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Home My WebLink About2012 - 00215 - addn/remodel/repair CITY OF ORONO I I I 1111111111111111 III I I III III IIII 2750 KELLEY PARKWAY * 2 1 S - 0 PJ 2 1 5 DATE ISSUED: 05/07/2012 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 : $ 1,571.00 NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) 2 PROJECTS-DECK&STIRS/ENTRY NOTE:BUILDING SEWER LINE IS`�Zi t4 D IN THE AREA OF THE 16'X 16'DECK. SEE ATTACHED SEPTIC AS-BUILT INITIAL APPLICANT PERMIT FEE SCHEDULE 60.75 PETERSON,RONALD STATE SURCHARGE(VALUATION) 0.79 4700 WEST BRANCH RD MOUND,MN 55364 TOTAL 61.54 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 ked at ' e f r due cause. 5 / / I / / Nxit / Applicant Permitee Signature Date Issue:y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 3 -ZS -12_ City of Orono Building Permit Application '6 4 for New Structures or Additions Mailing Address: Permit number: f —dd �,0,4, PO Box 66 Crystal Bay, MN 55323-0066 Date received: Z J Z ,..----.4.13 � O u' Received by: " ,a �, Street Address:' � , f /9 ��ct'„,,:4;61,24p, 2750 Kelley Parkway Plan review fee: 4 su Orono, MN 55356 citC/, 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: '/Tvo wz57L Er uAdA "Rd 0 o9,14.49 Will this be a Parade of Homes, Remodelers Showcase Home 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 event. Shuttle bus service will b required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: State License# Expiration Date: Phone: (office) (cell) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: J Name: o1 --'t-save- Phone(day): 9Sa a 3Q '?OS Address: Sow-te.. City: ZIP: Email and/or Fax )'fl ,rtr,scgp€s G 901tfv) , CAyv” ARCHITECT/ENGINEER INFORMATI Name: Phone(day): v Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Q eLt4y 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & Water Supply NNew Construction K Single Family with Residence Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage 0 Office/Commercial -N Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public El Storage ❑ Public Water "*Any earth movement may require ❑ Commercial El 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.orq Estimated Construction Valuation (excluding land) $ L5-7/. C,1Lj i STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) 2. Type of Construction a. Length(ft.)= I Cp Number of bedrooms= Wood/Frame Masonry b.Width(ft.)= /6 Number of garage stalls: ❑ Metal Attached= ❑ Pole Bldg. Areas in square feet Detached = ❑ ICF ❑ On-site Prefab c. Basement= D Off-site Prefab d. 1st Story = (0 S r ❑ Other(please specify): e.2nd 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 Enclosed'` Applicable 0 Permit Application 0 Proposed Building Plans ❑ 0 MN State Energy Code Calculations and Mechanical Code Requirements Form 0 Survey(meeting all requirements) ❑ 0 Stormwater Pollution Prevention Plan ❑ 0 Hardcover Calculation(s) ❑ 0 Septic System Site Evaluation Report ❑ 0 Access Permit ❑ ❑ Wetland Buffer Improvement Plan ❑ ❑ Engineered Plans for Retaining Walls 4 feet or above ❑ 0 Plan Review Fee ❑ 0 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. Applicant's Signature: Date: 3 , 1 a Plan Review �lChecklist for New Structures / Additions . Address/ PID/ Legal: iiX Vv eSi- branCfl Rei Description of work: Zvro (,IJ Gr i-- ��j / Septic review by: ,i _so, \ Date Approved: _-•5 .2-2- I Zoning review by: 'LO. mi.1 Date Approved: L-3 2-7 /2---- Building Building review by: A (0 Date Approved: - -- ( 2— Grading review by: Pr Date Approved: Zoning File#: Resolution#: Resolution Date: Zoning District Fire Department Post Office School District Zoning: Lot Area: 1,1 b SF/e) Width: Depth: Survey Submitted: ❑ Yeso Date of Survey: Proposed Setbacks: py usd o t 5 u r v / Old 5-2:1-11 Front pfei Rear( at-; ( N S E ( N S �E' W ) Other Buildings Wetland Side Sidi' i55 ' V 11c' 162- ' a ' q-ct`f 153' z, c 0 Bul ding Defl ed Height: (I Pc Building Peak Height: NA" #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 nd uppermost point on a_reurfd or other arch-type or other arch-type roof roof - SUBTRACT half the distance between jhe-h ghest window and SUBTRACT half the distance between the highest window highest roof peak of a pifched roof and highest roof peak of a pitched roof SUBTRACT the distance between the basement floor/crawl ADD the distance between the slab and the highest space floor and the highest existing grade within existing grade within the foundation the foundation or 10 feet,whichever is less. EQUALS Defined building height EQUALS Defined building height Lot Coverage: SF Shoreland District MCWD Permit Received Average Lakeshore Setback Bluff � LI Yes 1:1 No N/A �� 1:1 Yes 1:1 No CIT Yes No 1:1 Yes El No N/A Permit Number: .la Setback: Hardcover Zones Existing Proposed Variance Req�uir CUP Required 0-75' /' ❑ Yes A No 1:1Yes No 75-250' Type(s): Type(s): 250-500' • 7 500-1000' REMARKS (in-house): Updated: 09/11/2009 z:\forms\plan review checklist.docx Fees to be Charged YES NO Permit Plan Review State Surcharge Investigation Fee SAG-,Number of SAC Units Sewer Connection Water Connection Park Fee Site Inspection Other(specify) Miscellaneous Fees Calculated By: Square Footage $ per Square Footage Basement X = $ 1st Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ V.5-71- 0 D Orono Inspections Required Work Requiring Separate Permits Required State Permits ❑ Site ❑ Plumbing ❑ Grading / Filling 0 Well O Hardcover Removal 0 Mechanical 0 Fire 0 Electrical Footing 0 Septic 0 Water Connection O Poured Wall 0 Fireplace • ❑ Sewer Connection O Foundation Survey 0 Masonry 0 Lawn Irrigation O Radon Rock Bed El Mfg. Framing ❑ Other(specify) ❑ Insulation ❑ As-Built Survey Final O Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: ❑ YES ❑ NO New: ❑ YES 0 NO ,REMARKS (TO BE`NOTED ON PERpMIIT AND INITIALLED�BYpPERSON PULLING PE�RnMIT) \i'. tU No r- Bu 1 r ti ievt s3 ct ko Xity -eiftcic. all-ad sQ h c1 a5-latitt. Updated: 09/11/2009 z:\forms\plan review checklist.docx , . • ! — k•=11,1' . ve..... t., I auszaces, rs r.,(1 ----„ .. , , . ..) t.,. 1 7,--- i ! C‘k4 1 ._. . .,. . . _..– .. . , . ,.. .. ; ,• \,,....1, -, , , ......— , I .• eq. -,,',..: -- : . r . . \ ` \'' ' i , i ; \„,,,,,,_._,,c,,,...‘•-•-•• i 1 . , i 1 '..s_ , \ !. i \ . . ? i ‘ I .. .. 1 ...-----. .__ --,=, ....., Q . cro ,' , 4- i [ , 11 _ ',, , k',„ \,,,, ,...., we , , st..._ , DATE TIME 1 CITY OF ORONO C LED IN INSPECTION NOTICE SCHEDULED I1 Z'I Z PERMIT NO. / COMPLE D ADDRESS X71,0 COes �i`-E� j OWNER -P____ NO. <�Z 252 7 Q 406"" CONTRACTOR �i , • >. DESCRIPTION 3i t o 'f" Dec � F'" . I, 14 ❑ FOOTING ❑ PLUMBING FINAL 0 EXCAV/GRADING/FILLING Q 0 POURED WALL ❑ MECHANICAL RI 0 LAKESHORE/WETLANDS " 0 FRAMING 0 MECHANICAL FINAL ❑ TREE REMOVAL Z0 INSULATION 0 WOOD BURNER/FIREPLACE ❑ SITE INSPECTION C 0 RADON SLAB 0 WATER HOOK-UP 0 PROGRESS 0 FINAL 0 SEWER HOOK-UP 0 COMPLAINT v 0 DEMO-SITE 0 SEPTIC MAINT. 