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Home My WebLink About2015-00233 - addn/remodel/repair CITY OF ORONO * z 0 1 5 - 0 0 2 3 3 * ' ^ 2750 KELLEY PARKWAY DATE ISSUED: 03/09/2015 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 99 SIXTH AVE N PIN : 25-118-23-44-0012 LEGAL DESC : HOLLY ACRES 2ND ADDN : LOT 000 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 43,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STATE) BATH REMODEL APPLICANT PERMIT FEE SCHEDULE 636.87 CHOICE WOOD COMPANY STATE SURCHARGE(VALUATION) 21.50 3300 GORHAM TOTAL 658.37 ST.LOUIS PARK,MN 55426 Payment(s) (612)924-0043 CREDIT CARD 5477 65837 Minnesota State License#:BUIL-1532 OWNER BRISCOE,MR.&MRS. 99 SIXTH AVE N WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this pertnit 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 dces 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 wi[h whether or not specified herein.This permit will expire and become null and void if consVuction 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 are requested in nformance with the State Building Code.This permit may be revok d 'me r due cause. � -9 - 1 �, �,ss _ Applican e e Signature Date ssue y Signature Date City of Orono Bu'ilding Permit Application for Maintenance / Replacement / Remodel (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) O MailingAddress: � Permitnumber: ��.5"U�� - �O PO Box 66 � - / Crystal Bay, MN 553 �� Date received: �„� `d,.;` Street Address: �� '�� by� � - y�, ` 2750 Kelley Park y (�'/ �y/ � �L Plan review fee: ��. t �' Orono, MN 55356 /'`' ��-� �kEsxo�`�" aG 1`7 � c��:.��/� D�J� 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 sub itted Incomplete applications will be returned. (Please print) � �� GENERAL INFORMATION: � / Job Site Address: � �j p 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 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: Name: �N �JR�1� State License# '�('�(�( ,�a Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were consfructed prior to 1978 � Phone: (cell) a (office) q �� Mailing Address: � City: � ZIP: Contact Person: Applicant is: �Contractor / Homeowner (Circle One) Email and/or Fax: � PROPERTY OWN INFORMATI Name: �V� ��I�C�-�� Phone (day): Address: C�C� '� � � 9 City: � �� ZIP: �,�� Email and/or Fax: PROJECT INFORMATION: Overal� project description: 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) 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ 3 �3O 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 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 ' for tion is to a nually update our records and records of other governmental agencies required by law. If ou refuse to su I th i o 'on, t a lication ma not be issued. Applicant's Signature: Date: ��'1� Owner's Signature: Date: Last Updated:January 2015 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS ` Address: � � Go �n� n., �� Permit No.: Zm �S� od Z� Description of work: i��4 i�{- 1?�✓�1,pI�L=Z Date Rec'd: z�Z S— Z��S Septic review by: N/ � Date Approved: Zoning review by: �/ ✓-� Date Approved: Building review by: � Date Approved: ZsZ Z- 20��,,,� Grading review by: �/A Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: L t Area: SF/AC Width: Lot Coverage: F % Survey Sub ' ted: 0 Yes � No Date of Survey: Revise ate ? : Proposed Setbac : Front(Lake) ear(Street) ( N S E W ) ( N S E W ) er Buildings Wetland Side Side Defined Height: ak Height: FFE: F E minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50°/a = L.F. below grade #of Stories FOR A BUILDING WITH A BASEMENT OR CRAWL ACE: F A BUILDING ON A SLAB FOUNDATION: The distance between t lowest proposed The distance between the top of START WITH floor(of the basement or c wl space)and START WITH slab and the highest point of the the highest point of the roof. roof. If you have a... If you have a... • GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF( (no windows): Subtract half windows): Subtract half th is ce the distance between the between the highest poi of the ro highest point of the roof to