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HomeMy WebLinkAbout2016-00136 - addn/remodel/repair )0 / City of Orono , 5c/"� g� .Building Permit Application for Maintenance / Replacement / Remodel (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) Mailing Address: Permit number: op C9 /(o-or-)�3 PO Box 66 R Crystal Bay, MN 5532 Date Date received: -�0 Street Address: FEB 10 2016 Received by: YI'1 2750 Kelley Parkway Plan review fee: L �') Orono, MN 55356 CITY OF ORONO a SHO � 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 print) l GENERAL INFORMATION: Job Site Address: 7 OkkA W 1 )Z01 A Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ElYes No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle 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: State License# I?G O0 57W Expiration Date: Lead Certification Number: /,/q.T. - 0.5 Sjs _/ Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) 612- .2�2_/ 0 g y/ (office) G/Z. 8L7- y ySS Mailing Address: , City: /tet/ ZIP: SS i Contact Person: pee& W se c_t., Applicant is: on rac o / Homeowner (circle one) Email and/or Fax: pe,* jz� wGK-41 E042-4 PROPERTY OWNER INFORMATION: Name: fu u F /320-J^l a' 54A4 N 13 0 X-M A/ Phone (day): 6 iL - 353- y 9zo Cg ec p e rC-r) Address: 75'5- 7vti,<4W4 1.2t)44 City: 0 40"o ZIP: SS 35i Email and/or Fax: re PK ARCH GO^t (i/2cvrrC_r7 QN4*P.4Cf4__ /G6fuVert— PROJECT INFORMATION: Overall project description: AL.4 rx(r J � pw a».cr ��•c.�. re y r Type of Project: Any earth movement may also require c rc ❑ Door(s) © Remodel ❑ Fire Damage MCWD review&permits: c-vH WWIWAS ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) El 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) $ 2 rJU, D04 - 40 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 you refuse to supply the i orma ' application may not be issued. Applicant's Signature: Parse- J- G>e7,o Date: Owner's Signature: Date: Last Updated:January 2015 oc PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: 75 `�iQ r•U 2 Permit No.: Description of work: Q 40G Date Recd: Septic review by: VC4 Date Approv : Zoning review by: Date Approved: Building review by: Z, Date Approved: h(e Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date:_ Zoning: Lot Area: SF/AC Width: Lot Coverag SF % Survey Submitted: O Yes 0 No Date of Survey: Revised dateM: : Landscape plan submitted? D Yes 0 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: FF : FFE minus 6 feet= (Existing Contour) Perimeter(linear feet)= 0%= L.F. below grade Basement? 0 Yes 0 No, Stori s FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: The distance between the I st proposed Slab at or above grade— START WITH floor(of the basement or c space)and measure from highest existing the highest point of the rq f. START W ITH grade to the highest point of the roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR HI PED RO (no Slab below grade—measure (BASED ON windows): Subtract half th distance from highest existing grade to the ROOF TYPE) between the Aghest point f the roof highest point of the roof. to the low pdint of the corre ponding If you have a... gable or hifdped roof SUBTRACTION GABLE OR HIPPED ROOF • GABLE O HIPPED ROOF ith (BASED ON (no windows): Subtract half windows:Subtract half the stance ROOF TYPE) the distance between the betwee the top of the highes highest point of the roof to the low point of the windo and the highest point the roof corresponding gable or hipped roof • ALL OTHER ROOF TYPES(fla GABLE OR HIPPED ROOF mansard,etc):No subtraction. (with windows): Subtract SUBTRACTION Subtract the distance between the half the distance between (BASED ON basementtcrawl 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 Met? Cl Yes 0 No Permit Number: 0 Yes 0 No 0 N/A 0 Yes e No 0 0 N/A—see attached Setback: Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required circle one % ands %and s 0 Yes 0 No 0 Yes 0 No 1 2 3 4 5 Type(s): Type(s): Fees to be Char ed __,_YESON-WON s ,rK L . Plan Review L2 Investigation Fee 'k` f 4 ac.+ R o'0, �5 f#itS+w,sy � Other(specify) Square Footage $ per Square Footage Basement X. _ $ 18t Floor X = $ 2nd Floor X = $ Garage X = $ ,�1 ma Estimated Construction Value: $ Z�, (000 Orono Inspections Required Work Requiring Separate Permits 0 Footing 0 Site Plumbing 0 Grading/Filling 0 Poured Wall 0 Silt Fence/Erosion Control Mechanical 0 Fire 0 Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection 0 Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection Framing 0 Masonry 0 Lawn Irrigation Insulation 0 Mfg. 0 Landscaping As-Built Survey 0 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 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 -.SIC- %-­­­...- .,..I �- DATE TIME CITY OF ORONO CALLED IN — INSPECTION NQTICE SCHEDULED _ PERMIT NO. C Q�;_ODRIO COMPLETED ADDRESS— OWNER DDRESS OWNER TELEPHONE NO.(0\0""" -iiO3 SU CONTRACTOR pa.-r- DESCRIPTION 4 l~y ❑ FOOTING ❑ DEMO-FI L ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING C ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO cam., COMMENTS: Cc QC 0 WCc ✓� Q 2 D l� � C��u�✓ �' W - /tp leer.CSL arc v olv�� W Cc J W >il VVRK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE QZ ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Oww/Contractor on site: Inspector. '--� '— White Copyflnspeetor's File Canary Copy/She Notice (2-6 DATE IME CITY OF ORONO �lJk CALLED IN INSPECTION NOTICE I�' SCHEDULED 1 l PERMIT NO. c�110' COMPLETED ADDRESS OWNER TELEPHONE NO. CONTRACTOR ���%� ` VOCLrc�o.xtiJ DESCRIPTION �'�`�Q�- ' �a cr> \a - L'C30 ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL ZINSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP QZJ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: ac W a O O CC O v, W cc Q 2 W z W cc Z) WeRRECT FACTORY:PROCEED ❑ PROJECT COMPLETE W ORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C) BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. (_1 PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hou 'n adva 95 9) 249-4600 Owner/Contractor on site: Inspector. White CopYlinspector's File Canary C YlSite Notice