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Home My WebLink About2012-00644 - addn/remodel/repair � ' - CITYOFORONO * Z0 1 Z — fd0644 * 2750 KELLEY PARKWAY DATE ISSUED: 07/1U2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4265 CHIPPEWA LA PIN : 31-118-23-42-0019 LEGAL DESC : UNPLATTED : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 5,000.00 NOTE: SEVERATE PERMI I�S REQUIRED: EI.,ECTRICAL(STATE) KITCHEN REMODEL APPLICANT PERMIT FEE SCHEDULE 118.00 PHEASANT HILLS CARPENTRY INC. PLAN REVIEW 76.70 5700 REBECCA PARK TR LORETTO, MN 55357- STATE SURCHARGE(VALUATION) 2.50 (612)221-8577 TOTAL 197.20 Minnesota State License#:20629764 PAID WITH CC# 3163 OWNER MCCAFFREY, THOMAS& KATHLEEN 4265 CHIPPEWA LA MAPLE PLAIN, MN 55359- AGREEMENT AND SWORN STATEMENT The work for��hich this permit is issued shall be performed according to [he approved plans and specifications,applicable Ciry 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 goveming this type of work shall be compied with whe[her 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 I 80 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are re e iq co r ce wittrthe State Building Code.This permit may be v � y me r ue �use. n -' �� A t P mit ignature Date � �� Issued y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � . City of Orono Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: 020/ – Q ��,0,�.\ PO Box 66 G� Q :, 0 1� Crystal Bay, MN 55323-0066 Date received: – 7— ,a i v � ;�, �,) Street Address: Received by: '�'F, , �"^ Gtiti�� 2750 Kelley Parkway Plan review fee: /L'��F' 9-[.Qe c ' �9k�sx��'� Orono, MN 55356 ��-� Total Fee: n n Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � �% 7� � This application form must be completed in full and all required information must be submitted. lf,y�`� -��% 2 Incomplete applications will be returned. (Please print) GENERAL INFORMATION: �-- � - . Job Site Address: ' ,� / ) L,( `'C_3._� Will this be a Parade of Home , Remodelers Showcase e or other Display ome? ❑Yes No If yes,a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus se " will be required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: � � �N . «� State License# Expiration Date: �j �' lead Ce�tification Number: - Z -- � Expiration Date: 7 /¢ /(� (for work on homes that were constructed prior to 1978 Phone: �(p�� ?.2j -�� —fe#frcej cell ' Mailing Address: � Q City: [��p ZIP: � � Contact Person: Applicant is: ontracto / Homeowner (Circle One) Email and/or Fax: IJ-�y��a.�,�� 411-e��w�ln.�. ca.v�oc�;�-i'c� . �a� PROPERTY OWNER INFORMATION: Name: �pd��--4SW-Tt�l..£�•l �c.�4f-t=►�£U Phone (day): �j�'`jZ �- g ° � Address: Z(fltJ � � V�/►� ,�- C�tY� �`IJO ZIP: �"j�j��j-r�-� Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may 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 Phone: 952-471-0590 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Overall Project Description: -j� Estimated Construction Valuation of Project(excluding land) $ � 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 confidentiai. 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 generall cannot be given to either the public or the subject of the data. Our purpose and intended use of this informati is nu Ily update our records and records of other governmental agencies re uired b law. If ou 'nfor i , e a lication ma not be issued. Applicant's Signature: Date: � / � �. Last Updated: 08-09-2011 � Pian Review Checklist for New Structures / Additions Address/ PID / LegaL � �� e=� i F'F�C.�-�.�4 (�,�}� ,�_ Description of work: � � �'r�-��-t�s� �,��✓�%t�CZ Septic review by: �'LJ � Date Approved: Zoning review by: nJ��/'�` Date Approved: � Building review by: ��(�'t-t.w— Date Approved: 7-c-i -?�+ �Z._ � Grading review by: �'`-`i r� Date Approved: Zoning File#: Resolution#: Resolution Date: onin District Fire Department Post Office School District � Zoning: Lat Area: SF /AC Width: De Survey Submitted: �`` .