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CITY OF ORONO * Z 0 1 4 — 0 1 P1 9 6 *
2750 KELLEY PARKWAY DATE ISSUED: 10/03/2014
ORONO,MN 55356-
952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1420 SHORELINE DR
PIN : 11-117-23-22-0015
LEGAL DESC : DRAGONFLY HILL
: LOT 002 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 620,000.00
NOTE: DOORS AND WINDOWS
STUCCO REPAIR
APPLICANT PERMIT FEE SCHEDULE 4,056.75
STATE SURCHARGE(VALUATION) 310.00
JANETKA CONSTRUCTION CONSULTANTS TOTAL 4,366.75
3505 COUNTY ROAD 19
MEDINA,MN 55340- Payment(s)
(612)418-6708 CHECK 3622 4,366.75
Minnesota State License#: BUIL-BC639945
OWNER
FELDSHON,DAVID&ARCHELLE
1420 SHORELINE DR
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 after work has commenced.
The applicant is responsible for assuring all required inspections aze
request e with t ate ilding Code.This permit may be
r ed at any time for ue se.
/C/ / � �
e itee nature Date I d By Signature Date
. �
City of Orono
Building Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
�O�O Mailing Address: Permit number: �� Q��
PO Box 66
Crystal Bay, MN 55323-0066 Date received: � S�
Street Address: Received by:
� � 2750 Kelle Parkwa
�'�, G. Y Y Plan review fe �
t �, Orono, MN 55356 � ��� ��
qkESHOIt
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) ��� / 7J- ZZ
GENERAL INFORMATION: �P
Job Site Address: ��}�,� :��;��, �� � �.; j� �.
Will this be a Parade of Homes, Remod�lers Showcase Home or other Display Home? ❑ Yes o
If yes,a specral event permit is required with Pofice 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.
CONTRACTOR/APPLICANT INFORMATION: Q
Name: �,�r`.� � �' l(� '_ t�-�l c�-�
State License# 3 �'j Expiration Date: .,�-�"=�S'�
Lead Certification Number: _ 10 Q -r Expiration Date: j� j v j7
(for work on homes that were constructed prior to 1978
Phone: (cell) Z, � -�� (office) ,����
Mailing Address: ,S, �'j City: ZIP: �;f'�'
Contact Person: � � C,�,^ Applicant is: ontracto', / Homeowner (Circle One)
Email and/or Fax: ,_- ' ��. 76�._Z Z(v�- ti
PROPERTY OWNER INFORMA ON: +i
Name: ,�.v� �-�4�l.fbt.el� �- lTi'�l�,c�11� ��d�
Phone (day): �( Z--��j(o� d(��S'
Address: ]�IZd .S� � r c�ty:�rr.nfJ ziP: ,S-�S"_'r1l
Email and/or Fax: �r-L(.�.��� ����,JDUt�ns��{. b�la .�t�
PROJECT INFORMATION: Overall project de�^-`
Type of Project: Any earth movement may also require
oor(s) '—' , MCWD review&permits:
❑ Re-roof,as; � / ie Minnehaha Creek Watershed District(MCWD)
� 18202 Minnetonka Blvd
❑ Re-roof,cea �� Q`�� � n �.��� � Deephaven, MN 55391
❑ Re-roof,othe
O �� Phone: 952-471-0590
`�,� � / Fax: 952-471-0682
�f ^ �r.t www.minnehahacreek.orq
Estimated Cons � �q�P� • D ' $ Z..f�y �
APPLICANT AC,
�
• Agrees to prov, Department;
• Certifies that tha his/her knowledge. The applicant recognizes that they are
solely responsib, �at upon failure to do so, the staff has no alternative but to
reject it until it is�
• Some or all of the _pplication is classified by State law as either private or
confidential. Priva� ,, ue given to the public but can be given to the subject of the data.
