The URL can be used to link to this page

Home My WebLink About2015-01477 - addn/remodel/repair � ,, CITY OF ORONO * Z 0 1 5 - 0 1 4 7 7 * 2750 KELLEY PARKWAY DATE ISSUED: 1U24/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1199 ELMWOOD AVE PIN : 07-117-23-14-0059 LEGAL DESC : SKARP&LINDQUISTS FERNHILL LA : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTI VITY : 434-RESIDENTIAL VALUATION : $ 38,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STATE) BATHROOM REMODEL AND WINDOW REPLACEMENT APPLICANT PERMIT FEE SCHEDULE 580.44 SICORA INC STATE SURCHARGE(VALUATION) 19.00 5601 WEST LAKE STREET TOTAL 599.44 ST LOUIS PARK, MN 55416- Payment(s) (952)929-0098 CREDIT CARD 0999 599.44 Minnesota State License#: BUIL-BC253425 OWNER HARVEY, MR.& MRS. 1199 ELMWOOD AVE MOUND,MN 55364- AGREEMENT AND SWORN STATEMEIVT The work f'or 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[his 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. � �' \ -.__ ��.�s-5��.�-� ��1�� o �� , ,� Applicant Permitee Signature Date [ sue y Signature Date ' ' � _ City of Orono �c� � Suilding Permit Application for Maintenance / Replacement / Remodel 5 ' (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �O� Mailing Address: �J�� Permit number:a�` "Q� 7 O PO Box 66 Crystal Bay,MN 55323-0066 ��I�� Date received: L�` ��L / � � Street Address: Received by: �� ti� G� 2750 Kelley Parkway Plan review fee: . 7i �qkESHn�� Orono,MN 55356 �� vr �� 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. (P/ease print) GENERAL INFORMATION: Job Site Address: ��4q Famwo�d � _ 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 un/ess applicanf demonst�ates su(ficient on-sife parking is available. Non-permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: S1C0�0► �1�t. State License# $L Z,S L s Expiration Date: S 3� � Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (t'3Gq-Z2S� (office) QSZ'�17-q 'DOqg Mailing Address: (� '( L�- City: .Lpyls�q� ZIP:s$!.� 6 Contact Person: �� a�sp� Applicant is: / Homeowner (Clrcle One) Email and/or Fax: A O Q$ prA• M PROPERTY OWNER INFOR TION: Name: (�� Phone(day): r - 10- Ha Address � q� lmwen�l ArfL City:M�� ZIP: SSur� Email and/or Fax: SCO'r}�AcQ.V�I��.(�OM PROJECT INFORMATION: Overall ro'ect description: 0.� e.w.o d�e.l �Ad� w��,do� to bedr�w+ Type of Project: Any earth movement may also require ❑Door(s) �Remodel ❑Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑Re-roof,asphalt ❑Repair ❑Storm Damage 18202 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55391 ❑Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 �'Window(s) www.minnehahacreek.orp Estimated Construction Valuation of Project(excluding land) $ 3 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 altemative 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 ou refuse to su I the i formation,t a lication ma not be issued. Applicant's Signature: 1�7 Date: ��- �4T(s � C Owner's Signatur : a�. ' Date: ��' ��7 Last Updated:January 2015 � I � ��, I � , ' ► 2415 Wilshire Blvd BUILDING PERMIT , Mound, MN 55364 Phone 952-472-0607 ❑ Handout Given �� Fax 952-472-0602 ❑ Lead Handout Given �j .-�, SITE ADDRESS: � � '"i '"'� PID: 1)Was the home constructed before 1978?(YES o, continue with line 2, NO ❑ continue without completing EPA Section) 2)Will the work disturb>_6 sq ft of interior painted surfaces or�20 sq ft of exterior painted surfaces?(YES o go to line 4, NO o line 3) 3)Are there any windows being replaced?(YES❑, go to line 4, NO❑continue without completing EPA Section) • 4) Has this home been Certified Lead Free?(YES❑, you MUST Attach Certification Information, NO❑complete line 5) 5) EPA Contractor Certification Number: NAT- PROPERTY OWNER: �""x"` � ' Address: � r ''' �_� . City: State: Zip: Email: „ Contact Name: Phone: r , . CONTRACTOR: ; P a'�`+ • = Address: ' ` Cit : State: Zip: � Phone: Fax: Contractor License No: N� Contact Name: Phone: a `'i� Email: ' ,-> '�' ^ � �, ARCHITECT: � g Address: Cit : State: Zip: Phone: Fax: Email: Contact Name: Phone: ' TYPE OF WORK: ❑New Construction ❑ Deck ❑ Re-Roof ❑ Commercial ❑ Residential o Change of Use ❑ Pool ❑ Re-Side EST.VALUATION OF WORK ❑ Finish Basement ❑ Retaining Wall ❑Fence $ ' Remodel ❑ Porch ❑Shed Square feet: ❑Addition ❑ Demolition ❑Window/Door Replacement ❑Garage-Attached/Detach ❑ Misc Other #being replaced Detailed Description of Work: ❑Accesso Structure , :.; � , . Signature of this application by the legal property owner or a licensed contractor,as the owners representative,is required and authorizes the Zoning Administralor or designee and the Building Off�aal or designee to enter upon the property to perform needed inspections.Entry may be without prior notice.I hereby acknowledge that I have read this application and state that all information is true and correct to the best o(my knowledge.I further agree that all work pertormed will be in accordance with approved plans,specifications and conditions and to abide by all � ord�nances of the Municipality and the laws of the State of Minnesota regarding actions taken pursuant to this permit.I agree to pay all plan review fees even if I choose not to proceed with the work.Permit expires when work is not conwepced within 18D days from date of permit,or if work is suspended,abandoned,or not inspected for 180 days.Work beyond the scope of this ennit,or work without a ermit or ins ection will be sub ect to a enalt . SIGNATURE OF APPLICA T: DATE: PRINTED NAME: This is the signature of: ❑ Owner or ❑ Owner's Representative OCCUP.TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No VALUATION: $ COPIED APPROVED Permit Fee: $ Plan Review Fee: $ ZONING } State Surcharge: $ CITY ENG/DPW � Site Inspection Fee: $ PUBLIC WORKS z O S.E.C. Fee: $ UTIL TAX OTHER y Investigation fee/Other Fee: $ ASSESSING/UTIL BILL W Copy Charge($.25 per 8.5 x11 page) $ BUILDING OFFICAL v License Check($5)/Lead Check($5) $ LL 0 Sub Total $ Special Conditions/Required Setbacks: Building Approval By: DATE: Printed Building Approval By: ❑ License Verification ❑ Lead Verification-Checked By: City Approval By: DATE: Information supplied on this form will be considered public according to the MN Government Data Practices Act. See reverse side for an important statement regarding Indian Mounds. � : Supplemental Information for Building Permits — Indian Mounds and Earthwork Sites Applicant is advised that there are historic Indian burial mounds and/or earthwork sites in and around the City of Mound. While many of the mounds have been severely impacted by development over the years, the mounds do receive protection under state law and penalties are imposed for unauthorized disturbance of mounds. The City maintains some general information about possible sites in an inventory of the "Earthwork/Mound/Burial Areas" contained on the Cultural Resources Map in the Mound Comprehensive Plan and in surveys of the burial sites from Hill and Lewis in 1911 but the completeness or accuracy of this information is unknown. Additional information may be obtained through the Minnesota State Archeologist. Any formal investigation of a site, including a determination of whether a mound or burial area exists on a subject site, is the responsibility of the property owner or developer. The issuance of permits by the City to do work on a site does not relieve the owner or the developer of that responsibility. Revised 1/10 .� ; � ----_-- - -�' Minnesota Department of Labor and Industry Licensing and Certification Services Construction Codes and Licensing Division Phone: 651.284.5034 443 Lafayette Road N Email: DLI.License@state.mn.us Saint Paul,MN 55155 Website: www.dli.mn.gov/ccld.asp NOTICES NOT TRANSFERABLE SICORA INC CHANGE YOUR BUSINESS STRUCTURE 5601 LAKE ST W SUBMIT A NEW APPLICATION FOR NEW ENTITY MINNEAPOLIS, MN 55416 RENEW OR REPLACE INSURANCE POLICY SUBMIT NEW CERTIFICATE OF INSURANCE NOTIFY THE DEPARTMENT OF A CHANGE IN YOUR BUSINESS. Failure to do so,subjects you to administrative penalties of up to$10,000. 