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Home My WebLink About2012-00172 - addn/remodel/repair � _ ' � ' CITY OF ORONO * 2 0 1 z - 0 0 1 7 z * . 2750 KELLEY PARKWAY DATE ISSUED: 03/06/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1340 REST POINT CIR PIN : 07-117-23-31-0021 LEGAL DESC : REST POINT PARK LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 6,000.00 NOTE: SEPERATE PERMITS REQUIRED: ELECTRICAL(STATE) FILL IN SCREEN PORCH,INSULATE,DRYWALL,ADD WINDOWS APPLICA1�iT pERMIT FEE SCHEDULE 132.75 EDWARDS,JACK STATE SURCHARGE(VALUATION) 3.00 1340 REST POINT CIR TOTAL 135.75 MOUND,MN 55364 PAID WITH CC# 6725 OWNER EDWARDS,JACK 1340 REST POINT CIR MOLJND, MN 55364 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be perfortned 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 goveming 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 I80 days of the d e of issuance,or if constructiod is suspended for a period of 180 days any time after work has commemced. The applicant is responsible for uFing all required inspections are requested in conformance with t e 5tate Building Code.This permit nhay be revoked at an}�"s ue ca e. 1 �,,, ; � ,t / /�� / p icant Pe ' ee Signat Date Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � i , � � � City of Orono Building Permit Application for New Structures or Additions Mailing Address: �� /�,0,�\ PO Box 66 Permit number. ' , � Crystal Bay, MN 55323-0066 Date received: / '� �r � // /� ll�,a �''�,-;'� �,�, Street Address:� Received by: �-d/ ��'�,n ��, G�� 2750 Kelley Parkway Plan review fee: \'�R�'"�.�`r 4� � Orono, MN 55356 �kEsi�o=/ /L/ `�' ��/ � --- 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: `�' ��;, ,'; � ; /� ��f � �� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o If yes, a special evenf permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service be required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMA O Name: �ct c� �� i•�,��f State License# Expiration Date: Phone: - � .�- (.� office cell Mailing Address: P � ` � � Cit : ti ZIP: , _�� Contact Person: ,�. � ' Applicant is: Contractor / omeowner (Circle One) Email and/or Fax: `��=' - C� `'-- ` PROPERTY OWNER INFORMATION: Name: .�! - � S Phone (day): L �n G Address: D e�'f c��'�l� _`�'� Cit : �� ,;,-�� ZIP: � �� Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: r`l� �� S��iJ �iC'C�c�S ' �- i1'l d 1�v;�I�� :_��., ? I I � w •��u�,s 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & � Water Supply ❑ New Construction ❑ Single Family with �esidence ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer p y ❑Warehouse ❑ Public ❑ Storage ❑ Public Water "''`Any earth movement may 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.m innehahacreek.or Estimated Construction Valuation (excluding land) $ bG�, ; , �� , � , � , • "''R ► 1 STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= � Number of bedrooms= ood/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. 151 Story = ��i��-� �_ / � ❑ Other(please specify): � ,�. e.2nd Story= ` f. '/z Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ ❑ Permit A plication ❑ ❑ Pro osed Buildin Plans � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ ❑ Surve meetin all re uirements ❑ ❑ Storrnwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Report ❑ ❑ Access Permit ❑ ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee ❑ ❑ 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; • 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 govemmental 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 agreement to ensure completion of the as-built survey and all site improvements. �'� r � i ApplicanYs Signature: , �G�C�� _`�J Date: ,3'— � r �`��'`- � \ � r � ,r • BUILDING PERMIT APPLICANT: PROPERTY O�VNER `� ,. � I, ��r�.-�2 C��,�� _� �, understand that the State of Minnesota requires that a'�1 residential building contra,c s, remodelers and roofers obtain a state license unles�they qualify for a speci i emption from the licensing requirements. This license requ�`'ement applies to owners of residential real estate who build or improve such property for purposes of speculation or resale. By signing this document, I attest to the fact that I am improving this house for my own use and am not building or improving this house for the purpose of reselling it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, located at 1�(�� -�oiN��, Orono, is the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been e�titled under Minn. Stat. §514.01. Furthermore, I acknowledgle that I may be hiring independent contractors to perform certain aspects of the const#uction or improvement of this house and I understand that some of these contractors r�ay be required to be licensed by the State of Minnesota. I � understand that unlicensed xesidential contracting,remodeling, and/or roofing activity is a misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to $10,000. I further state that I understand that the filing of a false statement with the City of Orono may also result in criminal prosecution and/or civil penalties pursuant to applicable city ordinances and/or state sfatutes. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be�esponsible to the City of Orono for compliance with all applicable building codes alnd city ordinances in connection with the work being performed on this property: G�,•� ' N e ,! 3 �' � "' � �'� Date For questions or informati�n�on contractor licensing, or to check the licensing status and enforcement history of a�articular contractor, call the Minnesota Department of Labor and Industry, Construction Codes and Licensing Division, at(651) 284-5069. The Web site is: www.doli.state.mn.us/contractor DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. co" LETED � !•' `�� ADDRESS (�� C7 �Si Ya�N ?' �/�Q.� OWNER TELEPHONE NO. CONTRACTOR � DESCRIPTION � � FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHpNICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER,HOOK-UP ❑ COMPLAINT v ❑ 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: � W a or�t c� w o-�,�. v�rf �-� ��2v�►� s� � ,� 5 � s 5 we-c..P 0 � W � Q � 2 W � W � � d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN �TOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUtRED.CALL TO ARRANGE ACCESS: Cail forthe next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor Inspector. YVhite Copyllnspector's Ffle Canary CopylSite Notice �� DA TIME V CITY OF ORONO CALLED IN Z— INSPECTION NOTICE CHEDULED Z ��•'3v PERMIT NOa4/�/7� P�e�re� � ADDRESS �� OWNER f TEL�PHONE NO��-�7��s� CONTR TOR a DESCRIPTION � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ 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 i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ WARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATIOWREMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO ��., COMMEWTS: � W a o r '�.eS' �. � 0 � W � Q � 2 W � W � � W �NIORKSATISFACTORY:PROCEED ' ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRFCT WORK,CALL FOR REINSPECTION i TEMPORARY V BEFORECWERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ' ❑CITATION ISSUED ❑STOP OHDER POSTED.CALL INSPECTOR ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Ca11 forthe next inspection 24 ho�rs in advance. (952) 249-4600 Owner►Contractor on site: � Inspector. White Copyllnspector's Ffle Canary CopylSite Notice DATE TIME V CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED `� ' ' j � � PERMIT NO.��O�� COMPLETED ADDRESS � � �fl I�� o� .. fi � � '�C-1 � OWNER ��'C-� ��-�t.J��EPHONE NO. CONTRACTOR � DESCRIPTION �/LcS v [ A ��D N � ❑ FOOTING ❑ PLUMBING FINAL p EXCAV/GRADING/FILIING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL � ❑ TREE REMOVAL ? iL�fR6ULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION �❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ S�PTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � J O � � o �, .-�� W � Q � z W � W � j d W��1MORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W O CORRECT WORK 8 PROCEED ' ❑ ISSUE CERTIFICATE OF OCCUPANCY p ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFOREC�IERING PERMANENT ❑CORRECT UNSAFE CONDITION W17HIN HOURS. p pHOTO TAKEN INSPECTOR WlLL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPEICTOR ❑ IIVSPECTION REQUIRED.CALL TO pRRANGE ACCESS. Cail for the next inspectio 24 hours in advance. (952) 249�46�� OwnerlContractor on s' : Inspector. � White Copyllnspector's file Canary CopylSite Notice