Confidential data is .,��t be given to either the public or the subject of the data. Our purpose and
intended use of this te our records and records of other governmental agencies required by law. If
ou refuse to su .,��� n a lic ' a not be issued.
ApplicanYs Signature: � , - Date: / r �J �
Owner's Signature: Date:
Last Updated:03/06/2013
PLAN REVIEW CHEC�CLIST FOR NEW STRUCTURES / ADDITIONS
Address/Permit Number: ���L U -sl"}01Z�C-.1 N� 1�2\�
Description of work: IQ t;���2 S /a►n�r� �� �N�1 C9 uu / S�C C-v ( �. ��9 I/�
Septic review by: /� /✓� Date Approved:
Zoning review by: /J�/� Date Approved:
Building review by: Date Approved: /O ^Z--�.�1�
Grading review by: Nl/� Date Approved:
oning District: Zoning File#: Reso#: Reso Date:
Zoni : Lot Area: SF/AC Width: Lot Coverage: SF _%
Survey mitted: 0 Yes � No Date of Survey: Revised da ? :
Pro osed Se acks:
Front(Lake) Rear(Street) ( N S E W � ( N S E W ) Other B 'dings Wetiand
Side Side
Defined Height: Peak Height: FFE: FFE minu feet= (Existing Contour)
Perimeter(linear feet)= 50%_ #of Storie Ok? � YES
FOR A BUILDING WITH A BASEMENT OR CRA SPACE:
The distance betwee e lowest FOR UILDING ON A SLAB FOUNDATION:
START WITH proposed floor(of the b ment or crawl
space)and the highest poi of the roof. START WITH The distance between the top of siab and
If you have a... the highest point of the roof.
If you have a...
• GABLE OR HIPPED ROO o . GABLE OR HIPPED ROOF(no
windows): Subtract half the windows): SubVact half the distance
distance between the highest po t between the highest point of the roof
of the roof to the low point of the to the low point of the corresponding
SUBTRACTION corresponding gable or hipped roof SUBTRACTION gable or hipped roof
(BASED ON ROOF . GABLE OR HIPPED ROOF(with (BASED ON . GABLE OR HIPPED ROOF(vvith
TYPE) windows): SubVact half the ROOF TYPE) windows): Subtract half the distance
distance between the top of e between the top of the highest
highest window and the h' est window and the highest point of the
point of the roof roof
. ALL OTHER ROOF TYPES(flat,
• ALL OTHER ROOF PES(flat, mansard,etc:No subtraction.
mansard,etc):N ubtraction. ADDITION Add the distance between the top of slab
SUBTRACTION Subtract the distan between the (BASED ON and the highest existing grade adjacent to
(BASED ON EXISTING basemenUcrawl ace floor and the EXISTING the foundation.
GRADES) highest eadstin rade adjacent to the GRADES
foundation 10 feet(whichever is less). QUALS Defined bullding height
EQUALS Defined ilding height
Shoreland District MCWD Permit Received Avera e Lakeshore S ack Met? Bluff
0 Yes 0 No 0 N/A 0 Yes 0 No
� Yes O o � Yes � No � /A
Permit Number: Setback:
Stormwater uality Existing Proposed Variance Required CUP R uired
Overla D' trict Tier Hardcover Hardcover
� Yes G No � Yes 0 No
Type(s): Type(s):
+: January2013 �f6 Gr`���e
�lan review checklist 2013.docx
REMARKS (in-house):
Fees to be Cha ed < YES NO
'����„ �.t',e.A°yi k �;
.._.... .................. _ . ._ .
1'£ rv��t'��w�.
Plan Review
,�„�7�`�qq�V�����,��� S a �� »�b b r�f ,�;i f ,s..s�
investigation Fee
"S�iC�[um�r`;of SAC Units's: � :': � � ' ' �� "�: � � ,, � ��` � �" '
_��.��.
