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Home My WebLink About2012-00243 - addn/remodel/repair f„ CITY OF ORONO * 2 0 1 2 - 0 0 2 4 3 * * 2750 KELLEY PARKWAY DATE ISSUED: 04/09/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 75 STUBBS BAY RD N PIN : 32-118-23-34-0014 LEGAL DESC : UNPLATTED 32 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 12,880.00 NOTE: SEPERATE PERMITS REQUIRED: ELECTRICAL(STATE) ADDITION ADV.PLAN REVIEW PAID 2012-00242$153.40 APPLICANT pERMIT FEE SCHEDULE 236.00 GATES GENERAL CONTRACTORS STATE SURCHARGE(VALUATION) 6.44 3500 VICKSBURG LANE N PLYMOUTH,MN 55447- TOTAL 242.44 Minnesota State License#:6793 PAID WITH CC# 7533 OWNER MALBY,DONALD 75 STUBBS BAY RD N MAPLE PLAIN,MN 55359- 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 governing 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 I80 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 an time for due cause. _ y, 9 , ,� A 1' ant rmitee Signature Date �� " � /�� Issue By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ,R c��' � Cit of Orono � 1�. Y �`�1 Building Permit Application for New Structures or Additions � �a" �� . � /�;O�'� MailiPO Bo r66 . Permit number. '��/� � c�U.�4'3 � � � �QY � v� Crystal Bay, MN 55323-0066 Date received: � a /,�- � �� '� � Received by: � � �y\� �y�� ;� ��, Street Address:� � � ti � 2750 Kelley Parkway Plan review fee: ��: �:� - f��'� ��-• \�t��g,'�j Orono, MN 55356 �,,Esz�a f�3. �� ----- 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. (P/ease print) GENERAL INFORMATION: Job Site Address: �� jft�fr,1�� ;L�a��, ,;'�-,l. �� ,�✓ `'-S �� ' � Will this be a Parade of Homes, Remodelers Showcase ome 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 evenf. Shuttle bus service will be required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be alfowed � CONTRACTOR/APP�-�IC�T INFORMATION/: / Name: C��-1 C°S �+�ryG�lJ ( .r,rn"f✓ciCtay� ��. State License# �-��? � Expir tion Date: .�-^�/y Phone: -��:-?�o_ p��r � office � l,�/,. G;�- 7/�, '' (cell) Mailing Address ��"r�U 1/rC%�S�:r,�.r�, j,/. /' -�;;/ �^�- Cit�r: r� �-�'��- ZIP: '� �� , � � �:_:' � �,, ; .� Contact Person: �,,�i 5 �Cy,,��,�s�..�{�.� Applicant is: f Contracto� ;/ Homeowner �c��ie One) �? Emailand/orFax: �'� ��7�r�-=', " ��,:^��;o-,��i�r<<.�o%r /,� %c��-y-��_,7z�i,, PROPERTY OWNER INFORMATION: Name: _ �✓��;r' /�c�/6�f Phone (day): (a/Z _a�� i�/U � Address: , �� ' S `;�tc��b� ,�"a�� / City: C�r r'-, v zIP: ' S3S`i Email and/or Fax ARCHITECT/ ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & ` Water Supply ❑ I�Few Construction �Single Family with �2esidence �'Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑ Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Other: s eci ❑ Private Sewer ( p fy) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water ""`Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review& 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.minnehahacreek.or Estimated Construction Valuation (excluding land) $ ' v. �� y . . . .. .. � 4� y . . - , . � . � ' . . � '. ..�.. , . . . , � �.. . . - ��- - . . . . r ? STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length (ft.)= Number of bedrooms= [�Wood/Frame ❑ Masonry b.Width(ft.}= Number of garage stalls: ❑ Metal Attached= % ❑ Pole Bldg. Areas in square feet Detached = ❑ ICF "� � c. Basement= ❑ On-site Prefab � ❑ Off-site Prefab d. 15t Story = ❑ Other(please specify): � e.2"d Story= f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: � All of the information must be submitted in order for your application to be processed: Not Enclo$ed Applicable � ❑ Permit Appiication C� ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Requirements Form ❑ ❑ Surve meetin all re uirements � ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Septic S stem Site Evaluation Re ort � ❑ Access Permit � ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee :� ❑ ❑ Other '"� ;> ::� APPLICANT ACKNOWLEDGEMENT: ,: • Agrees to provide all information required or requested by the Building Department; �� h • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; .k • 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 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 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 agreement to ensure completion of the as-built survey and all site improvements. � . �� / /l-� ApplicanYs Signature: Date: � .. .. . ..i.