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HomeMy WebLinkAbout2014-00612-EXPIRED-never used cit nod lo UP �ITY OF O 11" BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS �Ol VO Mailing Address: /Receid PO Box 66 Crystal Bay, MN 55323-0066 - Street Address:' �l2750 Kelley Parkway S`fy 0 9Orono, MN 55356 r,t 0), SHMain: 952-249 4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required n// Id ubmitted. �jj Incomplete applications will be re_ turned ( ase rih J (/ GENERAL INFORMATIO / 17.30 '�d ( el A f°' Job Site Address: 3' © !U Will this be a Parade of Hollies, Remo eters Showcase Home r other Display Home? ❑ Yes [ No If yes, a special event permit is required with Police Department and City Council a ,oval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. No ermitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: 1�5 t--lov�v> mac State License# �L 2(o`tlo' b Expiration Date: 0 3 3l l S i~J Phone: cell (.ct ct office 1 i�,3 y a�;_ ;'333 Mailing Address: 'D 11 7 =t 1111— Cit : Na fV- - ZIP: 5 S 3 Contact Person: A4 a� Ww Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: ✓.1 a,LG °,,A—e,5 OA C_<)-A 7b '390 00"-( PROPERTY OWNER INFORMATION: Name: e,1 ,-, ,f,4 5 1/4 Phone (day): 7b 5_6S Zaoo Address: zs' Acf N Citv: Sf Cl0i4 ZIP: 5 30j Email and/or Fax Q� RVA.; ARCHITECT/ENGINEER INFORM ION: Name: Gry i K S� '` Phone (day): ­ " a `I Address: Zq i 3 I-h 11 u/ City: AtId�1' ZIP: Email and/or Fax: 5- 303 PROJECT INFORMAT N: Description of project: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & Water Supply ® New Construction eZ Single Family with Residence []Addition attached garage ❑ Garage/Accessory Bldg. El Public Sewer ❑Accessory Buil ' g [:1 Single Family with El Deck ❑ Relocation detached garage ElOffice/Commercial El Private Sewer El Other: (speci ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage Public Water **Any earth movement may also require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www,minnehahacreek.or Estimated Construction Valuation (excluding land) $ 'z_e; / O � k STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions (continued) 2.Type of Construction a. Length(ft.)= `7 �= Number of bedrooms= Wood/Frame b.Width (ft)= -36 Number of garage stalls: ❑ Masonry Areas in square feet Attached= E] Metal ❑ Pole Bldg. c. Basement= Detached= ❑ ICF d. 1"Story = �3`l °o _ ❑ On-site Prefab e.2"d Story= 5 ❑ Off-site Prefab f. '/2 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 Applicable ❑ ❑ Permit Application ❑ ❑ Proposed Building Plans ❑ ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form ❑ ❑ Survey(meeting all requirements) ❑ ❑ 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 ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: APPLICANT/OWNER 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; • 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. Applicant's Signature: �V�l�l `Y Date: �O / Date: Owner's Signature: i � G1:"� l 3l ` LLAtV REVIEWC1.6ECKLIST'FOR (EUV STRUCTURE S / ®DNTIOIVS �- Ad d-16 �+ y Permit No. Description of work: { + Date Rec1d: Septic review by. Date Approved: - <; Zoning review by. ..; iSate Approved: l Suiiding review'by: Date Approved: Grading review"by. -° Date Approved:IF _ Zanittg District: PletZoning Flie#:, Reso# �" R o Date: Zoning: Lot Area:33 : >=/AC Wid#li.'? j® Lo Co er"*. Sig %. Survey Submitted: Yes - V'No Datd of Survey:-� Revs Pro ed Setbacks: - Front '' Rear $ E ) N„ 5cteW � Other Sulldirtgs ; INe#land " t 4- L V Defined Hsight: c � Peak Heighi: � _ ,.FFE: 'FF'E miners 6.feet � � n our Did a wry Perime#er linear feet)= 50d�o Q L.F� below.grade #of,5tories TRC FOR A BUILDING,WITH A BASEMENT OR CRAWL SPACE, Ft�it A BUIL D ON A SLAB FOUNDATION. The`distanoe between the iowest proposed The distance between top of STA RT WIl ." floor(of the basement or crawl space)and START WITH J slob-and the highest int of the the highest point of the rgof. roaf. If You have a... If you have a... • GABLE OR HOPED ROOF(no GABLE HAWED ROOF windows): Subtract ha the dls nce (no Subtrath half trefween the highest point of the roof the stance"between the to the lowodh t of the corresponding h e"low pestpoinoint of th8 the' t4" SUBTRACTION gable or hlpped roof corresponding gable or (BASED Old . . ` GABLE OR"HIPPED ROf1F(with SUBTRACTION hipped roof" OOF"TYPE)" : windows) Subtract hall"the distance " (BASED ON . GABLE OR HIPPU ROOF. R 'between the too`ofthe.highest ROOFIXPE) Iwo, flows): Sutttroct window and the`highest point of"this half the distance between" roof' the top of the highest ALL OTHER ROOF TYEyl=S(fiat window and the highest mansard,etc):No subUactloo. point of the roof •" ALL 01"HER ROOF TYPES t SUS"IRACT"�N Subtract the dtetanoe'betwean;he (flat.inansaW,etc).No .(BASED ON bes tmert/crawl specs floor and the su on. a� IS^TiNG ;. highest existtrrg.gradeadiaoentto ADDITWN Add the distancse between tha�top GRADES) foundation OR 10 feet(whichever Is less). (BASED ON of slab and the ht hest existln" EQU S. Definad buUding height EXISTING „ grade ad)acento,thefoundaticn. ,�� p� GRADES IEQ Defined buadin$helght Average t,alt8shore Setback Shorsland,Dlstriat 19fICif1� P+ rmltMef't Sluff f f" Permit(dumber ` - " Yes D No N/A t Yes No " Yes 'I No [] NIA see attached ' Setback: Stormwater Quaitty Proposed F_icistingiardcover " Overlay Dlstriet o Hardcover- ; Parlance Required WP squired (.. 