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Home My WebLink About2016-00679 - addn/remodel/repair � � CITY OF ORONO * 2 0 1 6 - 0 0 6 7 9 * 2750 KELLEY PARKWAY DATE ISSUED: 06/16/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2195 SHADYWOOD RD PIN : ]7-117-23-43-0135 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 007 BLOCK 002 PERM[T TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUAT[ON : $ 4,000.00 NOTE: INTERIOR REMODEL ONLY-CREATING 4 SPACES,ADDING DOORS APPLICANT PERMIT FEE SCHEDULE 108.38 DUSSAUT, MARIE PLAN REVIEW 70.45 2195 SHADYWOOD RD STATE SURCHARGE(VALUATION) 2.00 WAYZATA, MN 55391- TOTAL 180.83 Payment(s) CREDIT CARD 7421 180.83 OWNER DUSSAUT,MARIE 2195 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 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 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 conformance with the State Building Code.This permit may be revoked at any time for due cause. , % \ - ` / , , � � �- ; � S-� I�, l �o, ,C� , � , � -- � -'�, �� ppli Permitee S�gnature Date Tssued Signature Date ,, i. �.��y u� v� c�� v Building Permit Application for Maintenance/ Replacement/ Remodel - Residential ONLY (6.�. v�rindca°�r�, ctoors, sic#ir�g, r�-roof, etc. — N� ST�iE�CTURA� EXPA��,��g ��`_ Mailing Address: -� l -, ��\ PO Bt�x 66 Permit number: .�,. �t��-' a. �. ,a' , ` Crystal Bay, MN 55323-0066 Date received: _�._J� —I(p � � � i Street Address: G�/�t,�/�- �� Received by: ,�� 2750 Kelley Parkway (p l �0 Plan review fee: `'C�is-��-'�-� �f 1 n y�lq �' Orono, MN 55356 kE5t1v�� _ Total Fee: / �Q, g� 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:_ /� _ r/�,� Job Site Address: ��C1� �SI'�� L �p�� l.Jv c�''i� M Y ' '�1 �� Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? ❑ Yes �y� No If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Shunle bus 4r�e wil!be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: ��,�,I,�,`,�C�� State License# Expiration Date: Lead Certification Number: Expiration Date: (for work ore homes that were constructed prlor fo 1978 Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER FORMATI -` Name: �'/1� 1 �1,�Q�T Phone (day): � 1��L� ^ �`1� —��n � Address: .�� City: � ZIP:SS�� Email and/or Fax: �Y� f�e ,�r��S��'� �• (Z��11� •C' c�✓�� YVI� v��S.�'.c u (`� � (twc� ��'� PROJECT INFORMATION: Overall project descript�on: Type of Project: �X� ��/Cw°c:l�v� s �425 u,� �� r� �— � Any earth movement may also require ❑ Door(s) �Remodel ❑ Fire Damage MCWD review &permits: ❑ Re-roof, asph8lt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof, Cedar ❑ Restoration ❑bUater Damage iUlinnetonka, MN 55345 ❑ Re-roof, other(specity) ❑Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ 1 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 comp�ete apptication being aware that upon failure to do so, the �taff has no altemative 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 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. ApplicanYs Signature: Date: Owner's Signature: 1 ` 1 Date: �� I�I ��'C�I � G%�2,/_ ��%�� (K �(� /((� 7�� '� � PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: � Permit No.: U/�((� � (�� Description of work: ' l<<'ICOI/' Date Rec'd: Septic review by: Date Approved: Zoning review by: Date Approved: Building review by: " �� Date Approved: � �� l 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? 0 Ye � No Landscaper: Proposed Setbacks: Front (Lake) Rear(Street) ( N S E W ) ( N E W ) Other Buildings Wetland Side Side Defined Height: Peak Height: FF . FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50% = L.F. below grade Basement? � Yes 0 No, Stor�s FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: ` FOR A BUILDING ON A SLAB FOUNDATION: The distance between the w st proposed Slab at or above grade— START WITH floor(of the basement or rawl pace)and measure from hiphest existinq the highest point of the r of. START WITH rg ade to the highest point of the roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR IPPED ROOF no Slab below grade—measure (BASED ON windows): ubtract half the 'stance from highest existing grade to the ROOF TYPE) between t e highest point of t e roof