HomeMy WebLinkAbout2009-00650 - PERMIT VOIDED , .
City of Orono ���S�o�
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: D� �
�,�,�. PO Box 66 Permit number:
Q ;, Q Crystal Bay, MN 55323-0066 Date received: ��� �
a
,� ��r �,�� Street�ddress: Received by:
1� ;;-
�',�,t� a '� �ti�" 2750 Kelley Parkway Plan review fee:
9g.E�*v Orono, MN 55356 n
�
Total Fee: � �j /��7
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. (P/ease print)
GENERAL INFORMATION:
Job Site Address: t�Op �,�; 1�,��„��
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 be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/AP,P`LICANT INFORMATION:
Name: t1�c,l.�uw.ti;rk .�.��c�.rs 1�e�
State License# ?l� �3i3 Sy� Expiration Date: 3�;i�„�
Phone: - - _ g� office �? - 29Z-p4�3 cell
Mailing Address: � Cit : � �,1(,rt ZIP: $'--
Contact Person: J�w� ���c,� Applicant is: ontrac / Homeowner (Circle One)
Email and/or Fax: ��w�, ,�,�LsaS [j �n��:'�.w�o.,rk - b���c�ws � C4�
PROPERTY OWNER INFORMATION:
Name: >�v�v�w �ww.�,
Phone (daY)� )S L - j�o�� �- 91u6��-�-�—
Address: (�c�c:� �,Lc► 1 s Ic+�d1 CitY: �4���nc> ZIP:
Email and/or Fax �1r�ti�e�uler � t�alle� c�,M
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review 8�permits
❑ Door(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑ Siding ❑ Restoration �Other: (specify) Phone: 952-471-0590
,-, . Fax: 952-471-0682
❑ Re-roof ❑ Fire Damage Ut.� � G�iS www.minnehahacreek.orq
Overall Project Description: � 'x� � i�J , u
Estimated Construction Valuation of Project(ex ding land) $ �C 0�
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department; �
�a�C�-
• Certifies that the information supplied is true and correct to the best of his/her knowledg ( y
are solely responsible for submitting a complete application being aware that upon failur ��� �J �,n p � e
but to reject it until it is complete; l�'UV lL
• Some or all of the information that you are asked to provide on this application is clas: n� �/���,� �r
���v t.v
confidential. Private data is information which generally cannot be given to the public e
data. Confidential data is information which generally cannot be given to either the p �1�Gry V1 1 v� " ' ir
purpose and intended use of this information is to annually update our records and re� � s
re uired b law. If ou refuse to su I the information,the a lication ma not be issued
ApplicanYs Signature: Date:
Last Updated: 05-04-2009
Plan Review Checklist for New Structures / Additions
Address/ PID/ Legal: (�OO (3C(o =s(,e,,�•,/,
Description of work: -�-o��.n�4-n�,..� 1�-`;1Q A i 2.
Septic review by: /�((� Date Approved:
Zoning review by: N r� Date Approved:
Building review by: Date Approved: /o -s -o�
Grading review by: /J�� Date Approved: /
Zoning File#: Resolution#: Resolution Date:
Zonin District Fire Department Post Office School District
Zoning: Lot Area: SF/AC Width: Depth:
Survey Submi d: � Yes 0 No Date of Survey:
Pro osed Setback :
Front(Lake) ear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland
Side Si
Building Defined Height: \� Building Peak He� ht: #of Stories Ok?: � YES
FOR A BUILDING WITH A BASEMENT OR CRA\QIL SPACE: FOR A BUILDING ON A SLAB FOUNDATION:
START WITH the distance between the basement floor/craw START the distance between the slab and the highest
space floor and the highest roof�eak,the to of WITH roof peak,the top of the cornice of a flat roof,
the cornice of a flat roof, the deck I�e of a/ the deck line of a mansard roof, or the
mansard roof, or the uppermost point Q�round uppermost point on a round or other arch-type
or other arch-t e roof roof
SUBTRACT half the distance between the highe win w and SUBTRACT half the distance between the highest window
hi hest roof eak of a itched roo and hi hest roof eak of a itched roof
SUBTRACT the distance between the base nt floor!crawl ADD the distance between the slab and the highest
space floor and the highest e � ting grade within existin rade within the foundation
the foundation or 10 feet, w chever is less. EQUALS Defined buildin hei ht
EQUALS Defined buildin hei ht
Lot Coverage: SF %
Shoreland District MCWD Permit Received Avera Lakeshore Setback Bluff
� Yes 0 No ❑ N/A 0 Yes ❑ No
0 Yes � No � Yes No � N/A
Permit Number: Setback:
Hardcover Zon Existin Proposed Variance Requi d CUP Required
0-75' � Yes O 0 Yes � No
75-25 Type(s): Type(s):
25 -500'
00-1000'
RE,A�IARKS (in-house): �v Cf�NG �
/
Updated: 09/11/2009
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Fees to be Char ed YES NO
Permit �
Plan Review �
State Surcharge ,/
Investigation Fee
SAC—Number of SAC Units
Sewer Connection
Water Connection
Park Fee
� Site Inspection
Other(specify)
Miscellaneous Fees
Calculated By:
Square Foota e $ per Square Foota e
Basement X = $
1 S' Floor X = $
2nd FIOOf X = $
Garage X = $
Estimated Construction Value: � 1 c�,C�c�o °=�
Orono Inspections Required Work Requiring Separate Permits Required State Permits
0 Site � Plumbing 0 Grading / Filling � Well
� Hardcover Removal � Mechanical 0 Fire 0 Electrical
Footing ❑ Septic 0 Water Connection
� Poured Wall ❑ Fireplace � Sewer Connection
� Foundation Survey 0 Masonry � Lawn Irrigation
0 Radon Rock Bed � Mfg.
❑ Framing � Other(specify)
� Insulation
❑ As-Built Survey
Final
❑ Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access:Existing: ❑ YES 0 NO New: 0 YES � NO
REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT)
Updated: 09/11/2009
z:\forms\plan review checklist.docx
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