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Home My WebLink About2014-01102 - addn/remodel/repair CITY OF ORONO * 2 0 1 4 - 0 1 1 0 2 2750 KELLEY PARKWAY DATE ISSUED: 10/13/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS 200 TRUFFULA TR PIN 33-118-23-44-0039 LEGAL DESC MEADOW WOOD POND LOT 005 BLOCK 001 PERMIT TYPE ADDITION/REMODEL/REPAIR PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDN/REMODEL/REPAIR ACTIVITY 434-RESIDENTIAL VALUATION $ 4,000.00 NOTE: DECK STAIRS AND HOT TUB NOTE: PRIO TO RELEASE OF ESCROW FUNDS ALL PROJECTS MUST BE COMPLETED,SHOWN,AND APPROVED ON AN AS-BUILT SURVEY. INITIAL: APPLICANT PERMIT FEE SCHEDULE 103.25 STATE SURCHARGE(VALUATION) 2.00 ADAMS,MR.&MRS. TOTAL 105.25 200 TRUFFULA TR Payment(s) LONG LAKE,MN 55356- CHECK 6972 105.25 OWNER ADAMS,DONALD&SHEILA 200 TRUFFULA TR LONG LAKE,MN 55356- 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 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested i formance a State Building Code.This permit may be revoked any .ti a for us . o Ap rrr► u Date Issu'4 By Signature Date CITY OF ORONO BUILDING PERMIT APPLICATION /0 FOR NEW STRUCTURES OR ADDITIONS OMailing Address: Permit number: �TO PO Box 66 Crystal Bay, MN 55323-006 Date received: Street Address:' 1►� Received by: /- yF 2750 Kelley Parkway �� Plan review fee: 11 �G Orono, MN 55356 KESH�� 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 12nnt) GENERAL INFORMATION: Job Site Address: N n Itt Will this be a Parade ofHomes, Remo eters Showcase Home or other Display Home? ❑ Yes RrNo 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/AP t (CANT INFORI,I4rION: Name: n �/lel 1 ;1 State License# vExpiration Date: Phone: cell � - - 31' office - Mailing Address I r ' - City: f Contact Person: VL _ Applicant is: Contractor / omeowner , (circle One) Email and/or Fax: , 1'-V1 -� PROPERTY OWN R INFORMATIO �W Name: S Phone (day): 44 Address: city: ZIP: Email and/or Fax c ARCHITECT/ ENGINEER INFORMAT ON: Name: L S Phone (day): Address: City:///;4 IP: Email and/or Fax: PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & Water Supply ❑ New Construction Single Family with ❑ Residence 1-7 Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer Accessory Building ❑ Single Family with ❑ DeckF `x Relocation /� detached garage ElOffice/Commercial tom,Private Sewer Other: (specify) L1 ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water **Any earth movement may also require ❑ Commercial Other(specify) MCWD review& permits. ElIndustrial -Cl �� ❑ 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) STRUCTURE INFORMATION: FaLengthuft)= tructre Dimensions 1. Structure Dimensions (continued) 2.Type of Construction Number of bedrooms= Wood/Frame idth (ft.)= Number of garage stalls: ❑ Masonry ❑ Metal Areas in square feet Attached = ❑ Pole Bldg. c. Basement= Detached = ❑ ICF d. 15t Story = ❑ On-site Prefab e. 2nd Story= ❑ Off-site Prefab f. '/z 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 Encl 'sed Applicable j ❑ Permit A lication ❑, Pro osed Buildin Plans ❑ MN S�(mee�tinqall de Calculations and Mechanical Code Requirements Form — ❑ Surve uirements rpNDAccess Stormwater Pollution Prevention Plan [� Hardcover Calculation(s) ❑ Septic S stem Site Evaluation Report ❑ Permit Wetland Buffer Improvement Plan13Engineered Plans for Retaining 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 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 to ensure completion of the as-built survey and all site improvements. Applicant's Signatur : Date: �^ Owner's Sign atur Date: `�� PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address/Permit Number: �n I (A Description of work: 4r- Septic review by: Date Approved: Zoning review by: Date Approved: q.30' Building review by: Date Approved: t V'I— 1 Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: Lot Coverage: SF _% Survey Submitted: es D No Date of Survey: q'/►IJ'�� Revised date(?): Proposed Setbacks: 71 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%_ #of Stories Ok? DYES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: The distance between the lowest FOR A BUILDING ON A SLAB FOUNDATION: START WITH 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... GABLE OR HIPPED ROOF no If you have a... ( GABLE OR HIPPED ROOF(no windows): Subtract half the windows): Subtract 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): Subtract 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 subtraction. ADDITION 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 basement/crawl space floor and the EXISTING the foundation. GRADES) highest existing grade adjacent to the GRADES foundation OR 10 feet(whichever is less). EQUALS Defined building height EQUALS Defined building height Shoreland District MCWD Permit Received Average Lakeshore Setback Met? Bluff Yes D No D N/AD Yes �FNO D Yes IVINo A D Yes D No �/A Permit Number: L1+- q Setback: Stormwater Quality Existing Proposed Variance Required CUP Required Overlay District Tier Hardcover Hardcover D Yes No D Yes No Type(s): Type(s): Updated: January 2013 v:\forms\plan review checklist 2013.docx REMARKS (in-house): Fees to be Charged YES NO Plan Review Investigation Fee Other(specify) Square Footage $per Square Footage Basement X = $ 1St Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ it Ood Orono Inspections Required Work Requiring Separate Permits Required State Permits 0 Site 0 Plumbing 0 Grading/ Filling 0 Well 0 Hardcover Removal 0 Mechanical 0 Fire 0 Electrical Footing 0 Septic 0 Water Connection - 0 Poured Wall 0 Fireplace 0 Sewer Connection 0 Foundation Survey 0 Masonry 0 Lawn Irrigation 0 Radon Rock Bed 0 Mfg. 0 Framing 0 Other(specify) 0 Insulation As-Built Survey X Final 0 Wetland Buffer 0 Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES 0 NO New: 0 YES 0 NO FF CIAL RE ARKS -TO BE NOT ON PERMIT D INITIALLED rias 6 YC � Um J*A t- shm rivi a n a. - wt 'Su(V�r mmkmam" A g6MM Updated: January 2013 v:\forms\plan review checklist 2013.docx CITY OF ORONO CALLED IN jXtl DATE TIME INSPECTION NOTICE SCHEDULED PERMIT NO. /S �/V//)7--COMPLETED ADDRESS 06 7 u OWNER Van A&M TELEPHONE NO. 42_ ' CONTRACTOR DESCRIPTIONS l W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q [IFOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL ZA J ❑ DEMO-SITE ❑ SEPTIC I+O^LL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES J4'NO COMMENTS: cc W W J O cc O WLQ cc Q 2 W W cc j O W ❑WORK SATISFACTORY:PROCEEDROJECT COMPLETE cc ❑CORRECT WORK&PROCEED ❑ ISSUE W CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p PHOTO TAKEN INSPECTOR WILL RETURN ❑ STOP ORDER POSTED.CALL INSPECTOR 0 CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. ' White Copytinspector's-File Canary CopyWe Notice