Other(specify)
S uare Foota e $ er S uare Foota e
Basement X = S
18t Floor X = $
2nd Floor X = $
Garage X = $
ao
Estimated Construction Value: $ �O�V� dd0 �
Orono Inspections Required Work Requiring Separate Permits Required State Permits
G Site � Plumbing 0 Grading/Filling 0 Well
� Hardcover Removal 0 Mechanical � Fire 0 Electrical
0 Footing � Septic G Water Connection
� Poured Watl � Fireplace 0 Sewer Connection
� Foundation Survey G Masonry G Lawn Irrigation
O Radon Rock Bed G Mfg.
�Framing � Other(specify)
�Insulation
�-Built Survey
Final
� Wetland Buffer
� Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access: Existing: � YES 0 NO New: � YES 0 NO
OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED
c G
o.�„
Updated: January 2013 �N°
v:lforms�plan review checklist 2013.docx . -
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CITY OF ORONO � �C� CALLED IN � � � �����' �
INSPECTIO I E SCHEDULED LG�L l�•"—
PERMIT NO�� COMPLETED
ADDRESS��2� ���� �'
OWNER � fi�r�- TELEPHONE NO.��3 2 3���21
CONTRACTOR ���k� C�`�"
>`; DESCRIPTION ��` ��
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� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREMIETLANDS
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
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
2 ❑ DEMO-FINAL O SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
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W ORKSATISFACTORY:PROCEED ❑ PROJECT CO PLEfE
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR Wlll REfURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 ours in advance. 249-46�0
OwnerlContractor on site:
Inspector.
White Copyflnspector's File Canary CopylSite Notice
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�� �� �j7`� DATE TIME �
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INSPECTION NO CE . SCHEDULED ,�
PERMIT NO. ���cOMPLETED
ADDRESS ���� ��>�l�/�'P�f/2C DI��
OWNER TELEPHONE NO. ��� �3J�7!
CONTRACTOR �'�"t"' / �-
� DESCRIPTION , ��L
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W ❑ FOOTING ❑ PLUMBING FINAL p EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS
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Q ❑ 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
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
� ❑ PLUMBING RI ❑ S TIC FINAL ❑ FOUNbATION/REMOVAL
� OWNERICONTRAC��R�EET YOU: YES_NO
� COMMENTS:
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V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL REfURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALI INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
�11To�tlie n� ' spection 24 hours in advance. (J52� 249-4600
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Inspector...'.��4`�- �
White Copyllnspector's File Canary CopylSite Notice
�� C�_�� DATE TIME V
CITY OF ORONO CALLED IN l e1 -.�D
INSPECTION OTICE SCHEDULED / -� 3/-/r5� B%
PERMIT NO. �� -D!D COMPLETED
ADDRESS � ��� J
OWNER TELEP NE N0.��3-��-8���
CONTRACTOR
>'; DESCRIPTION
�
W ❑ FOOTING ❑ PLUM ING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS
�
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q O RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� O FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL
Z OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑WORKSATISFACTORY:PROCEED ❑PROJECT COMPLEfE
� ❑CORRECT WORK 8�PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
W
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-46��
Owne onVactor on site: �C ��
Inspector.
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White Copyllnspector's File Canary CopylSite Notice
� � �j�� DATE TIME �
/ 'CITY OF ORONO CALLED I�N' -
� INSPECTION N TICE Ic� SCHEDULED Z 1 S �
PERMIT NO. � � v' �COMPLETED
ADDRESS� �Z� � �1 CY� I I✓►P l�P�
OWNER TELEPH�N N0. 7L���z��-��Z-I
CONTRACTOR �{�(� .I.t S�Q��fi.�c'c��
� DESCRIPTION �T �
ty ❑ 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 ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE ��PTIC INSTALL ❑ FOUNDATfON/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU: YES_NO
c�.� COMMENTS:
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� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN
INSPECTOR WlLL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS.
Call for the next inspection 24 hours' advance� 49-46��
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice