HomeMy WebLinkAbout2009 - 00570 (Voided) 4i o
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avt- (P/28'jpi — Dpep' 644-LI om City of Orono 1 J
She r « 4 Building Permit Application
relkovta • for New Structures or Additions
Mailing Address: • Permit number: 0200? -60 570
0-1)
Q PO Box 66
�` Crystal Bay, MN 55323-0066 Date received: 9-q--(2q
A I V;<.� Received by:
jStreet Address:', A ;I2750 Kelley ParkwayPlan review fee: ---
L9kzsiOrono, MN 55356
Total Fee: 47,
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: '(
Job Site Address: ,O GJ6sr 7-,k4w. 6, � kE
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes E--Ko
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: /L( /3 v S 5e1
State License# Expiration Date:
Phone: 2- lir office cell
Mailing Address: /%0 (,r5. Fo..,...— YeCit
Contact Person: Applicant is: Contractor / omeown r (circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION: A 5 v S 5
Name: a�.f14
Phone (day): 95—'2-- q7(o t / c- 11 3
Address: „ ,o Q.-4 - 1.4...._ A Cit : Cs-- C L• ZIP: a
Email and/or Fax cS LA./.c.,S&a4"..0 vVIS VA, • c,
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
Water Supply
❑ New Construction ❑ Single Family with ❑ Residence
❑ ition attached garage oerbarage/Accessory Bldg. ❑ Public Sewer
rii Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial rivate Sewer
❑ Other: (specify) [' Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
**Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review& permits. ❑ Industrialrivate Well
Minnehaha Creek Watershed District(MCWD) .2 her: (specify)
18202 Minnetonka Blvd 50✓.-'T -e E
Deephaven, MN 55391
Phone: 952-471-0590
Fwax: 952-4minne ahacr 0\-C?
www.minnehahacreek.orq
Estimated Construction Valuation (excluding land) $ IS-- '�
Last Updated: 6/22/2009
- 19 -
STRUCTURE INFORMATION:
1. Structure Dimensions 1.Structure Dimensions (continued) 2. Type of Construction
a. Length (ft.)= 7i Number of bedrooms= ❑Wood/Frame
❑ Masonry
b.Width (ft.)= ( Number of garage stalls: ❑ Metal
Attached= ❑ Pole Bldg.
Areas in square feet Detached = ❑ ICF
❑ On-site Prefab
c. Basement= • ❑ Off-site Prefab
d. 1st Story = 1:1Other(please specify):
e.2nd Story= fbVz2f
f. % Story =
g.Total Area=
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
Not
Enclosed Applicable
e� ❑ I Permit Application
❑ ern-- Proposed Building Plans
❑ �' MN State Ener y Code Calculations and Mechanical Code Requirements Form
❑ �9- -' all requirements)
❑ -‹E"' Stormwater Pollution Prevention Plan
❑ Hardcover Calculation(s)
❑ --�' Septic System Site Evaluation Report
❑ �—' Access Permit
❑ ��' Wetland Buffer Improvement Plan
❑ Engineered Plans for Retaining Walls 4 feet or above
❑ Plan Review Fee
❑ i7 Other
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Agrees to pay the City of Orono for engineering consultant 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 complete application being aware that upon failure to do so, the staff has no alternative
but to reject it until it is complete;
• Acknowledges the Escrow Agreement is completed and signed;
• Some or all of the information that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data.
Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and
intended use of this information is to annually update our records and records of other governmental agencies required by law.
If you refuse to supply the information,the application may not be issued.
Applicant's Signature: Date: , 3
Last Updated: 6/22/2009
-20 -
Plan Review Checklist for New Structures / Additions
Address/ PID/ Legal: t°1 60 LA.)EST P#904^" ((A A-r
Description of work: 138,4, f 4 u- e4.