❑ Yes ❑ No Date of Survey: Proposed Setbacks: `ti Front (Lake) Rear(St t) ( N S E W ) ( N S E W ) O er Buildings Wettand Side Side Building Defined Height: � Building Peak Height: #of Stories Ok?: ❑ YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/c wl ART the distance between the slab and the highest space floor and the highest roof peak,the top 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 round uppermost point on a round or other arch-type or other arch-t e roof roof SUBTRACT half the distance between the highest window d BTRACT 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 floor/crawl ADD the distance between the slab and the highest space floor and the highest existing grad�within existin rade within the foundation the foundafion or 10 feet, whichever is..,�ess. EQUALS Defined buildin hei ht EQUALS Defined buildin hei ht � � Lot Coverage: � SF �_ Shoreland District MCWI�`Permit Received Avera e•Lakeshore Setback Bluff � Y�S � No 0 N/A 0 Yes � No ❑ Yes 0 'No , � Yes ❑ No 0 N/A P,ermit Number: Setback: Hardcover Zones Existin Proposed Variance Required CUP Required 0-7�' ❑ Yes ❑ No � Yes ❑ No 75-259% Type(s): Type(s): 25 -500' 00-1000' REMARKS (in-house):_ /1�� C r-�ia�•�;� v Updated: 09/11/2009 z:\formslplan review checklist.docx Fees to be Charged YES NO . :Pecmit � � � �:p ;t'� Plan Review _ __, - .: . �: .,.,,,,, `Staxe:�Surcharge j a w a�� ., . , , �. ; -: 4:. " . . � __.. Investigation Fee ;°S��C �Nu�be.rlof.`SAC.LI;�iiits � _- .��r rts- � Sewer Connection �Vlla#�e ��'e��si,�.�=`.� u4 ,, �. f=� �y �ti..xm,�o�.x ,..�.en. "�.�F't�'a*�''��'��.�� `�'�°."',Y�,�t"�.�-�w�'`in�s ��`��. 3��.^t�� Park Fee ";�Sti�e�l�s�pex`�ion�'��-�,` . �� .. ,_ �y._.�,. � , , ,. q . ..�,� <. , .�._.� � _,� , , .. .. .... .. . .,r .-,. x _�3�, _ T, y-' Other(specify) ;'�tSC��i�tl@OIIS�Fe�S�'� `=�� '�z �,'��4�,�^.,�,rs'-�"c.7�•�"��t ��v, x� .;�,-- _ ��r- �. x, ,�,�+`� Calculated By: S uare Foota e $ per Square Foota e Basement X = � 151 Floor X = � 2nd FIOo� X = $ Garage X = � Estimated Construction Value: $ .$,U�O `�= Orono fnspections Required Work Requiring Separate Permits Required State Permits � Site ❑ Plumbing ❑ Grading / Filling ❑ Well ❑ Hardcover Removal � Mechanical � Fire Efectrical � Footing ❑ Septic ❑ Water Connection � Poured Wall � Fireplace � Sewer Connection � Foundation Survey ❑ Masonry ❑ Lawn Irrigation ❑ Radon Rock Bed ❑ Mfg. �Framing ❑ Other(specify) f}'Insulation ❑ As-Built Survey �Final 0 Other(specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access:Existing: ❑ YES 0 NO New: � YES ❑ NO REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT) U pdated: 09/11/2009 z:\formslplan review checklist.docx � `� �'--f- I o�f � c� D TE TIME CITY OF ORONO CALLED w �I �.3 � I I 2 INSPECTION NOTICE ' r SCHEDULED - ( I�- p � �.o0 PERMIT NO. � ? O `1�COMPLETED ADDRESS � OWNER TELEP ONE NO. ��a �� -o S �7 CONTRACTOR �I�SLC-�SC1!'1� � � � �S >; DESCRIPTION � ��"rn��I � `-�" 'u� • � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL 0 0 TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. � FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SE�Tl C FINA ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:L_YES�NO i� � COMMENTS: � W a � � O a � O � W � Q � 2 w � W � � a W� ❑�P9�K SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 Owner/Contractor on site: Inspector. a White Copyllnspector's File Canary CopylSite Notice � � � D E TIME ✓ CITY OF ORONO CALLED IN � � � INSPECTION NQT,I,� CHEDULED �� PERMIT NO. �J �� C PLETED ADDRESS OWNER T L NO�� l �O�� CONTRACTOR %G7i� >; DESCRIPTION �,!��GN(/ � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ 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 � COMMENTS: � W a � � O '' 'T`/'�T'e � �' I�r�-�'-S /�-.r C �--� � 0 � W � Q � z W � W � � J d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE �RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O �CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ;� CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cal{for the next inspection 24 hours in advance. �952� Z49-4600 OwnerlContractor on site:r� n �' �� Inspector. White Copyllnspector's File Canary CopylSite Notice