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Home My WebLink About2012 - 00951 - addn/remodel/repair 111111111111111111111111 CITY OF ORONO * 2 1012 - 0095 1 2750 KELLEY PARKWAY DATE ISSUED: 02/27/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4700 WEST BRANCH RD PIN : 06-117-23-33-0004 LEGAL DESC : UNPLATTED 06 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 1,800.00 NOTE: SEPERATE PERMITS REQUIRED: REPLACE ATTACHED DECK PAID ADV PLAN REVIEW FEE$43.71 CK 9/24/12 2012-00950 * AS-BUILT SURVEY TO INCLUDE WO'. PERMIT#2012-00367. ESCROW WILL BE REFUNDED AFTER SUBMITTAL AND APPROVAL OF AS-BUILT SURVEY. ` (INITIAL) APPLICANT PERMIT FEE SCHEDULE 67.25 PETERSON,RONALD STATE SURCHARGE(VALUATION) 0.90 4700 WEST BRANCH RD MOUND,MN 55364 TOTAL 68.15 OWNER PETERSON,RONALD 4700 WEST BRANCH RD MOUND,MN 55364 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 in conformance with the State Building Code.This permit may be ed a time for due cause. /‘X7 / /.8 ipp 02 Applicant Permitee Signature Date Is By y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. lD City of Orono (I'vV Building Permit Application S a lb for New Structures or Additions — ` Mailing Address: / 0�\ PO Box 66 Permit number: o?O/o2 -DD 9'� r O\ Crystal Bay, MN 55323-0066 Date received: 94l// 2— i I ��\ +r 1 ,{ �, Street Address:' Received by: \�cnt'l +� oti``' 2750 Kelley Parkway Plan-reviewfee: - 7 I �ik- '�Esz;o4� Orono, MN 55356 o�D/a.= 'S 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) GENERAL INFORMATION: Job Site Address: "T 703 Coe r Of)(k �c) UCOnc- Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes SPA 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.e required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APP I T INFORMATION: Name: '4 State License# Expiration Date: , Phone: (office) (cell) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (circle One) Email and/or Fax: PROPERTY OWNERINFORMAT�I Name: Hr ? 1–t,--fertS0 Phone(day): _ : _ r , C' a Address: •• �l "� t k „ A Lt rano Cit : ZIP: Email and/or Fax ��taldosc(3,.,� bJ s e '' -,cc-, . C,0r 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 SupplyXNew Construction Sin le Familywith ❑ Residence El Addition attached garage ❑ Garage/Accessory Bldg [' Public Sewer ❑Accessory Building ❑ Single Family with Deck .m.}0_,,_c.�.Q.c ❑ Relocation detached garage ❑ Office/Commercial Private Sewer ❑ Other:(specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public El Storage ❑ Public Water '*Any earth movement may require El Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial XPrivate Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.orq Estimated Construction Valuation (excluding land) 41,8nocclo STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= 4< I Number of bedrooms= 3 Wood/Frame I Masonry b.Width (ft.)= Number of garage stalls: ❑ Metal Attached= ❑ Pole Bldg. Areas in square feet Detached = 0 ICF c. Basement= ((jt ❑ On-site Prefab ❑ Off-site Prefab d. 1St Story = ❑ Other(please specify): e.2nd Story= f. '%Story = g.Total Area= /At REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not `Enclosed Applicable 0 Permit Application J7' 0 Proposed Building Plans ❑ 0 MN State Energy Code Calculations and Mechanical Code Requirements Form ❑ 0 Survey(meeting all requirements) O 0 Stormwater Pollution Prevention Plan ❑ 0 Hardcover Calculation(s) ❑ 0 Septic System Site Evaluation Report ❑ 0 Access Permit O 0 Wetland Buffer Improvement Plan ❑ 0 Engineered Plans for Retaining Walls 4 feet or above O 0 Plan Review Fee ❑ ❑ Other APPLICANT 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 agreement to ensure completion of the as-built survey and all site improvements. •` - ajar. Applicant's Signature: � ` t, � � .� Date: �� , �.T PLAN REVIEW,,CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address/Permit Number: -I1w brctnun Fd Description of work: be cr_. Septic review by: // � I Date Approved: Zoning review by: V //C'4 ;0 Date Approved: 0(24/ (24/2 11 Building review by: , .