Septic review by: Date Approved:
Zoning review by: Q Date Approved: 7. 21' 0 5
Building review by: eU • Date Approved: ,• 2/- Oct
Grading review by: Date Approved:
Zoning File#: Resolution#: Resolution Date:
Zoning District Fire Department Post Office School District
Zoning: Lot Area: SF/AC Width: Depth:
Survey Submitted: ❑ Yes ❑ No Date of Survey:
Proposed Setbacks:
Front(Lake) Rear(Street) ( N S E (WD ) ( N SCOW ) Other Buildings Wetland
Side Side
16. 1 I0 ' + Zos ' 20 gC ' N //+
Building Defined Height: 0 • — Building Peak Height: — #of Stories Ok?: YES
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION:
START WITH the distance between the basement floor/crawl START the distance between the slab and the highest
space floor and the highest roof peak, the top of WITH roof peak,the top of the cornice of a flat roof,
the cornice of a flat roof,the deck line of a the deck line of a mansard roof, or the
mansard roof, or the uppermost point on a round uppermost point on a round or other arch-type
or other arch-type roof roof
SUBTRACT half the distance between the highest window and SUBTRACT half the distance between the highest window
highest roof peak of a pitched roof and highest roof peak of a pitched roof
SUBTRACT the distance between the basement floor/crawl ADD the distance between the slab and the highest
space floor and the highest existing grade within existing grade within the foundation
the foundation or 10 feet,whichever is less. EQUALS Defined building height
EQUALS Defined building height
Lot Coverage: SF
Shoreland District MCWD Permit Received Average Lakeshore Setback Bluff
0 Yes KNo 0 N/A � ❑ Yes 0 No
0 Yes 17/No 0 Yes Po "N/A
Permit Number: Setback:
Hardcover Zones Existing Proposed Variance Required CUP Required
0-75' 0 Yes 0 No 0 Yes 0 No
75-250' Type(s): Type(s):
250-500'
500-1000'
REMARKS (in-house):
Updated: 09/11/2009
z:\forms\plan review checklist.docx
Fees to be Charged YES NO
Permit
Plan Review
State Surcharge
Investigation Fee
SAC—Number of SAC Units
Sewer Connection
Water Connection
Park Fee
Site Inspection
Other(specify)
Miscellaneous Fees
Calculated By:
Square Footage $ per Square Footage
Basement X = $
1st Floor X = $
2nd Floor X = $
Garage X = $
Estimated Construction Value: $ 3,000 oo
Orono Inspections Required Work Requiring Separate Permits Required State Permits
O Site D Plumbing 0 Grading / Filling 0 Well
O Hardcover Removal 0 Mechanical 0 Fire 0 Electrical
)3—Footing 0 Septic 0 Water Connection
O Poured Wall 0 Fireplace 0 Sewer Connection
O Foundation Survey 0 Masonry 0 Lawn Irrigation
O Radon Rock Bed 0 Mfg.
O Framing 0 Other(specify)
O Insulation
O As-Built Survey
Final
O Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access:Existing: 0 YES 0 NO New: 0 YES 0 NO
REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT)
Updated: 09/11/2009
z:\forms\plan review checklist.docx
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O 0 CITY of ORONO
Municipal Offices
\ �r Street Address: Mailing Address:
,A ` 4 2750 Kelley Parkway P.O. Box 66
, ,, Orono,MN 55356 Crystal Bay,MN 55323-0066
4k.ksHog
June 23, 2011
Don Asmussen
1960 West Farm Road
Long Lake, MN 55356
RE: Building Permit
Dear Mr. Asmussen:
On November 21, 2009, the Orono Building and Zoning Department approved your
application for a building permit for a boat shelter at 1960 West Farm Road in Orono.
As of today's date the permit has not been issued. The work has been completed
without a permit and the required inspections have not taken place.
This letter is to notify you that if the permit is not picked up by July 7, 2011, the City of
Orono will forward the matter to the City Attorney for legal action.
Sincerely,
d'C# "Vit
Lyle Oman
Building Official
loman(a�ci.orono.mn.us
City of Orono
Telephone(952)249-4600 • Fax(952) 249-4616
www.ci.orono.mn.us
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1960 West Farm Road
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http://www.bonestroo.net/infraseek_asp/Orono/mwf/Zoning.mwf Friday, May 15, 2009 12:41 PM
Mae, 15 2009 11 : 42AM Hansen Hometech 952-934-4603 p. 1
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Company: Hansen Hometech, Inc.
Phone: 952-934-0854 �I
Fax: 952-934-4603
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