HomeMy WebLinkAbout2014-00783 - addn/remodel/repair . •.
CITY OF ORONO * 2 PJ 1 4 - 0 0 7 8 3 *
27_50 KELLEY PARKWAY DATE ISSUED: 07/29/2014
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 1 18 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPF. : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 35,000.00
NO"I�E: SEPARATE PF,RMITS RFQUIRED: ELF,CTRICAi,(S"I'ATE)
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NOTE: PRIOR TO RELEASE OF F,SCROW,AN AS-I3UILT SURVh'Y MUS"1'BE SUBMITTED&APPROVED. tNIT1Al,: �� '�
NO'CE: CONTnCT TFIE WATLRSHF.,D DISTRIC�I�TO DETERMINE IF ANY PGRMITS ARE RI:QUIRGD. INITIAL: �
APPLICANT PERMIT FEE SCHEDULE 520.50
STATE SURCHARGE(VALUATION) 17.50
MITTELSTAEDT INC TOTAL 538.00
I 1730 BRADDOCK AVE SE Payment(s)
P O BOX 454
WATER"I'OWN, MN 55388- CHECK 1749 538.00
(612)716-9595
Minnesota State License#: BUIL-20012394
OWNER
PETERSON, DALE& DIANE
3515 SIX"I'H AVE N
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
fhe 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 governing this type ot'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 are
requested in conformance with the State Building Code.This pennit may be
revoked at any time for due cause.
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Applicant Permitee Signature Dale Issue Signature Date
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CITY OF ORONO �, �
BUILDING PERMIT APPLICATION �� �c�
FOR NEW STRUCTURES OR ADDITIONS �
�O�O Mailing Address: Permit number: �� '-�
PO Box 66 ?
Crystal Bay, MN 55323-0066 Date received: -�J—
Street Address:� Received by: I�
y�, G� 2750 Kelley Parkway Plan review fee: 3 3 g �
`�'�ESH�R� Orono, MN 55356 d D/c�!-�}�
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 p nt)
GENERAL INFORMATION: � �� <v"?`-� �
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
If yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be
required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFOR ATION:
Name: ,� � -*- �
State License# L . Expiration Date: /
Phone: cell .1- 6 - S- S"' office
Mailing Address: m�� � — Cit : �r�icc ZIP:
_
Contact Person: , ; - - Applicant is� - Contracto��/ Homeowner (Circle One)
Email and/or Fax: - � - � �_._-.. ---.-.---
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PROPERTY OWNER I FORMATION:
Name: � c.,/c /�c_��so�
Phone (day): G;�- �/,� - �ry" ��S�
Address: _T�� � bfG�• ,� � City��� � ZIP: ��j��
Email and/or Fax
ARCHITECT/ENGINEER IN�FORMATION:
Name: �`�.��v-�r �/
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of project:
1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8�
Water Supply
❑ New Construction ❑ Single Family with ❑ Residence
ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
**Any earth movement may also require ❑ Commercial ❑ Other(specify)
MCWD review 8�permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.min nehahacreek.or
$ x�'
Estimated Construction Valuation (excluding land) ����D
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STRUCTURE INFORMATION:
1. Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction
a. Length (ft.)= � Number of bedrooms= �ood/Frame
b.Width(ft.)= �� Number of garage stalls: ❑ Masonry
Areas in square feet Attached = ❑ Metal
❑ Pole Bldg.
c. Basement= Detached= ❑ ICF
d. 1 St Story =
❑ On-site Prefab
e. 2"d Story= ❑ Off-site Prefab
f. '/�Story = ❑Other(please specify):
g.Total Area=
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
Not
Enclosed Applicable
�Q- ❑ Permit A lication
•8- ❑ Pro osed Buildin Plans
❑ -� MN State Ener Code Calculations and Mechanical Code Re uirements Form
❑ ❑ Surve meetin all re uirements
❑ � Stormwater Pollution Prevention Plan
❑ �- Hardcover Calculation s
❑ .� Se tic S stem Site Evaluation Re ort
. ❑ Access Permit
❑ �0" Wetland Buffer Im rovement Plan
❑ � En ineered Plans for Retainin Walls 4 feet or above
❑ ❑ Plan Review Fee
❑ ❑ Application Escrow&Agreement
❑ ❑ Other:
APPLICANT/OWNER ACKNOWLEDGEMENT:
. Agrees to provide all information required or requested by the Building Department;
• Agrees to pay the City of Orono for engineering consultant review costs in excess of$500;
• 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;
. Acknowledges the Escrow Agreement is completed and signed;
• Understands some or all of the information that you are asked to provide on this appfication 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 you refuse to supply the information,the application may not be issued.
. Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the
Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000
escrow to ensure completion of the as-built s rvey a all site improvements.
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Applicant's Signature: Date:
Owner's Signature: Date:
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_ _ ; ; .._ . . .
