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Home My WebLink About2016-01093 - addn/remodel/repair {„ CITY OF ORONO * Z 0 1 6 - 0 1 PJ 9 3 * 2750 KELLEY PARKWAY DATE ISSUED: 09/27/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2166 SHADYWOOD RD PIN : 17-117-23-42-0011 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 000 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIV[TY : 434-RESIDENTIAL VALUATION : $ 78,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STATE) 1 ST FLOOR REMODEL APPLICANT PERMIT FEE SCHEDULE 936.56 STATE SURCHARGE(VALUATION) 39.00 REVISION LLC TOTAL 975.56 153 E LAKE STREET WAYZATA,MN 55391- Payment(s) (952)540-7150 CHECK 12552 975.56 Minnesota State License#: BUIL-BC639027 OWNER LACROIX, STEPHEN&SUSAN 2166 SHADYWOOD RD WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according[o 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 pennission 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 180 days at any time afrer work has commenced. The applicant is responsible for assuring all required inspections are requested in c ormance w the State Building Code.This permit may be revoked at y ti e for du use. � , f �_- �� , I C_: _ � /�—�-,C��E'-='1 �� / �'_l/ � �^ Applican P mitee Si ature Date Issued By Signature Date �, City of Orono , Building Permit Application for Maintenance/ Replacement/ Remodel - Residential ONLY (�.�, ��a��ir��. ��r�a�r�, �ic�sr��, ��c��, ��. -� �C� ��"��R��ffi`i.��. ��:��If�� j� O A�,. Mailing Address: � ermit number: p��p�d/D 9'� / � j Y� PO Box 66 �� ;� , Crystal Bay, MN 55323-0066 Date received: 9 --� 1�� SireetAddress: _._..--.---__ Received by;-__. _�_____ �� ti 2750 Kelley Parkway ''�-��C �C- l�24� Plan review fee. �PD gi��n �' ��t� .- `t�,G Orono, MN 55356 � � � _ �� k L 5�i O `._._______-��.___ -�8��1.•F�Ar-----�-- -- Main: 952-249-4600 Fax: 952-249-4616 wwvv.ci orono mn us � Y 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: �21 �� l�- S��I.��.��C�� Z�� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes,a special event permit is required with Police Depariment and City Council approval 60 days prior to ihe event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenis will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: � � �p State License# � Q'��(�L-', Expiration Date: 'Zj 2( �j� Lead Certification Number: ��T_ ��?a_ � Expiration Date: 2( • (for work on homes that were constructed prior to 1978 Phone: (cell) (��Z '�(U -- -1 Z��(SZ (office) (SZ�'Z-�j1LZ-- �,t�:x> Mailing Address: G)3 (�l/� S�- _ City: v�T,q ZIP: �� Contact Person: ( ,�� Applicant is; Contractor Homeowner (CirdeOne) Email and/or Fax: �------ ��11�1 �' �1 i�1G.�M 1�.�,�'.OP✓l PROPERTY OWNER INFORMATIP N�:'� �, � Name: S��t�j -I StXS��a �1]�i� Phone (day): Address: l� �� _- '�(� ��1�-d.. Iti.)�k`� �D City:- ZIP: ..��1 Email and/or Fax: PROJECT INFORMATION: Overall project description: 1.�� - 1G�� t� i�� S Type of Project: Any earth movement may also require ❑ Door(s) �-Remodel ❑ Fire Damage MCWD review & permits: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) ❑ Re-roof, cedar 15320 Minnetonka Blvd ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof, other(specify) ❑Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 — �Nindow(s) �vwav.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ - C�� `� 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 I 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 ou refuse to su I the information, the a lication ma not be issued. _.,,,,�.,._....,,,-:;�a—_ , Applicant's Signaturet'" �� Date: �- /� Owner's Signature: � Date: Last Updated:January 2016 C/�L`_ _ � (y �� //' i(/r 7 �/� � PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS ` Address: � f�/� Permit No.: ��l��' ��Q� Description ofwork: / s��6�d' , Date Rec'd: `, / �`� Septic review by: 67'�� /'p�[`� Date Approved: Zoning review by: Date Approved: Building review by: Date Approved: Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: Lot Coverage: SF % Survey Submitted: � Yes � No Date of Survey: Revised date ? : Landscape plan submitted? � Ye 0 No Landscaper: Proposed Setbacks: Front (Lake) Rear(Street) N S E W ) ( N S E W ) Other Buildings Wetland Side ide Defined Height: Peak Hei t: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50%= L.F. below grade Basement? � Yes � No, ories FOR A BUILDING WITH A BASEMENT OR CRAWL SP E: FOR A BUILDING ON A SLAB FOUNDATION: The distance between he lowe t proposed Slab at or above grade— START WITH floor(of the basement r craw space)and measure from hiqhest existinq the highest point of the oof. ra ade to the highest point of the START WITH roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR HIPP ROOF(no Slab below grade—measure (BASED ON windows): Subtra� half the distance from highest existing grade to the ROOF TYPE) between the highes�point of the roof hi hest oint of the roof. to the low point�f th corresponding If you have a... gable or hippe�roof SUBTRACTION ' GABLE OR HIPPED ROOF • GABLE OR H�PPED OOF(with (BASED ON (no windows): Subtract half windows): S btract h If the distance ROOF TYPE) the distance between the between the op of the ighest highest point of the roof to window an he highes point of the the low point of the roof corresponding gable or hipped roof • ALL OTH R ROOF TY S(flat, . GABLE OR HIPPED ROOF mansard, tc):No subtra tion. (with windows): Subtract SUBTRACTION Subtract the di�tance between t e half the distance between (BASED ON basemenUcrayol space floor and e the top of the highest EXISTING highest existirlg grade adjacent t the window and the highest GRADES) foundation O�2 10 feet(whichever s less). point of the roof • ALL OTHER ROOF TYPES I (flat,mansard,etc):No EQUALS Defined bu ding height subtraction. Defined building height EQUALS Updated: October 2015 z:\forms\plan review checklist 10-2015.docx Shoreland District MCWD Permit Average Lakeshore Setback Bluff Met? • Permit Number: � Yes 0 No 0 N/A � Yes O 0 Yes � No No � N/A—see attached Setback: Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required circle one % and sf % and sf 0 Yes 0 No 0 Yes 0 No 1 2 3 4 5 Type(s): Type(s): Fees to be Char ed YES NO Perm it Plan Review �/' State Surcharge (/� Investigation Fee � SAC— Number of SAC Units Other(specify� Square Footage $ per Square Foota e Basement X = $ 1 S� Floor X = $ 2nd FI00� X = $ Garage X = $ Estimated Construction Value: $ Orono Inspections Required Work Requiring Separate Permits � Footing 0 Site Plumbing � Grading/Filling � Poured Wall � Silt Fence/Erosion Control Mechanical � Fire 0 Foundation Survey � Hardcover Removal � Septic � Water Connection 0 Foundation Waterproofing � Other(specify) � Fireplace � Sewer Connection Framing 0 Masonry � Lawn Irrigation �Insulation � Mfg. 0 Landscaping � As-Built Survey � Other(specify) Final � Lathe Required State Permits � Other(specify) 0 Well Electrical REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: � See Builder Acknowledgement Form ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 �•\fnrme\nlan ravic�ni rhorklict 1!1_7(11F rinrv �� - _ DATE TIME CITY OF ORONO cnLLED IN ' INSPECTION NOTICE SCHEDULED Il•1 • � PERMIT NO. � '�� COMPLETED ADDRESS �'� OWNER TELEPHONE NO. Z' ��` . CONTRACTOR /i � DESCRIPTION � � ��""' 4� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YpU:_YES_NO y COMMENTS: � ' � � �� .,� /� �., � � - �. �-�- r-vo� o } �� ' G 1 /` C Q 1 � r{, GL O ✓(..�.., 1 /' v < . W / I � • � Q ` �/ .L �'t� i .,^ •v�, li 2 —, s • i� � ��✓� , � ' (7.J � w � S a �.nn� S r`!