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Home My WebLink AboutMisc applications etc �r x�� 9-C_�� Q-� -c �C,U1�y^ � �'"`` t CITY OF OR�..rNO F�«�i o BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS ,��I� IC�I�,U I �� / �O� Mailing Address: Permit number: o2D 1 -'b O Z.CI� � PO Box 66 ' / � Crystal Bay, MN 55323-0066 Date received: �-R'�'t StreetAddress:' Received by: d S y � 2750 Kelley Parkway Plan review fee: �' � Orono, MN 55356 `�kFSH�� Total Fee: 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: �"��i J �C;i,� �i C.�'t� � r �'i� Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is availa6le. Non-permitted events will not be allowed. CONTRACTOR/ PP11� FORMATION: t-�-NY�-c��s ,- Name: ��--�Y1��i l E�� Iti1�t.r 1� 5c�t,t��`� State License# ti j � Expiration Date: Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: � Name: �0.�^ K-- _� �-��'t� ll �:j J�1.��"S __ Phone (day): ��—�i C� --"7 ?3�i� c.t- Address: < <' ; E� r, cQ Cit : 1tc� ZIP: �J�;`_j� Email and/or Fax -`--�,�'; a i S� � c�c, � . c_c�wti ARCHITECT/ENGINEER INFORMATION: Name: �.,; � J� Phone (day): Address: r�F„• 71P• Email and/or Fax: �_-. I� � �`�- �4� , p : PROJECT INFORMATION: Description of project: x c_:• � 1�� 1.Type of Project 2. Proposed Use � ( �� . al 8 �� '�� ❑ New Construction �Single Family with �Addition attached garage ❑Accessory Building ❑ Single Family with - � �' r'� - �-� ❑ Relocation �, detached garage �� /„-CJ_I� ❑ Other. (specify) �"X � •�+�P ❑ Multiple Family/Condo � v� ❑ Public � �M � S�� ""Any earth movement may also require ❑ Commercial � L�I'►1 MCWD review&permits. ❑ Industrial � _ � Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) l�� (��(,{� 18202 Minnetonka Blvd r ��'` Deephaven, MN 55391 Phone: 952-471-0590 � Fax: 952-471-0682 www.minnehahacreek.or r ' v�' \ Estimated Construction Valuation (excluding land) � ` l� J�L� . - c{ '�c�C�-- .� ��_�� -� t ��z�_�� 'O q t, L� :F�REA 44a � `�-o�r,-,�,,r��'-e.,,— �U L�...lo�-�` ��s-MiL�-- -i—i k�,^ _ �x 2,,;,��-$� � � STRUCTURE INFORMATION: • r 1.Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length (ft.)= �`� � � Number of bedrooms= �Wood/Frame b.Width (ft.)= � � Number of garage sta s: ❑ Masonry �---�l.N�� hi� ❑ Metal Areas in s uar feet �, Attached = � �-k PS ❑ Pole Bldg. c. Basement= ��{-�,C Detached = ❑ ICF d. 1 S'Story = _�t,(L�� ❑ On-site Prefab e.2"d Story= ("�� ❑ Off-site Prefab f. '/z Story = � ❑ Other(please specify): g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ Permit A lication ❑ Pro osed Buildin Plans -- �-< � ❑ MN State Ener Code Calcula�ons and echanical Code Re uirements Form ❑ ❑ Surve meetin all re uirements ❑ � Stormwater Pollution Prevention Plan ❑ Hardcover Calculation s v� ' 2; - ` ❑ Se tic S stem Site Evaluation Re ort ❑ Access Permit ❑ Wetland Buffer Im rovement Plan ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: tJ�- ;+� \�«r� t - � • 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; • Understands 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. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site improvements. �_, ApplicanYs Signature: � ' Date: �� D � ��-- � � Owner's Signature: i ?''L' Date: �;- � �c ,�.�-l�� - , Print Form � � --- � WATER RESOURCE PERMIT APPLICATION FORM Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a proposed project or work which may fall within their jurisdiction.Fill out this form completely and submit with your site plan,maps,etc.to the MCWD at: 15320 Minnetonka Blvd.Minnetonka,MN 55345. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1.Name of each property owner: t (<� '`� Mailing Address: C < p, City: �r��41�State:�_ Zip:��q Email Address: -{-�Z�j`,��a S��ctc+[ . �-r w� Phone:��`]�,�jl� Fax: 2. Property Owner Representative lnformation (not required) (licensed contractor, architect, engineer, etc...) Business Name: � � Representative Name: Business Address: �' City: State: Zip: Email Address: Phone: Fax: 3. Project Address: ( � i �, a ; City: �Y�YL.C� State:_ {� t.� Zip: ��'' � ' Qtr Se tion(s): ��Section(s): 111 Township(s): '�Range(s): o� -6C t� Lot: Block: Subdivision: PID: - •a .�. _ c�<� 4. Size of project parcel (square feet or acres): r] Area of disturbance(square feet): � O� �.