15-Day Notice Requirement—Forms available ortline at www.dli.mn.qov/CCLD/LicUpdate.asp • Change in business'physical address,mailing address, phone number,or email address • Change in control,owners,officers,directors,members, partners • Change in business'legal name and/or assumed name • Loss of or change in QUALIFYING BUILDER • Change in general liability insurance or workers'compensation insurance coverage Immediate Notice Requirement—Notification to DLI in writing • Judpment Debtor. A licensed contractor has 15 days to provide written notice of the finding that it is found to be a judgment debtor based upon conduct requiring licensure. • Bankruqtcv Petition Fi1ed. A licensed cantractor has 15 days to provide written notice that it filed a petition for bankruptcy. . Conviction Notice_ A licensed contractor has 10 days to provide written notice that it has been found guilty of a felony,gross misdemeanor, rnisdemeanor or any comparable offense related to the license, including convictions of fraud, misrepresentation,misuse of funds, theft, criminal sexual conduct, assault,burglary,conversion of funds, or theft of proceeds in this or any other state or any other United States jurisdiction. YOUR CERTIFICATE IS BELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS. �M��wESaTa FPARTMENTOF RESIDENTIAL BLDG CONTRACTOR +��LABOR$e INDUSTRY Construction Codes and Licensing Division Licensing and Certlfication Services 443 Lafayetle Road N St.Paul.MN 55155 Website: www.dli.mn.00v/ccld.aso Email: dli.licenseCalstate.mn.us Phone: 651284.5034 This is to ceriify that the ceitificate holder is licensed as a RESIDENTIAL BUILDING CONTRACTOR in the state of Minnesota and is in compliance with Minnesota Statutes 326B.805,and may build residential real estate,contract or offer to contract with an owner to build residential real estate,and conuact or offer to contract with an owner to improve existing residential real estate;provided the responsible individual is at all qmes a QUALIFYING BUILDER and the certificate holder maintains compliance with the required general liability insurance,and workers'compensation laws. License : RESIDENTIAL BLDG CONTRACTOR � Lic Number : BC253425 SICORA INC � e Effective Date : 04/01/2014 5601 LAKE ST W � Expiration Date : 03/31/2016 MINNEAPOLIS, MN 55416 � T VERIFY UP-TO-DATE STATUS,BOND,AND INSURANCE INFO AT www.dli.mn.s�ovtccld/LicVerifv.asp (ENTER NUMBER). , �n. I . � �Itt�L� �'��I�� 1.�1�Ciri�l�YtYYtLYt��i� �i��L'.C�tl�Yt ,�1 Ltt� - � � �I�i� i� t�a ��er#t�� tl��#� a. ► . � �� `� `� �� . , _. �� _ �=�EPA Sicora �nc , • - , ' � has fulfilled the requirements of the Toxic Substances Control Act (TSCA) Section 402, and has received certification to conduct lead-based paint renovation, repair, and paintingactivities pursuant to 40 CFR Part 745.89 � , �► ,J� � �e �1�xri��i�#r�a�t u�: � All EPA Administered States, Tribes, and Territories This certification is valid from the date of issuance and expires May 07, 2020 �.�v NAT-26298-2 Certification # �� Michelle Price, Chief February 19, 2015 ,��;� Lead, Heavy Metals, and Inorganics Branch Issued On � ,��o �q�PRO��G - • �LA�V F�E`�IElnl ��ECKLt�T �QI� h�E1� ��`Rl1C�E��ES / /��DiTl�t�S Address: __ �l ! � �cv��'d2 rd/pG ,�U-�j Permit Flo.: Z.��S`i�� 7 T Description ofwork: ��l'j,/'6(�ryl p'�r2��l� �,2�jG�/' Date Rec'd: Septic review by:__ > �if/'�d' C�/ /r,�,ll Date ApprovecE: � Zoning review by: Date Approvecf: Building review by: -G� Date Approded: Grading review by: /�/ //�'� Date Approved: Zoning District: �oning File�: �eso : Reso Date: Zoning: Lot Area: SF/AC Width: t Coverage: SF o� Survey Submitted: Q Yes � No Date of Surve : Revised date(�)• Landscape plan submitted? a Yes Q No Landscap : Pro osed �etbacks: +;; Front(Lake) Rear(Street) ( S � W ) ( N S E 1M ) �ther Buildings Wetland Side Side Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing ContoE Perimeter(tinear feet) = 5 /o = L.F. laelow grade Basement? 0 Yes Q No, Sto ie _ FOR A BUILDING WITH A BASEMENT OR CRANYL� ACE: FOR A BUILDING ON A SLlAB FQUR�DATION: The distance be een the lowe t proposed Slab at or above grade- START WITH floor(of the ba ment or crawl s ace)and measure from hiqhest existi� the highest po' t of the roof. START W ITH ��e to the highest point of the roof even if flll was brought in to If you have ... elevate home. �� SUBTRACTION • GAB E OR HIPPED ROOF o Slab below grade-measure • (BASED ON 'win�ows): Subtract half the stance from highest existing grade to the ? ROOF TYPE) b�een the highest point of t e roof hi hest oint of the roof. to he low point of the corresp nding If you have a... g ble or hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF • ABLE OR HIPPED ROOF(wi h (BASED Ohl (no windows): Subtract half windows): Subtract half the dis nce ROOF 7YPE) the distance between the between the top of the highest highest point of the roof to window and the highest point of t e the low point of the roof corresponding gable or hipped roof • , ALL OTHER ROOF TYPES(flat, • GABLE OR HIPPED ROOF � mansard,etc):No subtracUon. (with windows): Subtract SUBTRACTION $ubtract the distance between the half the distance between - (BASED ON L�asemenUcrawl space floor and the the top of the highest EXISTING highest existing grade adjacent to the window and the highest ' GRADES) foundation OR 10 feet(whichever is less). point of the roof ` o ALL OTHER ROOF TYPES (flat,mansard,etc):No �� EQUALS Defned buifd'ong height subtraction. � Defined builciing height � EQU{4LS � �� Updated: October 2015 z:\forms\plan review checklist 10-2015.docx Shoreland District MCWD Permit Average Lakeshore Setback Beuff Met? Permit Number: ❑ Yes ❑ No ❑ N/A ❑ Yes ❑ 0 Yes � No No 0 N/A-see attached Setback: Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required circle one % and sf % and sf 0 Yes � No 0 Yes ❑ No 1 2 3 4 5 Type(s): Type(s): F'ees to be Char ed YES NO Perm it Plan I�eview C/ State Surcharge 1/ Investigation Fee l� SAC- Number of SAC Units �/' Other(specify) Square Foota e $ per Square Foota e Basement X - � 1 S' Floor X = $ 2nd Floo� X - $ ,; Garage X - $ 2 � 0 Estimated Construction Value: $ ✓U1�� Orono Inspections Required Work IZequiring Separate Permits ❑ Footing ❑ Site Plumbing ❑ Grading/Filling � Poured Wall 0 Silt Fence/Erosion Control L Mechanical ❑ Fire � Foundation �urvey Q Hardcover Removal 0 Septic Q Water Connection ❑ Foundation Waterproofing ❑ Other(specify) � Fireplace ❑ Sewer Connection �Framing 0 Masonry 0 Lawn Irrigation �Insulation ❑ Mfg. ❑ Landscaping ❑ As-Built Survey ❑ Other(specify) �Final � Lathe Required State F�ermits ❑ Other(specify) � Well �Electrical REII�AEZKS (in-house): OFFICIAL REM�►RF(S -TO BE NOTED ON PERMIT A.ND INITIALLED: ;` . ❑ See Builcier Acknowledgement Form � Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 �•\fnrmc\nlan ravio�u rhorklict 9(1_9f19F rinev �� ✓ �'�� DATE TIME CITY OF ORONO CALLED IN INSPECTION NO�ICE -,�CHEDULED �IG ��,� ) PERMIT NO. ��'/� -�'1 U 7 /connP��Eo ADDRESS I� �I � � r m�.t�� A� OWNER LEPH�NE NO! C�I,�7�7 -C�7� CONTRACTOR L- I C��r�I��,�� , �J � DESCRIPTION �l � 1 /: i�(/�j��r�y� ll1 ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOU ATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RA ON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION _ ❑ F AMING ❑ MECHANICAL FINAL ❑ RATED WALLS NSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT v FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP r BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL � ❑ DEMO-SITE �TIC INSTALL � OWNERlCONTRACTOR TO MEET YOU: YES_NO y COMMENTS: �_ � W a J ''� O ). � O � W 2 Q � 2 W � W � j d W ❑WORKSATISFACTORY:PROCEED PROJECT COMPLEfE � ❑CORRECT 1MORK&PROCEED ❑ I UE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hou in advance. (952) 24 -��0 OwnerlContractor on site: ; Inspector. White Copy/lnspector's File Cenary CopylSite otice •� e�� i D TE (TINNkEE CITY OF ORONO CALLED IN // - ��`�/ INSPECTION NOTICE �CHEDULED - - /• J� PERMIT NO. 0� "b� 7/c�MPLETED ADDRESS �l �� IIY�C�C�O�D�C �l/�2J OWNER ELEPH E NO.��a'7�9-�7/ CONTRACTOR �� r� �; DESCRIPTION �Zry� ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING R ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q �ERAMING ❑ MECHANICAL FINAL ❑ RATED WALLS ��i�.SL.LATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT v� FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO v�i COMMENTS: � p-- — a ` I� �a.w�,� �.i..� �o✓ ✓Z ec..� l.J� I50�?6 �..� �U� 0 �l/s w.w< ��✓ �4�Lt f+GlntUX�G - Vf� >. O /; ' 'i (/� �✓'Ov o`J G �ci!/ Ao ro��c�ta.T -�� W � � G ' Q � �,�1 r-��6 o r, 6��h ��F �'/�• ,1d4s� z � space � L.G� �o�� - � ��S� � a � r� �s�� W ❑WORKSA��CTORY:PROCEED��d ��R��COM�E�fE � �,ARRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORE COVERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 2a hours in advance. (952) 249-4600 OwnerfContractor on site: ��' Inspector. White Copyllnspector's File Canary CopylSlte Notice