HomeMy WebLinkAbout2015 - 00740 - addn/remodel/repair CITY OF ORONO 111111111111111111111111 II1111111111111
II
2750 KELLEY PARKWAY DATE ISSUED: 06/10/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2485 WOODHAVEN DR
PIN : 33-118-23-41-0017
LEGAL DESC : WOODHAVEN 3RD ADDN
: LOT 002 BLOCK 001
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 2,000.00
NOTE: SEPARATE PERMITS REQUIRED: MECHANICAL
FINISH ROOM IN BASEMENT.
NOTE: NO PLUMBING. INITIAL: 34/
APPLICANT PERMIT FEE SCHEDULE 77.44
PLAN REVIEW 50.34
WOLF,MARK STATE SURCHARGE(VALUATION) 1.00
2485 WOODHAVEN DR
LONG LAKE,MN 55356 TOTAL 128.78
Payment(s)
CASH 128.78
OWNER
WOLF,MARK
2485 WOODHAVEN DR
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 in conformance with the State Building Code.This permit may be
revoked at any time for due cause. /�
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4� / /
Applicant Permitee S. nature Date Issued By Signature Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
A(2 Mailing Address: ::::::
: ,c5 -vb 790
AD x66MN 55323-0066 6-9'/S
Street Address: Received by: /WP-.y L 2750 Kelley Parkway Plan review fee:
t Orono, MN 55356
�'�FSHO� 42.7
Total Fee: / CCU
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: 24 q5 c)000I4AV& Q(I VE
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes KNo
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# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION: ('
Name: (h Nalk (OLT
Phone (day): C t t to7-312
Address: /J{8s' 44100NAMe-,J City: (.O,JC i.AMc( ZIP:4 , .7 3s
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) Remodel ❑ Fire Damage
MCWD review&permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration 0 Water Damage Minnetonka, MN 55345
1:1 Re-roof,other(specify) 0 Siding ❑ Other:(specify) Phone: 952-471-0590
edi Fax: 952-471-0682
❑Window(s) FI�IIN (taco) to www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 7 OG.00
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 general) cannot be given to either the public or the subject of the data. Our purpose and
intended use of this information is to annual) pdate our records and records of other governmental agencies required by law. If
you refuse to supply the informa i e a ation may not be issued.
Applicant's Signature: G✓ �✓ Date: at- 07 1
Owner's Signature: Date: of-o9-iS
Last Updated:January 2015
• PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
' Address: c-9-R5" Wec c/ t[L'&n O/'/VPermit No.:
Description of work: I,. L. /"f n.I5.4 Date Rec'd:
Septic review by: Date Approved:
Zoning review by: Date Approved: /
Building review by: ,4li 1 1.2. Date Approved: /l/ l�
Grading review by: Date Approved: `
Zoning District: Zoning File#: Reso#: Reso Date:
Zoning: Lot Area: SF/AC Width: Lot Coverage: SF cyo
Survey Submitted: 1 Yes D No Date of Survey: Revised date(?):
Proposed Setbacks:
Front(Lake) Rear(' treet) ( N S E W ) ( N S E W ) Oth- Buildings Wetland
Side Side
Defined Height: P;ak Height: FFE: FFE mi' s 6 feet= (Existing Contour)
Perimeter(linear feet) = 50% = L.F. below grade #of Stories
FOR A BUILDING WITH A BASEMENT OR CR'WL SPACE: FOR A BUI •ING ON A SLAB FOUNDATION:
The distance b-tween the lowest proposed The distance between the top of
START WITH floor(of the bas.ment or crawl space)and START WITH slab and the highest point of the
the highest point.f the roof. roof.
If you have a... If you have a...
• GABLE OR HIPPED ROOF
• GABLE OR H •PED ROOF(no (no windows): Subtract half
windows): Sub act half the distance the distance between the
between the hig est point of the roof highest point of the roof to
to the low point o the corresponding the low point of the
SUBTRACTION gable or hipped ro,f corresponding gable or
(BASED ON • GABLE OR HIPPED ROOF(with SUBTRACTION hipped roof
ROOF TYPE) windows): Subtract -If the dista•ce (BASED ON • GABLE OR HIPPED ROOF
between the top of th- highest ROOF TYPE) (with windows): Subtract
window and the highes.point the half the distance between
roof the top of the highest
• ALL OTHER ROOF TYP_:(flat, window and the highest
point of the roof
mansard,etc):No subtra•t•n. • ALL OTHER ROOF TYPES
SUBTRACTION Subtract the distance betwe: the (flat,mansard,etc):No
(BASED ON basement/crawl space floo and th- subtraction.
EXISTING highest existing grade adj.cent to the ADDITION Add the distance between the top
GRADES) foundation OR 10 feet( ichever is I: s). (BASED ON of slab and the highest existing
EQUALS Defined building hei• t EXISTING grade adjacent to the foundation.
GRADES)
EQUALS Defined building height
Shoreland District WD Permit Average Lakeshore Setback Bluff
Met?
O Yes O No Permit N ber: Yes 0 No 0 N/A 0 Yes 0 No
•
0 N/A see attached Setback:
Stormwater Quality Existing Har•cover Proposed
Overlay District (%and f) Hardcover Vari nce Required CUP Required
Tier(circle one) /� (%and sf)
/ 0 Yes 0 No 0 Yes 0 No
1 2 3 4 5 / Type(s): Type(s):
Updated: January 2015
c:\users\rpeitso\documents\plan review checklist 2015.docx
REMARKS (in-house):
Fees to be Charged YE,� NO
Permit V
Plan Review
State Surcharge
Investigation Fee
SAC—Number of SAC Units
Other(specify)
Square Footage $ per Square Footage
Basement X = $
151 Floor X = $
2nd Floor X = $
Garage X = $
Estimated Construction Value: $ 4 0S0
Orono Inspections Required Work Requiring Separate Permits Required State Permits
O Site 0 Plumbing 0 Grading / Filling 0 Well
O Silt Fence/ Erosion Control Mechanical 0 Fire 0 Electrical
O Hardcover Removal 0 Septic 0 Water Connection
O Footing 0 Fireplace 0 Sewer Connection
O Poured Wall 0 Masonry D Lawn Irrigation
O Foundation Survey 0 Mfg. 0 Landscaping
O Foundation Waterproofing 0 Other(specify)
O Radon Rock Bed
22(Framing
D Insulation
0 s-Built Survey
Final
O ther(specify)
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 /Y P7 ? ? �-11�
Updated: January 2015
c:\users\rpeitso\documents\plan review checklist 2015.docx
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