-�e�� Volume of excavation/fill (cubic yards): �. Area of existing impervious surface: U Area ofproposed impervious surface: (�Qp-�(p�� c�,#' �' Length of shoreline affected (feet): ►�c Waterbody(&bay if applicable): N 1 lk 5. Type of permit being applied for(Check all that apply): � EROSION CONTROL -r"j�; �-}- �� I�.,�� ❑ WATERBODY CROSSINGS/STRLJCTURES ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT ❑ WETLAND PROTECTION �~ Q�'e' ❑ APPROPRIATIONS ❑ DREDGING ❑ ILLICIT DISCHARGE ❑ SHORELINE/STREAMBANK STABILIZATION 6. Project purpose(Check all that apply): �,SINGLE FAMILY HOME O MULTI FAMILY RESIDENTIAL(apartments) ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL ❑ UTILITIES ❑ SUBDIVISIONS(include number of lots) ❑ DREDGING ❑ LANDSCAPING(pools,berms, etc.) ❑ SHORELINE/STREAMBANK STABILIZATION O OTHER(DESCRIBE): 7. NPDES/SDS General Stormwater Permit Number(if applicable): 8. Waterbody receiving runoff from site: 9. Project Timeline: Start Date: �•�- �� Completion Date: 3� Permits have been applied for: City County ❑MN Pollution Control Agency ❑DN ❑COE ❑ Permits have been received: City County-�MN Pollution Control Agency—�DNR—�COE—� By signing below,I hereby request a pennit to authorize the activities described herein. I certify that I am familiar with MCWD Rules and that the proposed activity will be conducted in compliance with these Rules. I am familiar with the information contained in this application and,to the best of my knowledge and belief,all information is true,complete and accurate. I understand that proceeding with work before all required authorizations are obtained may be subject to federal,state and/or]ocal administrative ivil and/or criminal alties. ,� c � Signature h Property r Date �. Cu-�'� i,��•� ��x.i� I So;� �v b.e, �^�h1.ca�e� `�ar �trLc:Q, c� ` a U c�.-��.c�_ � CX`�,e�- �..Q_.c.�.. l�L�r� REVIE1dV CFiEC�LIST �OR �IE1IV STR�JCTtJRES / �DDITIONS Address/Permit Number: ��s� ��&''l�J��% � Description of v✓ork: _ �"��— �� Septic review by: Date Approved: Zoning review by: Date Approve�: Building review by: Date l�pproved: Gradinc� review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC NVidth: Lot Coverage: SF _% Survey Submitted: �Yes � No Date of Survey: Revised date(?): Pro osed Setbacks: ' � � `�` � a Front(Lake) Rear(Street) � � � E W ) ( �! S E � ) Other Buildings Wetland � Sicle Side � Defined Height: Peak Height: FFE: ��E minus 6 feet= (Existing Contour) '' Perimeter(linear feetj = 50% _ #of Stories Ok? � YES FOR A BUILDING�NITH A BASEMENT OR CRAWL SPACE: The distance between the lowest FOR A BUILDING ON A&LAB FOUN�ATION: START WITH proposed floor(of the basement or crawl space)and the highest point of the roof. START WITH The distance between the top oi slab and If you have a... the highest point of the roof. If you have a... a GABLE OR HIPPED ROOF(no • GABLE OR HIPPED ROOF(no windows): Subtract half the windows): Subtract half the distance distance between the highest point between the highest point of the roof of the roof to the low point of the to the low point of the corre5ponding SUBTRACTION corresponding gable or hipped roof SUBTRACTION gable or hipped roof (BASED ON ROOF . GABLE OR HIPPED ROOF(with (BASED ON • GABLE OR HIPPED ROOF(with TYPE) windows): Subtract half the ROOF TYPE) windows): Subtract half the distance distance between the top of 4he between the top of the highest r� highest window and the highest window and the highest point of the point of the roof �aaf ' . ALL OTHER ROOF TYPES(flat, • ALL OTHER RUOF TYPES(flat. mansard,etc):No subtraction. mansard,etc.No subtraction. ADDITION Add the distance between the top of slab SUBTRACTION Subtract the distance between the (BASED ON and the highest existing grade adjacent to X (BASED ON EXISTING basemenUcrawl space floor and the EXISTING the foundation. GRADES) highest existing grade adjacent to the GRADES foundation OR 10 feet(whichever is less). EQUALS Defined building height ti EQUALS Defined building height Shoreland District 11AC1M� I�ermit Receivec� ��era e Lakeshore Setbacl� lVlet? �lu � �/ � Yes � No N/A � Yes No � Yes � No � Yes � No �N/R Permit Number:� Setback: � Storerewater(�ualit� Existing Proposed �r�riance Required CUE' Required � Overla Distri�t Tier F9ardcov�r Hardcover � � Yes No � Yes No � Type(s): Type(s): Updated: January 2013 v:\forms�plan review checklist 2013.docx . .. - . -� . >E .,; --,� ; „ . � , ��; _ �� ri:�. REMARKS (in-house): Fe�s to be Char ec� YES NO Petlnit ; Plan �eview Sta#e Surch�rge $ investigation l�ee ;, SAC—Number of SAC Unit� Other(specifiy) S uare Foota e $ er S uare Foota e Basement X - $ �' 1 S�Floor X = $ 2nd Floo� X - � Garage X - $ Estimated Construction Value: $ Orono Inspections Required Work Requiring Separate Permits Required State Rereroits �; 0 Site 0 Plumbing Q Grading/ Filling � Well � Hardcover Removal 0 Mechanical 0 Fire Q Electrical � Footing � Septic 0 Water Connection � Poured Wall � Fireplace � Sewer Connection �a 0 Foundation Survey C� Masonry � Lawn Irrigation Q Radon Rock Bed � Mfg. 0 Framing 0 Other(specify) � Insulation � As-Built Survey � Final �� Wetland Buffer � Other(specify) REMARKS (in-house): � Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES 0 NO New: � YES � NO ` OFFICIAL REMARKS -TO BE NO�"�D OR! �ERN6iT AND If�tTIAL�LED ; � Updated: January 2013 v:\forms\plan review checklist 2013.docx , ti .:�..�, ¢" ��"�i��:«'�„�.��`��r�,�:,��' ;�:�.-��`".��a��,�� `q ,��'�' �.�` ��'�%?`"�`' ��, ,..,_ ..�, �__