � �� V r►ar�c� �.so �'` 33?-0 � 1�,q3 a c�.�� ''��' r� - STRUCTURE INFORMATION: ' 1.Structure Dimensions 1.Structure dimensiot�s(contirwed) 2.lype of Construction ' a.Length(ft.)= � I Number of bedrooms= � �W��prame b.Wdth(ft.}= �� i Number of gerage stalis: ❑Masonry � Areas in square feet Attached= �- ❑�etel ❑Pole Sldg. c.8asement= /C,TS$ i Detached= Q ICF d.1g Story = �_ � ❑On-site Prefab e.2r°Story= ❑Off-site Prefab f. %z Story = �Y� � � ❑Other(please specify}: ; g.Totai Area= I REQUIRED SUBMITTALS: All of the informai�on must be submitted in order for our a licatfon to be rooessed: Not '._._.... EnGa 3 Ap�licable Y ❑ Buildin Permit Escrow reement and Fess ❑ Plan Review�ee ❑ Com leted ication Form ____ ❑ Pro�osed Building Plans—2 full size sets to scale and 1 reduced 11 x 17 or 8%z x 11 set :............................... ........_........ �.....�_...�_____ � Minnesota State Ener Code Calculations and Mechaniql Code R uirements ❑ Surve —21u11 size,to scale me�in ALLsurve r uirements ❑ Hardcover Calculations i........................... .__........__....... ........,,,............___.... ._....._ ................._..................__....__......—._�__..._._ _ ___..........._.........__.........._...______ � Se ic S stem Certification L] Minnehaha Creek Watershed Distrid(MCWD)Permit a Documentation from MCWD stetin no ermit is re uired a }________,__ i ❑ �S. _: Landsca�e Walis and�or Retaining Vdall Plans ;.........._.......___—._—_ ; ❑ y1 �Stormw�ater Pollution Prevention Plan SWPPP ,__ ��_,.,,_...,_..._......_.—_ ; ❑ Access Permit ; _._.. —_.._ i........................_�....__.. _—.....� t...Data Privac�Advisory Form APPLICANTIOWNER ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the 8uilding Department; • A�ees to pay the City of Orono for engineering consulWrrt review costs in excess of$500; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a corr�lete application being aware that upon failure to do so,the stafi has no alternative but to rejed it until it is complete: • Acknowledges the Escrow Agreement is completed and signed; • Understands some a all of the information that you are asked to provide on this application is classified by State law as either private w confidential. Private data is information which generally pnnot be given to the public but can be given to the subjed of the data. Confidential data is information which generally cannot be given to either the public or the subjed of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agendes required by law. Ifyou refuse to supply the information,the application may not be fssued. • A�ees that in the event that weather or other con�tions prevent the completion of en as-built survey at the time the Certificate of Occupa�cy is requested,a rerrporary Certiflc�e of Occupancy mey be issued upon receipt of a S10,000 escrow to ensure completion of the as-built survey and all site improvemerrts. '— =r^----- . _ -- / ,�� Applican#'s Signati�e/�/" ,,�_.,.,._/L�� Date: � — 3l� � 7 t. Owner's Signature: Date: Packet Last Updated August 20?5 Page 22