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Home My WebLink About2010-00329 - addn/remodel/repair CITY OF ORONO PERMIT NO.: 2010-00329 , 2750 KELLEY PARKWAY � ORONO, MN 55356- DATE Iss[1En: OS/1U2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 1620 SHADYWOOD RD PIN : 17-117-23-21-0012 LEGAL DESC : SHADY-WOOD : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 2,000.00 NOTE: SEPERATE PERMITS REQUIRED: ELECTRICAL(STATE) OK'D BY LYLE OMAN OPEN WALLS ON MAIN&2ND FLOOR APPLICANT PERMIT FEE SCHEDULE 73J5 ROSACKER,DON STATE SURCHARGE(VALUATION) 1.00 1620 SHADYWOOD RD WAYZATA, MN 55391- TOTAL 74.75 OWNER ROSACKER, DON 1620 SHADYWOOD 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 specifica[ions,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 worh which requires separate permits. All provisions of laws and ordinances governing this type of work shal]be compied with whether or not specified herein.This permit will expire and become nul]and void if construction authorized is not commenced within 180 days of the da[e of issuance,or if consVuction is suspended for a period of 180 days at any time after work has commenced. The applicant responsible for assuring all required inspections are re e in conf mance with the S Building Code.This permit may be �� voked at any e for due cau . r/j' �/ j� l��4—' ( ( . � / �, �'. l ( l �' - , ��'Yj C� ��- � plicant Permitee Signat re Date � � Issued By Signa ure Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � j _ ±i Y tti42 v"�{�y�s��wyR»'++"'W 7f°',.nrf tt�•f^ �p"' i%E",: �Ug�'1 y � . �K� _ 3w �F.ti. ,y ��.�T` ��F�N �\ . . . . .. ��:� �' � ��: City of Orono �� Building Permit Application for Internal Work � .� , , �}f (windows, doors, siding, re-roof, etc.) � �f � Mailing Address: � �T �0,� PO Box 66 Permit number: �,w � ( 0 ,:\ Q Crystal Bay, MN 55323-0066 Date received: � } + r � Received b � �' i� � �� 4�+,� �, � Street Address: y� �� 6j� G��' 2750 Kelley Parkway Plan review fee: �� `�kEsxog'� Orono, MN 55356 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 retu ned. (Pleas pri - GENERAL INFORMATION: � �- �`` Job Site Address: . ' /(/�Jc. ,� t Will this be a Parade of Homes, Remodelers Showcase Ho or other Display Home? ❑ Yes ❑ No ��` If yes, a specia/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. k�r�' �� CONTRACTOR/APP�ANT IN�RMATIO� �� #F, ��: Name: 1 a,v '� �hS,hC P� �'` State License# Expiration Date: � Phone: _ ' - � office O cell '� �',, Mailing Address: - �� ' � City: � ,i,y,,�0 ZIP: �' Contact Person: � c� A licant is: Contractor / Homeowner pp (Circle One) �= Email and/or Fax: d o,i1 � �-r,�,�� ,� , L��,�, �� PROPERTY OWNER INFORMATION: ;�� .°r:: Name: " �O.� ` O S C�� a- �" Phone (day): �r Address: Cit : ZIP: Email and/or Fax � �� ;�?': - �. _ C � ('C� �;, - �: PROJECT INFORMATION: ��°�� Type of Project: Any earth movement may require �,� MCWD review 8� permits ��-' ❑ Door(s) �emodel ❑Water Damage �3 ;�� Minnehaha Creek Watershed District(MCWD) ❑ Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd '�'" Deephaven, MN 55391 <"' ❑ Siding ❑ Restoration ❑ Other. (specify) Phone: 952-471-0590 k �. ,°: Fax: 952-471-0682 �" ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq ��,; a� Overall Project Description: � � � � ��. Estimated Construction Valuation of roject(excluding la ) $ � �a'= ��} APPLICANT ACKNOWLEDGEMENT: � �; �; • Agrees to provide all information required or requested by the Building Department; ��: • 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; : • Some or all of the information that you are asked to provide on this application is classified by State law as either private or �,.a 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 ��: r, purpose and intended use of this information is to annually update our records and records of other governmental agencies re uired b law. If ou r�f�se�fo�s'u information, the a lication ma not be issued. �t .' n� �: � / �; ApplicanYs Signature: �• � Date: � �� .� � �,.�� Last Updated: 05-04-2009 � s .