HomeMy WebLinkAbout2002-P05742 - demo ' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Pos�42
Crystal Bay, Minnesota 55323 Permit Type: Demoi�t�on
(952) 249-4500 Date Issued: il�is�2oo2
SITE ADDRESS: 1125 Spring Hill Rd
Wayzata,MN 55391
P I D: 26-118-23-43-0004
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Pernut Class: Building Census Code 645
Permit Type: Demolition Permit Sub-type(s): Demo-Principal Structure
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
F'I�UIIUAUUIIS/All(1CIllU UCO11J W DC 1�CIIlUVC(1 llUill�'lUUIl(1 CX,(11SIJUSC(1 Ul Ull S1LC�Cl YI,H IC�UlAl1VI1J. VV C11S
m ist be abondoned. Insnection before backfilline.
FEE SUMMARY: Pernut Fee: $ 50.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 50.50
APPLICANT: Steiner&Koppelman OWNER: Addison&Cindy Piper
18340 Minnetonka Blvd 1125 Spring Hill Rd
Deephaven,MN 55391 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Si�nitures Required), 1-Apnlicant, 1-Monthlv Renorts. 1-Assessine, 1-Finance Page 1
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j�'�� � P.O. BoOx 66O(2O7 OK elley Pazkway) �PLICATION FOR DEMOLITION PERMIT
Crystal Bay, NIN 55323
' SPECIAL CONDITIONS & HOLD HARMI�ESS AGREEMENT
General Instructions
1. You may be required to obtain other pernuts, i.e. well abandonmment, etc.
2. Work must not begin unless the pernut card is available on the job site.
3. A 24 hour notice is required for all inspections. Call(612) 249-4600.
JOB SITE ADDRESS: �; ��_ �"� l( n
5 S�r��, a-� � I��
Occupancy Type: � Residential �� Commercial
OWNER'SNAME: l ,� � �, -v��y :%F�'; Phone:
Mailing Address: City:
CONTRACTOR'SNAME: ���f'����1 �Kv�L���rh� �� Bus.No.: ys :-'-y7,3 :y3s
Mailing Address:/`�� �5%' 1'j'l���e�o.uK� P L��Q City: GvE,�2�,�a_
Demolition if planned by means of: manual disassembly
:�l heavy equipment
Pernuts Iss�aed:
# 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 offadjoining 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.
7. 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
bui�ding 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 clai.ms, damages, losses or
expenses,including attomey 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.
9. Septic systems must be abandoned 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.
PERNIIT TYPE AND FEE CALCULATION
�C_ $50.00-Principal Structure
$30.00 -Accessory Structure
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1. Subtotal of above permit requested $ -SV
2. State Surcharge $ .50
so
3. TOTAL PERMIT FEE(add lines 1-2 above) $ ��
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
l�tinnesota,and certifies that all statements made on this application are complete,true and correct.
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APPLICANT'S SIGNATURE: � Date: �O /8 0,2
�
OWNER'S SIGNATURE: � �..�`��_. v Date: � �_
APPROVED BY: Date: to - 2.� -o Z
��� Princi al Dwellin Demolition Permit
O O p g
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'Q, � � ` �� ZONING DISCLOSURE & DECLARATION
�'�r�eso�'$
To the property owner: Demolition of the principal dwelling structure on a
property may automatically terminate certain rights which may have accrued to the property by virtue of the
continued existence of that building.
>Rebuilding on a substandard lot of record(i.e.a lot that does not meet the zoning district required lot area
or width standards) will, with few exceptions, require variance approval by the City Council, and such �
approval is not automatic nor guaranteed but requires that a hazdship be demonstrated.
>Additionally, all current zoning standards will have to be met by the new principal dwelling including
setbacks, lot coverage by structures,hardcover(impervious surface),height limits, etc.
>Where municipal sewer is not available, provision of two (2) sites for a conforming on-site sewage
treatment system is mandatory.
>Unless specifically approved by the City,all accessory structures must be removed at the time of principal
dwelling demolition.
The following information is presented for the purposes of advising the property owner of the implications of
removal of the principal dwelling on the property:
1. Property Address � � 2 S �PY� �9 1_�� � f �Ua� pINS# Z(o-��8 23- �3� D D 4 y
2. Zoning District LR-/� Required Lot Area Z a c r e Required Lot Width Z�D
)
,/ !
Actual Lot Area + �c r�S Actual Lot Width 7 yd
Lot area variance is s no quired. Lot width variance is ' quired.
1
3. Required Setbacks: Front(Street) 5 � Rear(Lake) ��� Side 3�
Side Street ` Average Lakeshore Setba • must be met is not a licable.
4. Lot Coverage by Structures: limited to 15% of lot area oes not annlv t area>2 acresl
5. Hardcover limitatio : are_applicable/ re not applicable. 0-75'zone= 0%allowed
75-250'zone=25%allowed 250-500' zone=30%allowed 500-1000'zone=35%allowed
6. Municipal sewer is available. �Municipal sewer is not available; on-site system testing and design must
be provided confirming that two conforming drainfield sites are available.