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PLAN REVIEW CHECF(LIST FOR NEW STRUCTURES / ADDITIONS
Address/Permit Number: ��� � �� �� r,v� �v
Description of work: C W(LPO/L'r �t✓J YJ� 'T')d /`�
Septic review by: C0►�'�IQ�I aVl� �' 3�' (Z Date Approved:
Zoning review by: d 1p1.�' — Date Approved: � 'Z5 '�y'
Building review by: ` Date Approved: 7- �t-1 �
Grading review by: Date Approved:
Zoning District: ' Zoning File#: Reso#: Reso Date:
Zoning: Lot Area: �� � � A� Width: Lot Coverage: SF _%
Survey Submitted: 0 Yes �No Date of Survey: _�'�Y'�.3 Revised date(?):
Pro osed Setbacks: �1S�d V�lnQvl(9- bU.�v'G�
Front(Lake) Rear(�) ( N S � W ) ( N S E W ) Other Buildings Wetland
Si � Side
__..
, � .____. �� l � �
Defined Height: Peak Height: � FFE: FFE minus 6 feet= (Existing Contour)
Perimeter(linear feet) = 50%_ #of Stories Ok? � YES
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE:
The distance between the lowest FOR A BUILDING ON A SLAB FOUNDATION:
START WRH proposed floor(of the basement or crawl
space)and the highest point of the roof. START WITH The distance between the top of slab and
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): SubUact 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): SubVact 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 subtracdon.
ADDRION Add the distance between the top of slab
SUBTRACTION Subtract the distance between the (BASED ON and the highest existing grade adjacent to
(BASED ON EXISTING basemenUcrawl space floor and the EXISTING the foundation.
GRADES) highest existing grade adjace�t to the GRADES
foundation OR 10 feet(whichever is less). EQUALS Defned building height
EQUALS Defined building height
Shoreland District MCWD Permit Received Avera e Lakeshore Setback Met? Bluff
� Yes G No � N/A 0 Yes � No
es � No 0 Yes � No N/A
Permit Number: Setback:
Stormwater Quality Existing Proposed Variance Required CUP Required
Overia District Tier Hardcover Hardcover
� Yes No � Yes No
3 Type(s): Type(s):
Updated: January 2013
v:lforms\plan review checklist 2013.docx
REMARKS (in-house):
Fees to be Char ed YES NO
P�errr�it t ' *� �'
Plan Review
`Sxaats,S�ha�e,. . {�, . ,: , ,
� m�� _�.
Investigation Fee
`S�G—�urriber;�`���►��ri�ts �r
a
Other(specify)
S uare Foota e S er S uare Foota e
Basement X - $
1$`Floor X - �
2nd Floo� X - $
Garage X - $
Estimated Construction Value: $ �� �d�
Orono Inspections Required Work Requiring Separate Permits Required State Permits
0 Site � Plumbing � Grading/Filling G Well
O Hardcover Removal � Mechanical � Fire � Electrical
�0'Footing 0 Septic 0 Water Connection
G Poured Wall 0 Fireplace � Sewer Connection
� Foundation Survey � Masonry 0 Lawn Irrigation
G Radon Rock Bed O Mfg.
Framing � Other(specify)
� Insulation
�'As-Built Survey
�Final
G Wetland Buffer
0 Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access: Existing: � YES � NO New: � YES 0 NO
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED
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Updated: January 2013
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� DATE TIME
CITY OF ORONO CALLED IN �—
INSPECTION N�j,Tf���7� SCHEDULED — —/ /�=�
PERMIT NO�`v COMPLETF�D
ADDRESS ��s ��I
OWNER TELEPHONE NO.�Z-7� � $
CONTRACTOR �
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� DESCRIPTION
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��EEOOTtNG ❑ PLUMBING F ❑ EXCAV/GRADING/FIWNG
Q ❑ POUHED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS
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Z ❑ INSULATION ❑ WOOD BURNERIFIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE O SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERlCONTRACTOR TO MEET YOU:_YES_NO
v�i COMMENTS:
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V BEFORECOMERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
all for the ne ' ion 2a hours in advance. (g52) 249-4600
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CITY OF ORONO CALLED IN � �
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ADDRESS ��� �- L� /►�
OWNER ELEPHONE O�—T�P'9S�S
CONTRACTOR �
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Q O HADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
`� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
= O DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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O CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
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Cail for inspection 2a hours in advance. (g52) 249-4600
Owner ctor on site:
Inspector: Q►I� t�
White Copyllnspector's File Canary CopylSite Notke
��� T TIME�
CITY OF ORONO CALLED IN �
INSPECTION OTIC SCHEDULED �—
PERMIT NO. � COMPLETED �
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ADDRESS
OWNER TELEPH E NO. � 2'
CONTRACTOR
� DESCRIPTION
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FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
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� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
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O CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 ho in advance. 5 -4600
OwnerfContractor on site:
Inspector.
White Copyllnspector's Ffle Canary CopylSite Notice
� � ��� DATE TIME �
CITY OF ORONO c/ CALLED IN
INSPECTION OTICE�.7�� SCHEDULED � �-)
PERMIT NO. COMPLEfED T_
ADDRESS �� � � �X�� �
OWNER TELEPHONE NO. �o�a '�����
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� DESCRIPTION ��� ( L l�'- 7�"� C7/! � �� •
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� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWEfLANDS
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Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z `�INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q �p RADON SLAB O WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
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INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS.
C ion 2a hours in advance. (952) 249-46�0
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Inspector. ��-
White Copylinspector's Ffle Canary CopylSite Notice
� DATE TIM��, ,
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CITY OF ORONO CALLED IN / —� ��._
INSPECTION IC� /��e�HEDULED �
PERMIT NO. � "-��� 0 P�ETEQ
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❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
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