- � . . . � , ._ li. . � � .. . . � . � ... � � � � Plan Review Checklist for New Structures / Additions Address/ PID/ Legal: � S� .��Tv Lj[� S ��`� �� Description of work: Septic review by: W 5��U fi�'S Date Approved: L�" �� !� Zoning review by: ' �tC�pate Approved: � Building review by: Date Approved: `-( �� - f Z Grading review by: � Date Approved: Zoning File#: Resolution#: Resolution Date: Zonin District Fire De artment Post Office School District Zoning: Lot Area: SF/AC Width: Depth: Survey Submitted: � Yes � No Date of Survey: Pro osed Setbacks: Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Building Defined Height: Building Peak Height: #of Stories Ok?: � YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/crawl START the distance between the slab and the highest space floor and the highest roof peak,the top of WITH roof peak,the top of the cornice of a flat roof, the cornice of a flat roof,the deck line of a the deck line of a mansard roof, or the mansard roof,or the uppermost point on a round uppeRnost point on a round or other arch-type or other arch- e roof roof SUBTRACT half the distance between the highest window and SUBTRACT half the distance between the highest window hi hest roof eak of a itched roof and hi hest roof eak of a itched roof SUBTRACT the distance beiween the basement floor/crawl ADD the distance between the slab and the highest space floor and the highest existing grade within existin rade within the foundation the foundation or 10 feet,whichever is less. EQUALS Defined buildin hei ht EQUALS Defined buildin hei ht Lot Coverage: SF % Shoreland District MCWD Permit Received Avera e Lakeshore Setback Bluff � Yes � No 0 N/A 0 Yes 0 No 0 Yes � No 0 Yes � No � N/A Permit Number: Setback: Hardcover Zones Existin Pro osed Variance Re uired CUP Re uired 0-75' � Yes � No � Yes � No 75-250' Type(s): Type(s): 250-500' 500-1000' REMARKS (in-house): � �,�WV'� . '� � C� ��. � Updated: 09/11/2009 z:\forms\plan review checklist.docx Fees to be Char ed YES NO �Per,mit> �, ,., Plan Review ;Sta�e"�urcfiaTge : �/ " Investigation Fee :��-=;�Mumber:of�SAC=linits - _ __ _ __ _ Sewer Connection �fa#er�Gor��ei�tion = _ � _ _ Park Fee -,Site.��#nspectiDn : Other(specify) 'M iscellan?eous;Fxees. . _ ., � _ Calculated By: S uare Foota e $ er S uare Foota e Basement X = $ 1�` Floor X = $ 2nd Floo� X = $ Garage X = $ Estimated Construction Value: $ 1 2- , Q�0 "� Orono Inspections Required Work Requiring Separate Permits Required State Permits 0 Site 0 Plumbing � Grading/ Filling 0 Well 0 Hardcover Removal � Mechanical � Fire �Electrical � Footing 0 Septic 0 Water Connection 0 Poured Wall � Fireplace � Sewer Connection 0 Foundation Survey � Masonry 0 Lawn Irrigation 0 Radon Rock Bed 0 Mfg. �Framing 0 Other(specify) �nsulation �s-Built Survey Final O Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: 0 YES 0 NO New: � YES � NO REMARKS(TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) _3� �J� s ;2oo,u lv u'�- fi� 1�� v.se c� (c�r- I� CI�.`f�"o�tJ /�- � .Sf e�' ��nf� � �1 � �' � '�`.S � Updated: 09/11/2009 z:\formslplan review checklist.docx � � '� - DAT TIME � CITY OF ORONO � CALLED IN `� � �� INSPECTION NOTI�E SCHEDULED _� � PERMIT NO. a�'�� C�`�� connP�ETEo ADDRESS �`�> ��7 t ,��.��, � �C,1��' OWNER TELEPHONE NO.��' � � � —��1�' CONTRACTOR �� DESCRIPTION `�_��:� �� t�� =_-�'�`'�`�L(S� �� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLI Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLA�� y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVA � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE O SITE INSPE Z _ �,�� Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPT C FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONT YOU• _ _.__,_,__4 O _ — � --''� o ( ,.2 (/l.� , �- , v � � � !� C�, , __ � � s� ��. ,- � __ W _ - � _ _ ____._.__ Q � Z W � W � j GW �IORKSATiSFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR W4LL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (J52� 249-46�� OwnerlContractor o site• ' Inspector. White Copyllnspector's File Canary CopylSite Notice