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Home My WebLink About2013-01156 - addn/remodel/repair � • s CITY OF ORONO * z 0 1 3 - B 1 1 5 6 * 2750 KELLEY PARKWAY DATE ISSUED: 1 U04/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3515 SIXTH AVE N PIN : 29-118-23-43-0002 LEGAL DESC : UNPLATTED 29 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAC, VALUATION : $ 40,000.00 NOTE: SF,PARA7'E PERMITS REQUIRED: PLUMBING, ELECTRICAL(STATE) KITCHEN REMODF,L APPLICANT PERMIT FEE SCHEDULE 574.25 MITTELSTAEDT INC STATE SURCHARGE(VALUATION) 20.00 11730 BRADDOCK AVE SE TOTAL 594.25 P O BOX 454 WATERTOWN, MN 55388- (612)716-9595 Minnesota State License#: 20012394 OWNER PETERSON, DALE& DIANE 3515 SIXTH AVE N LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMEIVT "l�he work for which this permi[is issued shall be performed according to the approvcd plans and specifications,applicable City approvals,and the State Building Code. This pennit is for only the work described and does not grant permission for additional or related work which requires separatc 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 consVuction authorized is not commenced within 180 days oY the date of issuance,or if construction is suspended for a period of 180 days at a �me after work has commenced. The applicant i onsi e for assu all required inspections are reques � conform ce � aYe il � Code.This permit may be oked at any[im f j� '� � /L // / // Appl t P r tee Si'. a r ate Iss By Signature Date C SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � ' 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: O�(�J�0 �Jc�p PO Box 66 Crystal Bay, MN 55323-0066 � Date received: I6 - 30- G3 Street Address: Received by: � S y � 2750 Kelley Parkwa � l� �'a 3�3• uc � �`' Plan review fee: , �fqkFSH��,C' Orono, MN 55356 �� D�3 �� 1�SS � Total Fee: �r' Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us fi, This application form must be completed in full and all required information must be sub itted. Incomplete applications will be returned. (Please print) �q,c�., � GENERAL INFORMATION: � / �'�� ; Job Site Address: �' '�l S -r- � � 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 s ice will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. '' CONTRACTOR/APPLICANT INFORMATION: j Name: �VI �'-�--cls-f-�{ ��f- �w� . ; ri7 State License# g� � � ,�� Expiration Date: �y�r�� 5- � Lead Certification Number: Expiration Date: �� (for work on homes that were constructed prior to 1978 Phone: (cell) ��- /� _ S- 5- (office) �; /� - S 5� } Mailing Address: �. � s- Cit : « ��--t- ��,� ZIP: -3 � � � � Contact Person: J�t�/ Applicant is: ontract � / Homeowner �c��ae o�e� '� z.. F�' Email and/or Fax: �� ,t.,e �� ; � ? R-, t1 � r ` PROPERTY OWNER INFORMATION: � Name: � � c Q�•-�-«5�� Phone (day): (��1- 7/G -ys'j5� ` � Address: 35-�Si ,�h hC✓ /1/ , City�ra ��p ZIP: 5 `j >�3 ;. L4; Email and/or Fax: �:` ,k '� PROJECT INFORMATION: Overall pro�ect description: Type of Project: Any earth movement may also require � - ❑ Door(s) �emodel ❑ Fire Damage MCWD review&permits: ; ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq P Estimated Construction Valuation of Project(excluding land) $ � `'s 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 informatio � �nually updat�ur r c and records of other governmental agencies required by law. If ''_ ou refuse to su I ' ormatiQrS�th li io ma i - 7 ApplicanYs Signature: Date: � - �� — � " Owner's Signature: Date: Last Updated: 03/06/2013 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address/Permit Number: 35�5 S � x'Tt--� i+�►vG Description of work: k �'rC�H tT.1 � f'��JC:.Z Septic review by: N /r4 Date Approved: Zoning review by: Date Approved: Building review by: +�l.�-- Date Approved: 11-1— ►3 Grading review by: Ov//� Date Approved: ning District: Zoning File#: Reso#: Reso Date: Zoni : Lot Area: SF/AC Width: Lot Coverage: SF % Survey mitted: 0 Yes � No Date of Survey: Revised date ? : Pro osed Se acks: Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Building Wetland Side Side Defined Height: Peak Height: FFE: FFE minus 6 feet- (Existing Contour) Perimeter(linear feet) = 50%_ #of Stories ? � YES FOR A BUILDING WITH A BASEMENT OR CRAWL ACE: The distance between the st FOR A BUILDIN ON A SLAB FOUNDATION: START WITH proposed floor(oi the basem t or crawl space)and the highest point of roof. The distance between the top of slab and START WITH the highest point of the roof. If you have a... If you have a... • GABLE OR HIPPED ROOF(no . GABLE OR HIPPED ROOF(no windows): Subtract half the windows): SubVact half the distance distance between the highest point 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(with TYPE) windows): Subtract half the ROOF TYPE) windows): Subtract half the distance distance between the top of the between the top of the highest highest window and the highest window and the highest point of the point of the roof roof . ALL OTHER ROOF TYPES(flat, • ALL OTHER ROOF TYPES(flat, mansard,etc:No subtraction. mansard,etc):No subtraction. A ITION Add the distance between the top of slab SUBTRACTION SubVact the distance between the (BA D ON and the highest existing grade adjacent to (BASED ON EXISTING basement/crawl space floor and e EXISTI the foundation. GRADES) highest existing grade adjace o the GRADES foundation OR 10 feet(whi ver is less). EQUALS Defined building height EQUALS Defined building hefgh � Shoreland District MC Permit Received Avera e Lakeshore Setback Met Bluff � Y s � No 0 N/A Yes 0 No 0 Yes 0 No � Yes � No 0 N/A P mit Number: Set ck: Stormwater Quality Existing Proposed Variance Required CUP Required Overla District Tier Hardcover Hardcover � Yes � No � Yes � Type(s): Type(s): ` Updated: January 2013 v:\forms\plan review ch cklist 2013.docx REMARKS (in-house): Fees to be Char ed YES NO Permit Plan Review State Surcharge �/ Investigation Fee SAC=Number of SAC Units ` Other(specify) (� S uare Foota e $ er S uare Foota e Basement X = $ 1°`Floor X = $ 2nd FIoo1' X = $ Garage X = $ Estimated Construction Value: $ Ml��c�00 � Orono Inspections Required Work Requiring Separate Permits Required State Permits � Site �Plumbing � Grading/Filling 0 Well � Hardcover Removal � Mechanical � Fire �Electrical Footing 0 Septic � Water Connection � Poured Wall � Fireplace � Sewer Connection � Foundation Survey � Masonry 0 Lawn Irrigation � Radon Rock Bed � Mfg. Framing 0 Other(specify) � Insulation � As-Built Survey �7'Final � Wetland Buffer � Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES 0 NO New: � YES 0 NO OFFICIAL REMARKS-TO BE NOTED ON PERMIT AND INITIALLED Updated: January 2013 v:\forms\plan review checklist 2013.docx