� j !7✓vt f7 � � �Jq�ORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE � ❑OORRECT W'ORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY � ❑(�RRECT WORK,CALL FOR REINSPEC710N TEMPORARY V BEFORECdI/ERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS_ O PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP OR�ER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS. Cau for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: Inspector: V a�L White CopyAnapecMPs File Canary CopylSite Notks �� - �--' D_ /STE ,� TIME CITY OF ORONO cnLLED IN ��-�,——� INSPECTIO �/D / ?�cHEDULED �� / /Co �D=l90 PERMR NO� �" PLETED ADDRESS OMINER TELEP ONE NO. 9 ��'��57� CONTRAC'ro� t�l,��LO�YC l � � DESCRIPTION '�� 1y ❑ FOOTINCa ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAVlGRADING/FILLINQ O ❑ FOUNDATION WATERPROOF ❑ PLUMBINCa FINAL ❑TREE REMOVAL Z ❑,�RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ,J�FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � �❑ INSULATION ❑WOOD BURNER/FIREPLACE ❑ COMPLAINT � ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP 41 ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIOWREMOVAL _ v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 O�l1�1lCONTRACTOR TO MEET Y�U:_YES_NO �let• � - /- 3 '/6 � �M� _ � _�, /IrOv rlG�i �10 i��/�.s� o✓ (�� 1� o -�leb- j o.s� 4s �•s�4 ss� - � � rC7l�i'�� /�✓L= T��[Is� �a�' ° L. vL �r... Sr�•t �aos•1 W � Q i �a'S� 4�,DG�s✓f � lC � ✓� �I� //�S�G�. �/!S �'J � j W ❑WORK SATISFACTORM PROCEED ❑PROJECT COMPLETE � WORK�PROCEED O ISSUE CERTIFK`.ATE OF OCa1PY1NCY 0 O W�ORK,CAIL FOR REINSPECTION TEMPORARY V �� PERMANENT ❑ppqRECT UNSAFE CONOITION WITHIN HOURS. ❑pHpTO TAKEN INSPECTOR WILL RETl1RN ❑3TOP ORDER P08TED.CALL INSPECTOR ❑qTAT10N ISSUED ❑INSPECTION REQUIRED.CALL TO ARRAN(3E ACCESS. caN�n��za no„�s��►�oa. (952) 249-4600 o�e�rcomra�o�sn�: . i�s�to ��- .� Whib CuPY��FlN Gn�ry Cop�NWIe� � �� CITY OF ORONO cnLLED IN '�—o�T�� T� INSPECTION N TICE HEDULED '—' '— � PERMIT NO. /D �MPLETED ADDRESS �� OWNER TELEPHONE NO. � �S7 CONTRACTOR �Z� � � DESCRIPTION ! '�� ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL 2 ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SIT ❑ SEPTIC INSTAIL 2 OMINEFUQ RACfOR TO M Y�OI�-�YES_NO � COMM 4 C> c.. �--�t.J �` j J O � � � �' 1 �r` 17r � � � �� • �' � ,�v e � d- Q _ � W W � � , W ❑WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE � O OORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECONERING PERMANENT O CORRECT UNSAFE CONDITION VYITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED �NSPECTION RE(]UIRED.CALL TO ARRANGE ACCESS. Call forthe next inspectbn 24 hours in advance. (952) 249-4600 OwnerlContractor or}site: �nspector:��L � WMte CopyAnspector's Flle Gnary CopyfSfta Notbs �`/� DATE TIME CITY OF ORONO cnLLED IN INSPECTIO ICE�, G scHEouLED - �..dO PERMIT NO. � COMPLETED ADDRESS � �C� � , 1 aMNER - TELEPHONE NO.� � �� CONTR�►CTOR ��St Un r � � DESCRIPTION l` � �Q'- � `� �' l ��.�-�'�C`l.�. ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POUR�D WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING �Q ❑ FOUNWATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADO�I SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION _ ❑ FRAM�NG ❑ MECHANICAL FINAL ❑ RATED WALLS � INSUU4TION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT `� FINAL) ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ A BU�LT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OWNERI�ONTRACTOR TO MEET YW:_YES_NO � COMMENTS: � � rr ro�� ' � 0 � � �� 0 � ,� - Q y � _..__..� r ��li l 2 �_-._.._ ----_---- � ��rt� a�e�•�+� � �o/[, -o�357 - D�.-,+:��eA y w - _ _._ _ < < - __.. � ;� ��e,�+:��G- D��q�: .2 �p . �,�(� per,+�•Y'i �.r�l,�� o�--- ----._ _ W� ❑WORKSATISFACTORY:PROCEED PROJECT COMPLETE w ❑CORRECT WORK 3 PROCEED ❑ISS CERTIFlCATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOMERINO PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ��TATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cafl for the next inspection 24 hours in advance. (952) 249-4600 OMmerfContractor on site� inspector: ' YVhits C.oPYMspector's File C�nuY�DYISib Notkx