The URL can be used to link to this page

Home My WebLink About2016-01365 - addn/remodel/repair � �! ' CITY OF ORONO * 2 0 1 6 - 0 1 3 6 5 * 2750 KELLEY PARKWAY DATE ISSUED: 1U0U2016 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 3010 SOMERSET LA PIIv : 04-117-23-22-0029 LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN : LOT 001 BLOCK 003 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 13,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) BATHROOM REMODEL APPLICANT PERMIT FEE SCHEDULE 247.79 PLAN REVIEW 161.06 FAIR&SQUARE REMODELING STATE SURCHARGE(VALUATION) 6.50 210 EAST DEAN AVE CHAMPLIN,MN 55316- TOTAL 415.35 (612)245-5826 Payment(s) Minnesota State License#: BUIL-BC638907 CREDIT CARD 7582 415.35 OWNER BUTLER,PATRICK&JILL 3010 SOMERSET LA LONG LAKE,MN 5535Cr 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 are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �G 4� /� � D/� /(o pplicant Permitee Si Date Issued By ignature Date ,�,� City of Orono Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �� Mailing Address: Permit number: "�C��k�� _3 �� PO Box 66 Crystal Bay, MN 55323-006 Date received: 1 L,- Z �r- l�, Received b "�I� Street Address: l� Y� �-� y�, � 2750 Kelley Parkway �� Plan review fee: � �;, l�� y�j � Orono, MN 55356 � � lqkESHO�� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �i� This application form must be completed in full and all required information must be su mitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: � c> ( (; � , , � 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. Shutt/e 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: - �ir' c � �� -�� +'lc.{.��,�1�-c, State License# (;� � �j�� " Expiration Date: ; � Z Lead Certification Number: �/,� j .....��, �C��, - Z Expiration Date: , (for work on homes that were constructed prior to 1978 Phone: (cell) ��Z- SZ,,�_ �y�� (office) -- Mailing Address: z �� ,,,,� �,�, � City: ��,, ,,,� ZIP: �y�,� Contact Person: ��,� S,�t�� Applicant is:� Contracto`r / Homeowner (CircleOne) _ , Email and/or Fax: ------- - h�_-�l,.��. . «..,��1 S<;,.,� �z rt.s,.t��,��,�4 ,�: :... 4 PROPERTY OWNER INFORMATION: Name: ��, ,��/,�� R�.-�1-�,,, Phone(day): `/'S� - 737- �3Zu Address: >o/G 5��, �-r..� I�� . City: ��..,,,�., �1� ZIP: JS-�S-l�: Email and/or Fax: PROJECT INFORMATION: Overall pro'ect description: ��'`��'��=�'L'E'�� '''� Type of Project: Any earth movement may also require ❑ Door(s) [�Remodel ❑ Fire Damage MCWD review 8 permits: ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,cedar 15320 Minnetonka Blvd ❑ 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.ora Estimated Construction Valuation of Project (excluding land) $_ �,��t,�,c-- 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 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: Date: �, / Last Updated:January 2016 ��'G/L� `��%� /�� ' � . /. l � ' � PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: �� '/ / �i �^- �!' 2 �-" %�_ '� Permit No.•� J ,..� " Jf �,1,� s'' / . / /- Description of work: Date Rec'd: �' '`J � �� Septic review by: Date Approved: Zoning review by: Date Approved: , Building review by: ✓'�_ � � ��.�- Date Approved: �� !�.� '� � �- , 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? � Yes � No Landscaper: Proposed Setbacks: Front (Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50% = L.F. below grade Basement? � Yes 0 No, Stories FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: The distance between the lowest proposed Slab at or above grede— START WITH floor(of the basement or crawl space)and measure from highest existinq the highest point of the roof. START WITH rade to the highest point of the roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR HIPPED ROOF(no Slab below grade—measure (BASED ON windows): Subtract half the distance from highest existing grade to the ROOF TYPE) between the highest point of the roof hi hest oint of the roof. to the low point of the corresponding If you have a... gable or hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF(with (BASED ON (no windows): Subtract half the distance between the windows): Subtract half the distance ROOF TYPE) highest point of the roof to between the top of the highest the low point of the window and the highest point of the roof corresponding gable or hipped roof • ALL OTHER ROOF TYPES(flat, • GABLE OR HIPPED ROOF mansard,etc):No subtraction. (with windows): Subtract SUBTRACTION Subtract the distance between the half the distance between (BASED ON basemenUcrawl space floor and the the top of the highest EXISTING highest existing grade adjacent to the window and the highest GRADES) foundation 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 EQUALS Updated: October 2015 z:\forms\plan review checklist 10-2015.docx Shoreland District MCWD Permit Average Lakeshore Setback Bluff M et? � 0 Yes p No Permit Number: � Yes 0 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 0 No 1 2 3 4 5 Type(s): Type(s): Fees to be Char ed YES NO Permit (/` Plan Review � State Surcharge (/' Investigation Fee (��' SAC- Number of SAC Units (/' Other(specify) �- Square Foota e $ per Square Foota e Basement X = $ 1 S' Floor X = $ 2"d FIOo� X = $ Garage X = $ li � Estimated Construction Value: $ / 7,�� Orono Inspections Required Work Requiring Separate Permits � Footing 0 Site Plumbing � Grading/Filling 0 Poured Wall � Silt Fence/Erosion Control -�Mechanical � Fire 0 Foundation Survey � Hardcover Removal � Septic � Water Connection � Foundation Waterproofing ❑ Other(specify) 0 Fireplace � Sewer Connection �Framing O Masonry 0 Lawn Irrigation � Insulation � Mfg. � Landscaping � As-Built Survey ❑ Other(specify) Final 0 Lathe Required State Permits 0 Other(specify) 0 Well Electrical REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: 0 See Builder Acknowledgement Form � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 �•\fnrmc\nlan rovio�ei nc�rlrlict 1 fl_9M�i rinrv