hi hest oint of the roof. to the lo point of the corresp ding If you have a... gable o hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF • GAB OR HIPPED ROOF(wit (BASED ON (no windows): Subtract half wind ws): Subtract half the dista ce ROOF TYPE) the distance between the bet een the top of the highest highest point of the roof to wi dow and the highest point of th the low point of the r of corresponding gable or hipped roof • LL OTHER ROOF TYPES(flat, • GABLE OR HIPPED ROOF mansard,etc):No subtraction. (with windows): Subtract SUBTRACTION Su tract the distance between the half the distance between ' (BASED ON b emenUcrawl space floor and the the top of the highest EXISTING h' hest existing grade adjacent to the window and the highest GRADES) f undation OR 10 feet(whichever is less). point of the roof • ALL OTHER ROOF TYPES (flat,mansard,etc):No EQUALS Defined building height subtraction. Defined building height �9 EQUALS Updated: October 2015 z:\forms\plan review checklist 10-2015.docx � .� . '. ` Shoreland District MCWD Permit Average Lakeshore Setback g�uff Met? ' 0 Yes � No Permit Number: 0 Yes ❑ No ❑ N/A � Ye No � � 0 N/A—see attached Setback: ; Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required circle one % and sf % and sf � Yes � No � Yes � No 1 2 3 4 5 Type(s): Type(s): Fees to be Char ed YES NO Permit Plan Review � State Surcharge � Investigation Fee c� SAC— Number of SAC Units � Other(specify) Square Footage $ per Square Footage Basement X = $ 1 S� Floor X = $ � 2�d FIOOr X = $ Garage X = $ Estimated Construction Value: $ �^ (NO �o r, Orono Inspections Required Work Requiring Separate Permits 0 Footing 0 Site � Plumbing ❑ Grading/ Filling � Poured Wall 0 Silt Fence/Erosion Control ❑ Mechanical 0 Fire ❑ Foundation Survey � Hardcover Removal � Septic ❑ Water Connection 0 Foundation Waterproofing � Other(specify) 0 Fireplace 0 Sewer Connection �Framing ❑ Masonry � Lawn Irrigation ❑ Insulation � Mfg. ❑ Landscaping 0 As-Built Survey � Other(specify) Final ❑ Lathe Required State Permits 0 Other(specify) � Well Electrical i REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: � See Builder Acknowledgement Form 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 r\fnrmc\nlan ravic�ni rhorklict 1(1_9f11F rinrv �C� �. _ DATE /� TIME CITY OF ORONO CALLED IN — INSPECTION OTICE �j� SCHEDULED — - PERMIT NO. – �"� OMPLETED ADDRESS � OWNER ''uTELEPHONE NO�a�7S'�'�3��iD� CONTRAC OR , � DESCRIPTION 4~j ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � ❑ 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 � ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YiOU:_YES_NO v�, COMMENTS: � ' � � �/evtd� �/OcZ'`�'ec&.G Ks - � , o ��v«� ,o`.s� �,�.�e✓ jv<<L. '� �� . �_ b� �s�4..s — 0 W � Q � � W � j W O WORK SATISFACTORY`.PROCEED ❑PROJECT COMPLETE � ❑OORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W 0 O CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORE COMERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED �SPECTION REQUIRED.CALL TO ARRANGE ACCESS. �i — Ca8 for the next inspection 24 hours in advance. (952) 249-4600 OwneHContractor on Site: �rf� Inspector:� ` /�3 - o��s 3� !� WhiM CopyAnspector's File Cenary CopylSite Noties DATE IME CITY OF ORONO cnLLED IN INSPECTION NOTI E �p SCHEDULED �� PERMIT NO. —�� / COMPLETED ADDRESS o2/`j.S �Sft�e�oa� IP.P. OWNER TELEPHONE NO. CONTRACTOR ��a�� ` 1M�M � DESCRIPTION � �`� �y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATtON WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL � ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION �FR�4AAING ❑ 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 ll�U:_YES_NO � COMMENTS: �IQG� ��, �'a!-/� � p ��Qwl��ls �ar //I�CI�a�"' l�"«qiQs� ' .O�/ /l�art ' � � � � �i� -�- Co v�r � W � Q � W � W � � J � �RKSATISFACTORY:PROCEED ❑PROJECT COMPLEfE W� ❑CORRECT W'ORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECTVI�RK,CALL FOR REINSPECTION TEMPORARY V BEFORECdVERiNG PERMANENT O(�RfiECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REW IRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: /�r�� Inspector: � �^''�t'�— White CopyAnspector's Flis Canary CopylSMe Nofkx