HomeMy WebLinkAbout2012-00718 (demo - accessory structure) • • CITY OF ORONO * z 0 1 2 - 0 0 7 1 8 *
2750 KELLEY PARKWAY DATE ISSUED: 07/30/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1473 BAY RIDGE RD
PIN : 10-117-23-34-0005
LEGAL DESC : REG. LAND SURVEY NO. 0192
: LOT 000 BLOCK 000
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTTON TYPE : DEMO-ACCESSORY STRUCTURE
NOTE:
1. FOUNDATIONS/ALL DEMO DGBRIS TO BE REMOVED FROM GROUND&DISPOSGD OF OFF SI`fE,YER PCA REGULATIONS.
2. INSPECTIONS DONE BEFORE BACKFILLING.
*OTHER INSPECTION-HARDCOVER GRADING.
* FINAL INSPECT ON TO VERIFY HARDCOVER AND ASSURE S[1'E IS GRADED PROPGRLY. I.F,.NO NEGATIVE IMPACT TO
N�IGHBORS. �(INIT[AL)
APPLICANT DEMOLITION -ACCESSORY STRUCTURE 50.00
MCCUNE, THOMAS STATE SURCHARGE DEMO 5.00
1473 BAY RIDGE RD
WAYZATA, MN 55391- TOTAL 55.00
OWNER
MCCUNE, THOMAS
1473 BAY RIDGE RD
WAYZATA, MN 55391-
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 I 80 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked any time for due caus�
r
��� 3 � �'' l ��l L,�
pplicant Permitee gnature Date Issu [3y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0 City of Orono F�USE ONLY
� � P.O.Box 66 Date Received: / Permit#�O��"0�7 �
��;,,��� �� 2750 Kelley Parkway ,��
`� '�� Crystal Bay,MN 55323 Amount: $�J�� SAC Gedit:
t� �� �' "�d'� (952)249-4600
��°�'y Homeowner(s)Signed: ❑Yes
Resolutions(if any)Signed:�Yes ❑None Required
Zonin Disclosure Signed: ❑Yes ❑None Re uired
�t ia�'9 �
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
� � �/.•Owner Information: ;
Type: � Residential ❑ Commercial
Site Address: /'y 7 3 �A'�/ /2l D6E �Uk'D , �!+y��T14�B/2oNo� , 11�1/1!
Owner: �}O�!'1�J5 �/'V/°�'V/�!E Mailing Address: /y7,��y ,���� R�
City: D 2o ND Zip: S�3�/
Home Phone: �S Z- �73- 3a ys Alternate Phone: tGE�[,� a 3 g- al I G -o O 2 8
� ` � �cant Information: DEr►10 �EA��7ttWolZ� .Sv13�b�c7a�
,w.._....,�... .._ �
o��ER $oLLi cov,vcnlS, /�./�
�i�oi ?y Ro�-y 3, I`�P Kl.vs rn n1
Contractor/App.: 7ff�oalpS �2, IY)��'UN� Contact erson: SS3y,3
c��-n Fz
Address: / 3 �y 1 � �D State License #: o r /���
City: �i4-��-�-Tf� Zip: 5�53'�'/ Expiration Date: ntor� �E�'D
Phone: qSz -y73 �3 a ys Alternate Phone: 95Z— 938-h�l33 Cc��D�
.�:�!��,��.�;�����`�SP�C�AL�l�T��T�0�1S&HOZ�=HARIVILESS AG1tE�E�%IENT
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:
l. 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 $2,000 escrow and an escrow agreement signed by the property owner.
4. Keep all structure(s) enclosed and/or secured until such time as demolition is complete.
5. 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.
6. Completely remove foundation(s) from the ground.
7. Completely dispose of all demolition debris off site in accordance with all applicable PCA
requirements.
8. Abandon water wells in accordance with State Health Department regulations.
9. Call for an inspection when all debris has been removed, before backfilling.
10. 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).
1 l. 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.
12. 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) SO� On
l. Subtotal of above permit requested $ So, p 2
2. State Surcharge 5.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $ S"s, DO
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: �e�,� � �� Date: z S /Z
0
Owner's Signature: < <' Date: zr
Approved By: � � Date: �7 -��= ' I Z.
uilding Official)
* Zoning Disclosure Required? ❑ YES NO
*This must be filled out by Zoning Department—For eithe answer, a Zoning Official must si�n all applications.
�
* Approved By: � � �� � ��- Date: � ���� �
(Zoning Official)
Plan Review Checklist for Zoning Permit Applications
Address: r� 1._J �� i��
Description of work: � D a,
Type of permit: �iV v l �� '{'� �' � //�/l.GY�C' � �'
Zoning review by: rna�Y�{ �V�l Y I-� Date Approved: I � �� �L---
Grading review by: Date Approved:
Other Review, Reviewed by: _ -�' Date Approved: � � 3��--�Z
�
Zonin : �
Zoning File#: Resolution #: Resolution Date:
Lot Area: SF/AC Width: Depth:
Survey Submitted? Yes � No Date f Survey:
,. a�°�
Existin Setbacks: �C��
F t(Lake) Rear(Street) (� S E W ) ( N S E W ) Other Buildings Wetland
Side ide
1 ' �U' �35
Pro osed Setbacks: �"j�
Front(Lake) Rear(Street) (� S E W ) ( N�S E W ) Other Buildings Wetland
Side `�ide
l� ` 3
Shoreland District MCWD Permit Received Average Lakeshore Setback Met? Bluff
0 Yes � No 0 N/A 0 Yes No
�es 0 No �s � No � N/A
Permit Number: Setback:
Hardcover Zones Existin Proposed Variance Requi CUP Require
0-75' i 0 Yes No 0 Yes No
75-250' �r „`�r,p�� �� n �� Type(s): Type(s):
�Y V-/ "�
250-500' Zoning File#: Zoning File#:
500-1000' Resolution#: Resolution#:
Created: March 29,2011
z:\forms\plan review checklist for zoning permit applications.docx
. ,
Pianning Review Checklist for Zoning Permit Applications
Page 2 of2
Cubic Yards
In Out Total
Haul Route? ? ❑ Yes 0 No
Explain haul route in detail:
Fees to be Charged Amount Orono Inspections Required
Permit Amount �O
� Site
Escrow Amount 0 Hardcover Removal
�� 0 Footing
Signed escrow received? � Poured Wall
� As-Built Survey
0 Yes ❑ No � Planting Plan
0 etland '
Escrow amount received? � inal
�es 0 No Other(specify) �d -
Engineering review needed?
0 �
� Yes � No
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
REMARKS (TO BE NOJ'ED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT)
�l�G� (,�'� c G� �U 1/Y� v cZ SS�-G� c �
CS_��,Q� d yD,D�.-�� . ( . • t�.o �a-�� c �a c� ��
�n.�c�,��,,�
Created: March 29,2011
z:\forms\plan review checklist for zoning permit applications.docx
� � �e� DAT TIME V
CITY OF ORONO CALLED IN � ��
INSPECTION NOTICE�,�j SCHEDULED o� �-- �
PERMIT NOo�/a��l�t'J/�� COMP TED
ADDRESS ��73 �
OWNER TELE ONE N .�S ' 7.3 3 Z�S
CONTRACTOR �^ �,
>; DESCRIPTION � �
�
l� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS
y
O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �QlORKSATISFACTORY:PROCEED �ROJECTCOMPLEfE
W O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-46QQ
�
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
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