� , � „: �';�� . �� " � ,�= � t �K � a �: ��.''�,.ak� �s� ' �_�.�x,_�r= �__.. „ �.s��a : __._ _. . . Plan _Review_Checklist for New Structures / Additions - - Address/ PID/Legal: I (o?�O S t-4-r4✓Jy �00� Description of work: `_ c�QC37V 5 O� ,.a..r.�.S �1.o D ►4�—�,,��,yZ S Septic review by: /✓��j Date Approved: Zoning review by: �� Date Approved: Building review by: Date Approved: �"-//-/(� Grading review by: N l� Date Approved: Z ning File#: Resolution#: Resolution Date: Zonin District Fire De artment Post Office ool District Zoning: Lot Area: SF/AC Width: Depth: Survey Submitt : � Yes 0 No Date of Survey: Pro osed Setbacks: Front(Lake) R r(Street) ( N S E W ) ( N S E W Other Buildings Wetland Side Side Building Defined Height: Building Peak H �ght: FOR A BUILDING WITH A BASEMENT OR CRA SPACE: F A BUILDING ON A SLAB FOUNDATION: START the distance between the ba ment floor/ START the distance between the slab and the WITH crawl space floor and the high t roof peak, WITH highest roof peak, the top of the cornice the top of the cornice of a flat roo the deck of a flat roof, the deck line of a mansard line of a mansard roof, or the upper ost roof, or the uppermost point on a round or oint on a round or other arch-t e ro other arch-t e roof SUBTRACT half the distance between the highe SUBTRACT half the distance between the highest window and highest roof peak of itched window and highest roof peak of a roof itched roof SUBTRACT the distance between the ba ment floor/ ADD the distance between the slab and the crawl space floor and the � hest existing highest existing grade within the grade within the foundat� n or 10 feet, foundation whichever is less. EQ LS Defined buildin hei ht EQUALS Defined buildin he' t Lot Coverage: SF % Shoreland District MCWD Permit Received Avera e Lakes re Setback Bluff 0 Yes p � Yes � No � N/A p Yes O No 0 N/A � Yes � No Permit Number: S�tback: Hardcover nes Existin Pro osed Variance Re uired CUP Re uired �'� O Yes 0 No Yes � No 75- 50' Type(s): T e(s): 250 500' 500-1 0' REMARKS (in-house): /��4r��-P Updated: 07/01/2009 z:\forms\plan review checklist.doc�c - Fees to be-Cha ed - YES N0 --- -__ _ , ---- �t��' � �" - � , Plan Review �/' �t�e�c�, e Investi ation Fee - �� -�"s1��ber��fsS�4►��a�ts Sewer Connection ��r�� _ Park Fee �a��i ,��#�c��a, , Other(s eci _ ,. .. ,_ ��a�as��s�e�es;; ° . : :, Calculated B : � UBC: Construction Type: S uare Foota e $ er S uare Foota e Basement X = $ 1 Floor X = $ 2" FlOor X = $ Gara e X = $ Estimated Construction Value: � 0 00 �� Orono Inspections Reauired Work Reauirinu Separate Permits Required State Permits 0 Site 0 Plumbing 0 Grading / Filling � Well 0 Hardcover Removal 0 Mechanical � Fire Electrical � Footing � Septic 0 Water Connection � Foundation Survey 0 Fireplace � Sewer Connection �'Framing 0 Masonry � Lawn Irrigation � Insulation � Mfg. � � Wall Board � Other(specify) 0 As-Built Survey � Final 0 Other s eci REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: 0 YES � NO New: � YES � NO REMARKS (TO BE NOTED ON PERMtT AND INITIALLED BY PERSON PULLING PERMIT) Updated: 07/01/2009 z:\forms�plan review checklist.docx � �� . � �� Rq!�� . �� ,�� '� , . __ �y�..�,�.x BUILDIlvG P =�P ►� l+tti Hr.V!�VV - M45PEGTOft _C��/�f�l/e�`_ �d'-��!-�� t��f � -�ATF"_�__I_I_�L�---- ..._ _:,?..;T rl'_�___J /� ��•� �� EE ,t�?'�'"'a�:�}�;:.�� ',��4,9.��.' �r�l' �. 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CONTRACTOR �: DESCRIPTION �� l� ❑ FOOTING ❑ PLUMBING FINAL ❑ EX V/GR DING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LA E/WETLANDS � 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 � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTAIL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � � O � � O � W � Q � Z W � W � � . GW �r �NORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CAIL INSPECTOR � CITATION ISSUED O IHSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (J52� 249-4600 OwnedContractor on si : � Inspector. l � White Copylinspector's File Canary Copy/Site Notice