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Home My WebLink About2012-00941 - addn/remodel/repair CITY OF ORONO * 2 0 1 Z - 0 0 9 4 1 * • '' 2750 KELLEY PARKWAY DATE 1SSUED: 09/27/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 350 BROWN RD S PIN : 03-117-23-13-0001 LEGAL DESC : UNPLATTED 03 1 17 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDIT[ON/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 31,000.00 NOTE: SEVERA"I'E PERM[TS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE, ELEC'IRICAL(STATE) DECK REYAIR APPLICANT PERMIT FEE SCHEDULE 477.50 CHALFEN, RICHARD PLAN REVIEW 310.38 350 BROWN RD S LONG LAKE, MN 55356- STATE SURCHARGE(VALUAT[ON) 15.50 MISC FEE 0.00 TOTAL 803.38 OWNER CHALFEN, RICHARD 350 BROWN RD S LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT 'Che 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 pennits. All provisions of laws and ordinances governing this type of work shall be compied wi[h whether or not specif ied 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 I 80 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."l�his permit may be revoked at any time for due cause. l /ri�/'�l�,� � �z� �7v, z �%�� l p��l oZ � pplic�itce Signaturc Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �,r�`' �� . � a��`� City of Orono I � , .--� Buiidin Permit A lication ��' �� J pp � for New Structures or Additions Mailing Address: Permit number: p�Q/� —�/'�( �f� �0,�. PO Box 66 ' / Crystal Bay, MN 55323-0066 Date received: �/y�/o� 0�.:�y�:. � �a ''�!';{ -�` ,, , StreetAddress:' Received by: �'�c, ��, ��' 2750 Kelley Parkway Plan review fee: \r � , Orono, MN 55356 '�$�sxo4`'/ ,_,_--___=- �D 3. 3� 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: � S U �l(J�✓1/ �� S Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuftle bus seivice will be repuired unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APP CAN INFOR ATI N• 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 OWNE NFORMATIO : Name: �L� � � �� Phone (day): L- � (� Address: � �,y Cit : j'� ZIP: �� ,3 S Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZI P: Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. P oposed Use 3.Structure Type 4.Sewage Disposal & Water Supply ❑ New Construction Single Family with ❑ Residence ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with �Deck ❑ Relocation detached garage ❑ Office/Commercial '�-Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water **Any earth movement may require ❑ Commercial ❑ 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.or Estimated Construction Valuation (excluding land) $ � l V�� i � � STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction a. Length (ft.)= Number of bedrooms= ood/Frame l(�(� � C�,y r b.W i d t h (ft.)= N u m b e r o f g a r a g e s t a l l s: ❑ M a s o n ry '�` Areas in square feet Attached = ❑ Metal �eLl� ❑ Pole Bldg. / �,�� v, c. Basement= Detached= �� ❑ ICF �r S �V✓C��il�'� d. 15i Story = ❑ On-site Prefab � nd �.,�- /� e. 2 Story= ❑ Off-site Prefab �� ' ;� S� !' � f. YZ Story = ❑ Other(please specify): �' ,.� g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed A licable ❑ Permit A lication ,'� ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form ❑ ❑ Surve meetin all re uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ ❑ Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ Plan Review Fee ❑ ❑ Other: APPLICANT/OWNER 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 to ensure completion of the as-built survey and all site improvements. Applicant's Signature: d�– - �f ��/�G�----- Date: �" �� `�` Owner's Signature: �, - ��l�,--�— Date: `"l � �� , �. Plan Review Checklist for New Structures / Additions Address/ PID / Legat: 350 (3(L.o w►�/ �o��l Description of work: 1.._►2 c.