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Home My WebLink About2011-00195 - addn/remodel/repair „ CITY OF ORONO PERMIT NO.: 2011-00195 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: OS/12/2011 � 952 249-4600 FAX: 952 249-4616 � ADDR � : 3120 SUSSEX RD � PIN : 04-117-23-32-0009 LEGA DIES : FOX BEND : LOT 003 BLOCK 001 PERMI fiY : ADDITION/REMODEL/REPAIR PROPE 'CY PE : RESIDENTIAL CONS UC ON TYPE : ADDN/REMODEL/REPAIR ACTI T!Y : 434-RESIDENTIAL VALU TXO : $ 116,000.00 NOTE: �7PE TE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) FINISH OIWE LEVEL AND CONVERT DECK TO SCREEN PORCH ADV.P A�I IEW$749.29 PD 4/1/I 1 2011-00194 i APPLICANT pERMIT FEE SCHEDULE 1,152.75 L.C ER O. STATE SURCHARGE(VALUATION) 58.00 5500 L ICO DRIVE#180 EDIN ,1'�IN 5436- MISC FEE 0.00 (952)9 Sr84 TOTAL 1,210.75 Minne t�St e License#: 0002064 PAID WITH CC# 1423 OWNER ANDE $O BRETT& STEPHANIE 3120 S �SE RD LONG L1�K MN 55356- C'rR MENT AND SWORN STATEMENT The wo k�'or ch this permit is issued shall be performed according to the app ovled p s and specifications,applicable City approvals,and the State B il�ing de. This permit is for only the work described and does not gr t erm ion for additional or related work which requires sepazate permits II pr isions of laws and ordinances goveming this type of work shall b c mpi with whether or not specified herein.This permit will expire bec e null and void if construction authorized is not comme c d w' in 180 days of the date of issuance,or if construction is suspen e for iod of 180 d at an ime after work has commenced. The ap li ponsib or assu � g all required inspections aze request orm with tate Building Code.This permit may be 're ok e r d ause. � , / L—f- G I 1 �/ /� � . li P Sig ature Date Iss By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. _. �} � �� z�� i� � Cit of Orono C� Y Building Permit Application for New Structures or Additions � �a�O' �� Mailing Address: Permit number. a�flj/—Od!�.� � PO Box 66 � 0 Crystal Bay, MN 55323-0066 Date received: -^I� �� F StreetAddress:' Received by. �� ,�, �ti 2750 Kelley Parkway Plan review fee: 7 .�� '�:E^7 w Orono, MN 55356 �0�� G� Total Fee: ain: 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) GEN f�A NFORMATION: i Job itae dress: ��O � 55� R d Will t i� b Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes, speci event permit is required with Police Department and City Counci/approva160 days prior to the event Shuttle bus service will be require unles pplicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. CON RjAC R/APPUCANT INFORMATION: Name L , G,r-��.�,^ (,7��:�,w�2.� � gw, �c�a�-S State i�en # ' O Expiration Date: Phon : a— � office � — 3 p cell /�qr k� Mailin Ad ss: 00 'v�G� L �� Cit : �' r� ^ ZIP: Cont t Pe on: L�:,.rr v Gra w.4� Applicant is: o ra / Homeowner (Circle One) Email amd! Fax: PRO ER OWNER INFORMATION: Nam : �l' 't' .��,c�eS'SUv� Phon (da '73— �� Addr s8: ?� l �O �t,�_�-�,jC (Zc� City: Q�'O N O ZIP: Email a�d/ Fax i ARC ItE /ENGINEER INFORMATION: Nam : Phon Qda : Addr s�: City: ZIP: Emai and/ Fax: PR �C INFORMATION: Lo w�e,r- LP,u�e�, �"i � ,s h — D�.C�- —E'o �G�"�te,n, T BY'Gt�� 1.T e of oject 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� Water Supply ❑ N Co truction � Single Family with Residence �A ition attached garage �Garage/Accessory Bldg: ❑ Public Sewer ❑A e�sso Building ❑ Single Family with ❑ Deck ❑ R locati detached garage ❑ Office/Commercial ❑ Private Sewer ❑ �r:( cify) ❑ Multiple Family/Condo ❑Warehouse ' ❑ Public ❑Storage �Public Water "'kAn e rt ovement may require ❑ Commercial ❑Other(specify) MC ev' 8�permits. ❑ Industrial ❑ Private Well Minne a a ek Watershed District(MCWD) ❑ pther:(specify) 1820 M nne nka Blvd Deep a en, N 55391 Phon : 52 1-0590 Fax: 5 -47 0682 www. i neh acreek.o Esti a�ed onstruction Valuation(excluding land) $ � � �, �i� LBst dated: 1/26/2011 --r - 19- i I. ,� . . � , . 1- , � 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 sauare feet Detached= ❑ iCF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 15�Story = . � ❑ Other(please specify): e.2"d Story= . , f. %z Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclased licable ❑ ❑ Permit A lication ❑ ❑ Pro osed Buildin Plans ❑ ❑ MN State Ene Code Calculations and Mechanical Code Re uirements Form ❑ ❑ Surve meetin all re uirements � ❑ Stormwater Pollution Prevention Plan 0 ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort i. ❑ ❑ Access Permit � i ❑ ❑ WeUand Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee � ❑ ❑ Other i � APPLICANT ACKNOWLEDGEMENT: '', • Agrees to provide all information required or requested by the Building Department; I • 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 i, are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject it until it is complete; • Acknowledges the Escrow Agreement is cotnpleted and signed; ' G • Understands some or all of the information that you are asked to provide on this application is classified by State law as either ��I 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 govemmental agencies I required by law. If you refuse to supply the information,the application may not be issued. y I • 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 j' escrow agreement to ensure completion of the as-built survey and all site improvements. � i�l j ApplicanYs Signature: Date: ; Last Updated: 1/26/2011 I -20- '� � Plan Review Checklist for New Structures / Additions Ad r�ss PID/Legal: �f°" � S `"' S S E� �'�- (C � � . De cripti nofwork: '�l�s� LOGfi-�� +i(r� � ��n'�1��f/� p�Gl� '�° S(,�-�s.��i�-�.. ptic review by: Date Approved:�� `��.� ning review by: Date Approved: � � ilding review by: � Date Approved: �/ - ! � ' � 1 rading review by: � Date Approved: Zo i �g � #: Resolution#: Resolution Date: nin District Fire De artment Post Office School District Zo ing: Lot Area: SF/AC Width: Depth: Su Qy bmitt � 0 Yes 0 No Date of Survey: Pr ose Setbacks: ron Lake) Rear reet) ( N S E W ) ( N S E W ) Other ildings Wetland Side Side Bui ding efined Height: uilding Peak Height: #of Stories Ok?: � YES FO /A B DING WITH A BASEMENT OR CRAWL SPACE: FOR UILDING ON A SLAB FOUNDATION: S A T ITH the distance between the basement floor/crawl ART the distance between the slab and the highest space floor and the highest roof peak, the top of ITH 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 uppermost point on a round or other arch-type or other arch- e roof roof S R T half the distance between the highest wind and SUBTRAC half the distance between the highest window hi hest roof eak of a itched roof d hi hest roof eak of a itched roof S B� T the distance between the basement fl r/crawl ADD the 'stance between the slab and the highest i, space floor and the highest existin rade within existin rade within the foundation the foundation or 10 feet,which er is less. EQUALS Defined b ' in hei ht E AL Defined buildin hei ht Lot Cpv ge: SF % Sh reland District CWD Permit Received Avera e Lakeshore Setback Bluff 0 Yes 0 No � N/A 0 Yes � No '� es 0 No 0 Yes � No 0 N/A Permit Number: Setback: hlar over Zo es Existin Pro osed Variance Re uired CUP Re uired 0-75' � Yes � No � Yes 0 No ' 75 50' Type(s): Type(s): � 50-500' 00-1000' RE �R (in-house): Upd t�d: /11/2009 z:\f 1pl review checklist.docx r Fees to be Char ed . YES NO � �Permif - � - _ _,_ .. , . Plan Review �/ =State�urc�ar,ge ��'�...; - - i Investigation Fee 'S�C�t��uinberfo#�SAC �n:its - �:�= Sewer Connection �IUate�or��ec#iorr � � r,,,� _ Park Fee �i5ite�ln�psction , , , - �.; �•�. _ ,.. . .. _: . ,. . .., _. _. .,.� ... _,_ Other(specify) ,�ISC8�18�I18AUS�-�E�S.;. z,;` t ,.;;' - - �} �_ . , ...,. . , . . . ,_, . . • - .. Calculated By: S uare Foota e $ er S uare Foota e Basement X = $ k 15t Floor X = $ 2nd Floo� X = $ Garage X = $ Estimated Construction Value: $ 11��Ot� °° � Orono Inspections Required Work Requiring Separate Permits Required State Permits � Site Plumbing 0 Grading/Filling 0 Well 0 Hardcover Removal �Mechanical � Fire �'Electrical � Footing � Septic � Water Connection � Poured Wall �'Fireplace � Sewer Connection � � Foundation Survey � Masonry O Lawn Irrigation 0 Radon Rock Bed �Mfg. �Framing 0 Other(specify) �Insulation 0 s-Built Survey �inal � Other(specify) REMARKS (in-house): I Other Review: Reviewed by: Date Approved: Access:Existing: � YES � NO New: 0 YES 0 NO REMARKS(TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) Updated: 09/11/2009 ' z:\forms�plan review checklist.docx � �' D TE TIME ✓ � CITY OF ORONO U cALLED IN ��l� ��1 � INSPECTION NOT CE�y� SCHEDULED �_1L -�� PERMIT NO.�� C.�IJ��S COMPLETED ADDRESS 3( �O �'iSS� � OWNER TELEPHONE NO. �O � a-��-33�c, CONTRACTOR L ►�ao'1'zo(L Cyn• � DESCRIPTION f�-f�ln I ��'�=I'Y�C�� C,l � ❑ FOOTING ❑ PLUMBING FINAL� v EXCAV/GRADING/FILLING Q � POURED WALL ❑ MECHANICAL RI ��•` ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL � ❑ INSULATION ❑ WOOD BURNER/FIR r ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP �t� ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SE�C FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU: YES_NO v�, COMMENTS: � W 0. o V � � • �T' S� `7j e�a �' ,��J '' -�'!'��.5 ��S /�I�� 0 � W � Q � 2 W � W � � d W ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE ��`G25RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECOND�TIQNWITHIN HOURS. ppHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS. Cail forthe next inspection 24 hours in advance. (952) 249-4600 Owner/ConVactor on sit�: � Inspector. White Copyllnspector's File Canary CopylSite Notice �'� Df�TE TIME � CITY OF ORONO `�ca,�LED IN r� � INSPECTION NOTIC` � /� SCHEDULED Lo��D►I f � PERMIT NO. �O t I —��K�COMPLETED ADDRESS OWNER TELEPHONE N�� a��`3�� CONTRACTOR � �r�� DESCRIPTION C 1�/ '�u-�� l��►"�> � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q p POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SE�FINAL ❑ FOUNDATION/REMOVAL � OWNERICO TRACTOR TO MEET YOU: ` YES_NO c�., COMMENTS: � W a � J O a � O � W � Q � 2 W � W � � � d WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CAI.L TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on s'te: Inspector. White Copyllnspector's File Canary CopylSite Notice