to the low point of the rresponding SUBTRACTION gable or hipped ro the low point of the corresponding gable or (BASED ON . GABLE OR HIP ED ROOF(with SUBTRACTION hipped roof ROOF TYPE) windows): S tract half the distance (BASED ON • GABLE OR HIPPED ROOF between t top of the highest ROOF TYPE) (with windows): Subtract window nd the highest point of the half the distance between roof the top of the highest • OTHER ROOF TYPES(flat, window and the highest ansard,etc):No subtraction. point of the roof • ALL OTHER ROOF TYPES SUBTRACTION tract the distance between the (flat,mansard,etc):No (BASED ON asemenUcrawl space floor and the subtraction. EXISTING highest existing grade adjacent to the DDITION Add the distance between the top GRADES) foundation OR 10 feet(whichever is less). ( SED ON of slab and the highest existing EQUALS Defined building height EXI ING grade adjacent to the foundation. GRA S EQUAL Deflned building height Shoreland istrict MCWD Permit Average Lakeshore Setback g�uff Met? � Yes 0 No Permit Number: � Yes 0 No � N/A � Yes � No � N/A—see attached Setb ck: Stormwater Quality Proposed Overlay District Existin g Hardcover Hardcover Variance Required CU equired Tier circle one (/o and sfl %and s � Yes � No � Yes O No 1 2 3 4 5 Type(s): Type(s): Updated: January 2015 z:\forms\plan review checklist 2015.docx REMARKS (in-house): __ Fees to be Char ed YES NO Perm it Plan Review ,r/ State Surcharge Investigation Fee SAC—Number of SAC Units Other(specify) S uare Foota e $ er S uare Foota e Basement X = $ 1S`Floor X = $ 2nd FI00� X = $ Garage X = $ ec� Estimated Construction Value: $ '"'�3 f d�� "' Orono Inspections Required Work Requiring Separate Permits Required State Permits 0 Site Plumbing 0 Grading/ Filling � Well � Silt Fence/ Erosion Control Mechanical � Fire � Electrical O Hardcover Removal 0 Septic � Water Connection � Footing 0 Fireplace � Sewer Connection � Poured Wall � Masonry � Lawn Irrigation � Foundation Survey � Mfg. � Landscaping � Foundation Waterproofing � Other(specify) 0 Radon Rock Bed Framing �nsulation � �►s-Built Survey �Final � Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: � YES 0 NO New: 0 YES 0 NO OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED Updated: January 2015 z:\forms\plan review checklist 2015.docx \ C�� t O� � DATE TIME � �CITY OF ORONO CALLED IN —�—,,��„�, INSPECTION OTICE_ ��CHEDULED ="��S� PERMIT NO. COMPLEfED ADDRESS � S �,X� �l „�/�/ OWNER TELEPHONE NO. � � CONTRACTOR � ��\ �� '� � DESCRIPTION �r� '� / � 1 � C �� l� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI� ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL rs�/�ft�TREE REMOVAL Z ❑ RAD AB ❑ MECHANICAL RI ❑ SITE INSPECTION F� ❑ MECHANICAL FINAL ❑ PROGRESS ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ S1EWER HOOK-UP ❑ HARD COVER REMOVAL v ❑ DEMO-SITE ❑�PTIC INSTALL ❑ FOUNDATION/REMOVAL Z OWNERlCONTRACTOR TO ME�� YES_NO � COMMENTS: oc W a � J ' O �. � O� �� t, � W � Q � 2 W � w � 37-�33T- � J d W ❑ K SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑ RRECT WORK,CAIL FOR REtNSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WFLL RETURN ❑STOPORDER POSTED.CALI INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. 9 2) 249-46�� OwnerfContractor on site: ' Inspector. White Copyllnspector's File Canary CopylSite Notice � i �� y DATE TIME �/� CITY OF ORONO CALLED IN INSPECTION N TI /�i 3�HEDULED �� '`3 -. PERMIT NO. '`^' COMPLEfED ADDRESS -� r OWNER TELEP ONE NO. �� D_(��7�� CONTRACTOR �II/ � ��!)('Z'Zn� j. DESCRIPTION �� h a / ��`�� ly ❑ 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 ❑ PTIC INSTALL 2 OWNERICONTRACT09,T0 MEET YOU: ' YES_NO c�.� COMMENTS: � � W a � � O �. � O � W � Q � 2 W � W 2 � J d � W ❑WORKSATISFACTORY:PROCEED ROJECT COMPLEfE � ❑CORRECT VYORK 8 PROCEED ❑ SUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORECOVERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS_ p pHOTO TAKEN 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. ��5 49-46�� OwnedContractor on site: Inspector. L�� "� White Copyllnspector's File Canary CopylSite Notice