0 FOLLOW-UP st LLI 0 DEMO-FINAL 0 SEPTIC INSTALL 0 HARD COVER REMOVAL v 0 PLUMBING RI 0 SEPTIC FINAL 0 FOUNDATION/REMOVAL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO C. COMMENTS: li /�,\ Feril . I C f � Q. o L) / /...- 6X) i 7 H a o W cc 41. J z y LL jI C - 6T I I ��. W z W cc GW CIWORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE CCW CI CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑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. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: ' , Inspector. U L/ "7 White Copy/Inspector's File Canary Copy/Site Notice Se)-- ATE TIME V CITY OF ORONO / CALLED IN 7 d---- INSPECTION — INSPECTION NOTICE �/V� SCHEDULED 3 /0- i3 :6)6 PERMIT NO.r ,R_OOOv.5 COMPLE D L_ ADDRESS � S I V)14* OWNER 'i d i f t� ' U / TELEPHONE NO95 3 2--- "'D' 5 CONTRACTOR / . • a DESCRIPTION � -S -r--o-r- d e c(c - 5 [at G 6. W ❑ FOOTING ❑ PLUMBINC�FINAL .L ikeit IETICifAtaDING/FILLIN6--1 LL. 0 POURED WALL 0 MECHANICAL RI 0 LAKESHORE/WETLANDS y O 0 FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL ❑ INSULATION 0 WOOD BURNER/FIREPLACE ❑ SITE INSPECTION • ❑ RADON SLAB 0 WATER HOOK-UP 0 PROGRESS 6, ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE 0 SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL 0 HARD COVER REMOVAL v ElPLUMBING RI CISEPTIC FINAL 0 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO o COMMENTS: 3 i CLL-1/1:q -- oZ61 ( -46CI74 N O i AJf - 1 0 5 h�ecpi - ao, - 0011 a � �i , A (-e a / a cc 0 cc 1 - T . C-- �� A C i 6 de ` -c z W cz 0 W El WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE CCW CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O CICORRECT WORK,CALL FOR REINSPECTION TEMPORARY (..) BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN CISTOP 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 on site: Inspector. White Copy/Inspector's File Canary Copy/Site Notice 74 *WI/ Cf DATE TIME CITY OF ORONO ‘110.' CALLED IN • INSPECTION NOTICE - 15 SCHEDULED PERMIT NO. COMPLETED [� ADDRESS) ( U ; R rUD1C ted OWNER 14,k1 '(' R W CY1 TELEPHONE NO.C(c; CONTRACTOR >: DESCRIPTION I raw\ t - a �Z S W ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING ❑ POURED WALL 0 MECHANICAL RI 0 LAKESHORE/WETLANDS y ❑ FRAMING CI MECHANICAL FINAL ❑ TREE REMOVAL • ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB 0 WATER HOOK-UP ❑ PROGRESS • ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v 0 DEMO-SITE 0 SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTAL ❑ HARD COVER REMOVAL U PLUMBING RI ❑ SEPTIC FINA 0 FOUNDATION/REMOVAL Q OWNER/CONTRACTOR TO MEET YOU:_YES NO 2 COMMENTS: OC -("CiCC a cc O cc O U- W Q LU CC O WCC K ORK SATISFACTORY:PROCEED E1PROJECT COMPLETE ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY • ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY U BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ 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 on site: �'� Inspector. U- 6-(13"3 FS White Copyllnspector's File Canary CopylSite Notice