- -- Date Approved: VD 2— ' /3 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: I• X4'13 Revised date(?): Proposed Setbacks: Front( ) Rear(St t) ( N S E C ( N S E W ) Other Buildings Wetland Side Side fav 140 ' 20.3' Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet)= 50% = #of Stories Ok? ❑ YES 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... If you have a... • GABLE OR HIPPED ROOF(no 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 1:IYes ❑ No ❑ N/A ❑ Yeso 0 Yes ,el No ❑ Yes 0 No /A — Permit Number: Setback: Stormwater Quality Existing Proposed Variance Required CUP Required Overlay District Tier Hardcover Hardcover 0 Yes o 0 Yes ANo Type(s): Type(s): Updated: January 2013 v:\forms\plan review checklist 2013.docx REMARKS (in-house): Fees to be Charged YES NO Permit Plan Review 17. State Surcharge rr Investigation Fee SAC-Number of SAC Units Other(specify) Square Footage $per Square Footage Basement X = $ 1st Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ 1, 6 Ud Orono Inspections Required Work Requiring Separate Permits Required State Permits D Site D Plumbing D Grading/Filling 0 Well O Hardcover Removal 0 Mechanical 0 Fire 0 Electrical ooting 0 Septic 0 Water Connection O Poured Wall 0 Fireplace 0 Sewer Connection O Foundation Survey 0 Masonry 0 Lawn Irrigation D Radon Rock Bed 0 Mfg. „ Framing 0 Other(specify) O Insulation1-0C�,u, 0 e �o-i/�-�--�'Z)� As-Built Survey lZ t0-2 (-0-1 �inal D Wetland Buffer O Other(specify) REMARKS (in-house): Alfin(47 QCtifill — 4-de-7/4A-ibeivvvi Ce6171 p(yv 7g- 1405 (3) Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES 0 NO New: 0 YES 0 NO OFFICIAL REMARKS -TOB NOTED ON PERMIT AND INITIAL D 4 Ab(c� 5ury vlwi WOvt(- Yv ' 2.01L-00 /7. Vyav NtalpiU attic i niva- - ,(- bU rut.i- Updated: January 2013 v:\forms\plan review checklist 2013.docx DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED ! PERMIT NO. 0(olr'1' tX 31 COMPLETED .� /r-/".'y %; ADDRESS 7OU Ai E'-. ,6rtirt,'i , 2 OWNER _ *Ta",641SITELEPHONE NO. CONTRACTOR DESCRIPTION /9<?� W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION • FRAMING 0 MECHANICAL FINAL 0 PROGRESS is ❑ INSULATION ❑ WOOD BURNER/FIREPLACE 0 COMPLAINT �7FINAL 0 WATER HOOK-UP OLLOW-UP W 0 AS BUILT-SURVEY 0 SEWER HOOK-UP 0 HARD COVER REMOVAL . ❑ DEMO-SITE 0 SEPTIC INSTALL 0 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU: YES_NO COMMENTS: Pe( ecr Q.• 1;--41 /rl S/✓c Z5, i / /6 /7c zAr.% /06/A1 .04, 4e cc 0 vi Ft eV ECe I IA•s 7'/. e W _/ n Q �oC> r S Aa ff�3 id �Je?e/I/OC�/` , /D 6 4e 10.)00— z o/0•tW e),-enc, OcC,/o0..s jQG- r) _464%e' dr go/Ai a W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE CCW ID CORRECT WORK&PROCEED El ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN 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 Owner/Contractor n site:, Inspector. White Copy/Inspector's File Canary Copy/Site Notice _ice ✓ CITY OF ORONO CALLED I /�/� TIME N INSPECTION NO ICE _ �,��sCHEDULED /O-' 5-/ / //:,.3 O PERMIT NO. �1/ 7 (-( �)I OMPLETED 6A.-cm-c-_//c.ADDRESS 7 7c6 tc),1-- 7 `C OWNER kV 1 - �,S 4�TELEPHONE NO. -5 CONTRAC OR /3"-kb- i DESCRIPTION D `711:H L IQ FOOTING 042..c..-4, 0 PLUMBING FINAL V 0 EXCAV/GRADING/FILLING Q 0 POURED WALL 0 MECHANICAL RI 0 LAKESHORE/WETLANDS y 0 FRAMING 0 MECHANICAL FINAL 0 TREE REMOVAL Z ❑ INSULATION 0 WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP 0 PROGRESS ❑ FINAL ❑ SEWER HOOK-UP 0 COMPLAINT J ❑ DEMO-SITE 0 SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL 0 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:?DYES_____NO LI COMMENTS: fie& A 5` a Sa.Z — D,‹ 4�J Q / OS ler L s` /P� Y.ir ! a `' J o/ /v '`, e. / oil /60756 M'l - 6.E ' f b4 r ._ ccO � - re►Mrj ✓Q 4wy 10o5e /6()IL I-or‘.� 6b2V6.n W / dC KOIPi. it,rto✓ 1,34,cc/t !'potCrde-tC Wcel m.t new p4 K 4 c' , r �'av4G CC ,/cc a - C 1u.4 ¢ o f bra•.%..z .4 .4 . ..t 3 J S a W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE CCW ORRECT WORK&PROCEED El ISSUE CERTIFICATE OF OCCUPANCY C) ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR CI CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. C. . : _ ".spection_24 hours in advance. (952) 249-4600 Ow : , �l, •ctor on site: �� Inspector. 40 I1.-D WhCopy/Inspector's File Canary Copy/Site Notice