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Issue Date: Fees:F Paid: Last Paid: Voided By: Voided Date: Status:': Due:3 Last Receipt: ._._............ _.....� N � 1 --1 f,M E" € iipxtafi€e r�ddra,s;s Permit{t 2014-00612 to Main PIN Address Permit Address; 13730 Norff-rem Ave n1,"1k:ina#PlN Add N rcr a€:+1,::€urn g:m;;rrpi OR APPROVED,H:a8 Pale Issue r Permit y liJ General Fees Inspections(12) Notes }Applicant Detail i CO Detail Note 1: Separate Permits Required:Plumbing, Mechanical,Fireplace,Grading,Fire, Water Connection,Sewer Connection,Lawn Irrigation,Other ,Well(State),Electrical(State) 3 t Note:Sift Fence must be installed and inspected by City prior to any work.A minimum of 24-hour notice is required prior to an i inspeciton.Initial: 3 NOTE: Prior to the start of framing an as-built foundation survey must be submitted and approved by the City or a stop work order will be issued: Initial: -210W lk V-1 Note 2: ri all vrrc needed to add$1 ee+roas originally wrong valuation. However,that difference was based off 2014 rates. The rates increased in 2015 now the difference ovveo on the Plan Review Fee is:$97.72 which will be added to the permft. 2A 7A 7 PERMIT IS EXPIRED j e . MINNEHAHA CREEK WATERSHED DISTRICT QUALITY OF WATER QUALITY OF LIFE Pursuant to Minnesota Statutes Chapter 103D, and on the basis of statements and information contained in the permit application, correspondence, plans, The Minnehaha Creek maps, and all other supporting data submitted by the applicant,and made a part hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant Watershed District is named below for use and development of land in the Minnehaha Creek committed to a leadership Watershed District. role in protecting, improving and managing Issued to: Atlas Homes Permit No: 14-586 the surface craters and Location: 3730 Northern Ave Orono affiliated groundwater Purpose: Erosion Control—Single Family Home resources within the Date of Issuance: 12!412014 Date of Expiration: 12/4/2015 District,including their By Order of the Board of Managers relationships to the ecosystems afwhich Brandon Wisner they are an integral part District Technician We achieve our mission This permit is not transferable without District approval, and is valid to the date of through regulation, expiration. No activity is authorized beyond the expiration date. if the permittee requires more time to complete the project, an application for renewal of the capital projects, permit must be received by the District at least 30 days before expiration. education,cooperative The applicant is responsible for compliance with all District Rules and for the endeavors,and other action of their representatives, contractors, and employees. programs based on Conditions: Project to be completed as described in plans submitted to the sound science, MCWD office on November 26th, 2014 according to the provisions of this permit. innovative thinking,an ® Properly install and maintain all required erosion control measures until the disturbed areas are re-stabilized informed and engaged . When the site is re-stabilized and the MCWD staff has constituency,and the performed a final inspection, all silt fences must be removed cost effective use of (Statement concerning fees for inspections, violations, etc... on following page) public funds. 15320 Minnetonka Boulevard,Minnetonka,MN 55345.Office: (952)471-0590• Fax: (952)471-0682 9 wwwminnehahacreek.org MIEHAHA CREEK WATERSHED DISTRICT QUALITY OF WATER QUALITY OF LIFE Inspection/Analysis/Monitoring Fees The Minnehaha Creek A site inspection and monitoring by District staff will be performed where the Watershed District is activity involves: committed to a Leadership • a commerciaUndustriallmulti-family residential development role in protecting, . a single family residential development greater than 5 acres or of any size if improving and managing within the Minnehaha Creek subwatershed • any alteration of a floodplain or wetland the surface waters and • dredging within the beds, banks or shores of any protected water or wetland • a violation affiliated groundwater • any project which in the judgment of the District staff should be inspected resources within the due to project location, scope, or construction techniques District,including their relationships to the In these cases, the applicant shall pay to the District a fee equal to the actual costs of field inspection of the work, including investigation of the area affected ecosystems of which by the work, analysis of the work, and any subsequent monitoring of the work, which in the case of a violation shall be at least$35. they are an integral part We achieve our mission through regulation, Standard Fee Schedule capital projects, District professional staff $ 65.51* education,cooperadw District interns $ 40.35* District clerical staff $ 46.69* endeavors,and other Consulting Senior Engineer $contracted rate programs based on Consulting EngineerlTechnician $ contracted rate District Counsel $ contracted rate sound science, Application fee $ 10.00 Copy costs $ .25+ actual staff time innovative thinking,an Color copy costs $ 1.00 + actual staff time infomel and engaged constituency,and the * Hourly cost effective use of public funds. 15320 Minnetonka Boulevard, Minnetonka,MN 55345.Office:(952)471-0590•Fax:(952)471-0682•www.minnehahacreek.org