HomeMy WebLinkAbout2013 - 01268 (voided) City of Orono
Eluolc+..ing Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
�T Mailing Address: �/�-d/ e
�l/ PO Box 66 Permit number:
1 VO 0 I Ai" 13 Crystal Bay, MN 55323-0066 Date received: /Z-s J
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Street Address: Received by: /29 _ >
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2750 Kelley Parkway Plan review fee:
Orono, MN 55356
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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: I/S-5-6 (�c-.4 S 1 vQ.J40- ?I 0.(..Q___ 0 ream
Will this be a Parade of Homes, Remodelers Showcase Horn or oth r_Display Home? ❑ Yes 2-No
If yes, a special event permit is required with Police Department and City approval 60s prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-siteparking i available. Non-p rmitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATIO :
Name: n r3VA-Srt'v-. 5 ' .' o
State License# 903 8 c/-7 ac 4 Elpiration Date: 5 -31 -/
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior t• *78
Phone: (cell) 6 s—/- 674 - •4 . (office/769-3 acCa - 13 (G
Mailing Address: Q 6.0 i4.,a-h-1.6.,...1- a 5-,,,-- . /Of City: .0.�r,.,r„,,eri-.a„ ZIP: 5-s-,3 '
7
Contact Person: s Applicant is-_tractor / Homeowner (Circle One)
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Email and/or Fax: r Y a,,v 4 crAl skvl.„ *:,�,.• ray 7c;;3'-zis-6 /39/
PROPERTY OWNER INFORMATION:
Name: 4/r .�l",'ori-, (1,);./66
Phone (day): (ay. -- St 5 j--.9Yd-4, 99
Address: 9- IJ (���)v2.c- �., r'1ace_ City: Orry- ZIP: 6-5-3s-7
Email and/or Fax: 0, ejcoi C ei rn� I , .
7 ...�U , � 1^? f/
PROJECT INFORMATION: Overall project description: �' ,a c=je �_e. f`- w , 'ON- /1.2. ek 1- a,I r
Type of Project: Any earth movement may also require
ElDoor(s) Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof, other(specify) ❑ Siding CIOther: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) cjei � www.minnehahacreek.orq
Estimated Construction Valuation of Project (excluding land) $ y!, 3..3 G . .S�=
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 information, the application may not be issued.
'.------Applicant's Signature: Date: 4.-.7"
. -S/3
Owner's Signature: Date:
Last Updated: 03/06/2013
PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
Address/Permit Number: `1 5 W DLVG l T OAU PC_A c
Description of work: J (A-) 0 - G(<V1/4)Co AN p 11-11"1-1'JS DP.1 c.-.,--)L t sr liv6 /JQcec
Septic review by: Ai(A Date Approved:
Zoning review by: to Date Approved:
Building review by: ;,li,,l._ Date Approved: / Z-5- - 2.-013
Grading review by: IN(A Date Approved: ,
/
ning District: Zoning File#: Reso#: Reso Date: /
Zonin•• Lot Area: SF/AC Width: Lot Coverage: _%
Survey Su i . itted: D Yes O No Date of Survey: Revised da/e(
Proposed Setb. . s:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other uildings Wetland
Side Side
/
Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour)
Perimeter(linear feet) = 50% = #of Stories Ok? D YES
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: /
The distance between the.lowest F R 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 r of SUBTRACTION
(BASED ON ROOF • gable or hippedHIPPED
GABLE OR HIPPED ROOF ith (BASED ON • GABLE OR HIPPED ROOF(with
TYPE) windows): Subtract half t e ROOF TYPE) windows): Subtract half the distance
distance between the to of the between the top of the highest
highest window and t - highest window and the highest point of the
point of the roof roof
• ALL OTHER ROS.F TYPES(flat, • ALL OTHER ROOF TYPES(flat,
mansard,etc):No subtraction.
mansard,etc): o subtraction. ADDITION Add the distance between the top of slab
SUBTRACTION Subtract the dis- ce between the (BASED ON and the highest existing grade adjacent to
(BASED ON EXISTING basement/era space floor and the EXISTING the foundation.
GRADES) highest exis• g grade adjacent to the GRADES)
foundatio •R 10 feet(whichever is less). EQUALS Defined building height
EQUALS Define• building height
Shoreland District MCWD Permit Received Average Lakeshore Setback Me Bluff
D Yes D No D N/A Yes D No
D Yes • No D Yes D No D N/A —
Permit Number: Set ck:
Stormwrr Quality Existing Proposed Variance Required CUP Required
Overlay istrict Tier Hardcover Hardcover
D Yes D No D Yes D No,
Type(s): Type(s):
Updated: January 2013 0 CAA�, e
v:\forms\plan review checklist 2013.docx / �
REMARKS (in-house):
Fees to be Charged YES NO
:permit �W.i
Plan Review / 1/
:State Surcharge s, • , ; 2 ' {° ,r.:
Investigation Fee
.SAC Number ofSAC Units ' 'ti `:.
Other(specify) e/
Square Footage $per Square Footage
Basement X = $
1St Floor X = $
2nd Floor X = $
Garage X = $
Estimated Construction Value: $ `t(1330`
61.
Orono Inspections Required Work Requiring Separate Permits Required State Permits
O Site 0 Plumbing 0 Grading/ Filling 0 Well
O Hardcover Removal 0 Mechanical 0 Fire 0 Electrical
O Footing 0 Septic 0 Water Connection
O Poured Wall El Fireplace 0 Sewer Connection
O Foundation Survey 0 Masonry 0 Lawn Irrigation
O Radon Rock Bed 0 Mfg.
O Framing 0 Other(specify)
0 Insulation
O As-Built Survey
Final
O Wetland Buffer
El Other(specify)
1
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access: Existing: 0 YES 0 NO New: 0 YES 0 NO
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED
Updated: January 2013
v:\forms\plan review checklist 2013:docx
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