The undersigned property owner hereby acknowledges receipt of the above information. Staff Initials
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1� - � D .Z
Pro Owner's Signature Date
(Original:Street File; Copy:Property Owner)
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� ' ` Minnesota Pollution Control Agency
Notification of Intent to Perform a Demolition
V'� Type of Notification [ J 4ri inal
g [ ]Amended [ ]Project Cancellation
Demolition Contractor: . Building Information•
Name:-W I�n pN �4 u S P� l)c�.o ✓�'�'.'�� Building Narece•
Addras:�7�iL7 = �� �l u �R�✓ Address/Location:_ ��et 5 S��K i!t,� ��1� ,p�
C��a,aNe n'I/� -�53a 2 O�o�,� �/U .sS �s 6
- c�cy,sc�c�,z�p:_
c�ty,srace,zip: � councy: �v�e�J;,�,.� �
Contact Penon: D a�✓N ' Phone Number(s):
Phone Number(s): QS�''yd�� 56 S 3 Age of Bldg.(years):�v? Size of Bldg.(sq:R):
Number of Floon Including Bascment Level(s): �
Building Owner: p J /
�/ Present Use of Bldg.: l�P 5 i d P�/7 ,-a
N��: �a� � C,�r�l y �vP2 p
p Prior Use of Bldg.:_ I��s i�l ti���
Address•_f /�S S,pfl r'�{,� ����l��, ,
Dates when de olition or intention 1 urning
will Begin /A o Z- & End �/ s o2
ciry,stac�,zip: ORv�vv /�?,/l� S5 35G �
Notification must be postmarked or rcceived ton(10)working days
Contact penon: before demolition begins. •See item#S for emergency demolitions.
Phone Number(s):_�� 3 - �7 3- a 6�3 Both Beginning and Ending dates should be amended in writing as
nccessary to reflect current project dates.
If there is>2601inear feet or>160 square feet of Regulated Asbestos-Containing l�iaterial(RAC1Vn in the building
to be demolished,it must be removed by a licensed asbestos contractor prior to demolition. The State of MN.
Notice of Intent to Perform an Asbestos Abatement Project must be used to notify for the asbestos removal.�
Is nonfriable ACM present in the structure to be demolished ? [X]YES [ ]NO
If YES complete items 1-9. If NO complete items 3-9. _
1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category I�
nonfriable ACM left in place. �^ Y:__`_
, .
Categ.I Linear Feet Categ.II Lineaz Feet � . �
Square Feet Square Feet
Cubic Feet Cubic FeeC
Cate��i nonfriabie ACM means asbestos-containing packings, at Porv Ii nonfriable AGI�"means any material,excluding
gaskets,resilient floor covering,and asphalt roofing products Category I nonfriable ACM,containing more than one percent
containing more than o.ne percent asbestos. asbestos that,whrn dry,canciot be cnimbled,pulverized,or
•Category I aonfriable ACM is aot allowed to remain in place reduced to a powder by hand pressure.
for demolition if it is in poor condition. •Category II nonfriable AChf is not allowed to remain in pl�ce
for demolition if it has a hiQh probability of becoming crumbled�
pulverized,or reduced to a powder during demolition�trsnsport,
- or disposal. (ex transite,cement,slate roofing)
2. Description & Location of ACM remaining in place(including tloor#and room#):
�c CC l�PM G J� B,� I/'e;� f�.�;�d.�,v ��
2 38v� .�,,,e�� K;u` g�r�
.Sk� � l0
i k--.-->>. �`°�W /�'�N .� � . .
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3. Company and/or individua]that conducted tbe building inspection aad the procedure nsed fo determine the . •
presence or absence of ACM(including analytic method)z *Prior to demolition all�buildingi rpust be inspeeted by ad Epp
accredited Inspector.
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4. Description of planned demolition and the specific method(s)that will be useds
�C'a �f3� �Ru�OMP�v�
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5. If the demoIition was ordered by a government agency,please identify the agency and attach a copy�of the. .
order•
Name: Title: � Authori •
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Date of Order(M/D/�: Date Ordered to Be in �
g (Min�: -
* Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than;he .
following working day. A demolition is considered an emergency OIYLY when the faciliry has been deemed structuraliy unsound and
in danger of Imminent collapse. If the structurally unsound building is known to contain any regulated ACM or:is suspected:to'
contain any regulated ACr1,special procedures hIUST be followed. If you are unaware of the special procedures,
instructioas/regulations can be obtained by contacting the hIPCA at Ehe address or phone number listed below..
6. Description of procedure to be followed in the event`that unexpected RACM is found or Cat.II nonfriable'
ACM becomes crumbled,pulverized or reduced to powder:> .
7. Waste Transporter Information: 8. Waste Disposal Information: -.
Transported�Name: Ui/i���Pv �u c,,.51,C � �
Land611 NamE:_ �Q,�1.�0 ti
Transporter Contact: OwnedOperator �
TransporterAddress:_ Address/I;ocations
CitY.State;Zip: �� /Da�NQ /�� s l�' � Z Ciry,State,Zip: . �(o �
Phone Number�- 9�'L — �/6 6 � .�es 5,3 Phone Number�
9. I certify that the above information is correct and I am a bonafide representative of the demolition
contractor or building owner and have authority to enter into agreements for my employer.
Signature of Con�actor/Owner .
Date
Send o�Fa�c to: For questions call:
Asbestos Coordinator-Air Qualiry Division ` 612-296-7300 �
MN Pollution ControI Agency � 1-800-657-386�
520 Lafayette Road North Far: 612-215-1593
St.Paul,NiN 55155-4194 