-t� ('��-�Ai(G��6� Septic review by: �/✓f' Date Approved: Zoning review by: /`'� Date Approved: Building review by: Date Approved: °r— Z y- 2a�t, Grading review by: �..1 ,� Date Approved: 0 Zoning File#: Resolution#: Resolution Date: Zonin istrict Fire Department � Post Office School District Zoning: Lot Area. SF/AC Width: D Survey Submitted: 0 Y ❑ No Date of Survey: Pro osed Setbacks: Front (Lake) Rear(Street) ( N S E W ) ( ..N S f W � ther Buildings Wetland Side Side Building Defined Height: uilding Peak Height: #of Stories Ok?: ❑ YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: R 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 a ro d '� uppermost point on a round or other arch-type or other arch-t e roof I roof SUBTRACT half the distance between the highest wi ow and �, SUBTRACT half the distance between the highest window hi hest roof eak of a itched roof � and hi hest roof eak of a itched roof SUBTRACT the distance between the basement oor/crawl D the distance between the slab and the highest space floor and the highest existi grade within � existin rade within the foundation the foundation or 10 feet, whic ver is less. EQU S �; Defined buildin hei ht EQUALS Defined buildin hei ht Lot Coverage: SF % Shoreland District WD Permit Received Avera e�Lakesh re Setback Bfuff Yes ❑ No 0 N/A ❑ Yes ❑ No ❑ Yes ❑ No 0 Yes ❑ No N/A Permit Number: Setback: Hardcover Zone Existin Proposed Variance Required CUP Required 0-75' 0 Yes ❑ No Yes ❑ No 75-2 ' TYPe(S): Type 25 -500' 500-1000' REMARKS (in-house): /�v��'l2�"r� Updated: 09/11/2009 z:\formslplan review checklist.docx Fees to be Charged YES NO '� � , �Per.mit � _ , ; , .. ; Plan Review �` 'State�Surcharge ti ,� ,�°A,� �� , , . Investigation Fee '�AC ;�Nurriber.ro#SAC�U.�a:its� �,��,��„��, �'� �;�, � �, �;,�� ,, . �, ,. .. r , f :: ,., �. ., , . �. . ;: Sewer Connection ��1t��i`ATIi�Il@C�l1�.11"� �w�' �gw, �{ ..A �� ,�;: �,., .., �,_, .,,.:�s�,;' �w,�..U.,. ..r�...,. . . .�,. .:+�.,.. ._..�:.�z�`r�.+CSy''��µ� �_ ",,r,�`�.� .- '"��^..��.� ..... . �. . .�.-.h Park Fee - � ._„ ��te�I�s,�ez�E�pn�� A�-"��. ,�,�yr �. ��r- _ _ _ _ = F?4, Px"«�1�Y'�i s�^c'�w�s�. z ��d.��`hd4%kFs'a."F�'�4�., .��., rh. � Other(specify) �Nfsc�rl�au�e��s�F�ee�� `� `��'��'�'�-� ��-��, *�� _ � s�iv�:s:.�«r, s�,.�.,,. -1r�f�.��i'i�, .� ,1. _ -�s*� �.,� -t1:��_��"d'�.+n �'"�'fi�.., .w.., _.,�,'"�+,_5'.` Calculated By: ,..� Square Foota e $ per Square Foota e Basement X = � 15' Floor X = � 2nd Floo� X - $ Garage X = � Estimated Construction Value: $ � �� (�00 °, Orono fnspections Required Work Requiring Separate Permits Required State Permits � Site 0 Plumbing ❑ Grading / Filling 0 Well 0 hiardcover Removal ❑ Mechanical � Fire � Electrical �Footing ❑ Septic ❑ Water Connection � Poured Wall � ❑ Fireplace � Sewer Connection ❑ Foundation Survey ❑ Masonry ❑ Lawn Irrigation ❑ Radon Rock Bed ❑ Mfg. �Framing ❑ Other(specify) 0 Insulation ❑ As-Built Survey ,�Final ❑ Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: 0 YES ❑ NO New: ❑ YES � NO REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMtT) U pdated: 09/11/2009 z:\formslplan review checklist.docx 7 / TE� TIME � CITY OF ORONO CALLED IN r�_ INSPECTION NOTI E // SCHEDULE��— �i-L7� PERMIT NO. ��y`�/ COMPLETED ADDRE � OWNER G � TELEPHONE NO. � CONTRACTOR � DESCRIPTION �`�-� �� l� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO v�i COMMENTS: � w a � J O � � O � W � Q � 2 W � W � j d /�,� W� ❑WORKSATISFACTORY:PROCEED �OJECT COMPLETE W ❑CORRECT WORK 8 PROCEED O ISSUE CERTIFICATE OF OCCUPANCY � ❑COflRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE C01/ERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 2a hours in advance. (952� 249-46�0 OwnerlContractor on sit . Inspector. White Copyllnspector's File Canary CopylSite Notice �� _ ATE TIME �/ CITY OF ORON� CALLED IN � � � INSPECTION N ICE // SCHEDULED .-��._ /D.�(� PERMIT NO. oZ C�"�1Y"� co LETED ADDRESS OWNER TELEPHONE NO -��y CONTRACTOR >; DESCRIPTION ^ ��--- � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT Q ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP = O DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J O PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEEf YOU:_YES_NO � COMMENTS: � W a � J O >. � O � W � Q � Z W � W � � d W�ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W� ❑CORRECT WORK&PROCEED ^ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR '� CITATION ISSUED G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952) 249-46�0 Owner/Contractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice