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Home My WebLink About2013-00452 - addn/remodel/repair 3 � CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 3 - 0 0 4 5 z * DATE ISSUED: 06/1 U2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2435 COUNTRYSIDE DR PIN : 04-117-23-11-0005 LEGAL DESC : COUNTRYSIDE MANOR : LOT 001 BLOCK 002 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 55,000.00 NO"TE: SEPERA7'E PERMITS RF',QUIRED: PLUMI3ING, MECHANICAL, ELEC`IRICAL(S"1'A'I'F:) INI�ERIOR REMODEI, APPLICANT PERMIT FEE SCHEDULE 719.25 LEMMERMAN CONST. INC. PLAN REVIEW 467.51 9037 CTY. RD 17 SE DELANO, MN 55328 STATE SURCHARGE(VALUATION) 27.50 (763)972-3003 TOTAL 1,214.26 Minnesota State License#: 4854 OWNER FULLERTON&ANDRIA MOLDZIO, JOHN 2435 COUNTRYSIDE DR LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which[his 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 rela[ed work which requires separate permi[s. 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 Yor assuring all required inspections are reques[ed in conformance wit t�ie State Building Code."I'his permit may be revoke at any time for du cau . --�-�-�-��- �l l /� � U��--� �� l 5 A pli ant Permitee Si qature Date Is, ed By Signature Date I SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. s . City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) OA, Mailing Address: Permit number: p� 3 —D� pv � f VO PO Box 66 Crystal Bay, MN 55323-0066 Date received: 5"� .� � Street Address: Received by: ---��_ y � 2750 Kelley Parkway Plan review fe : `� �'� Orono, MN 55356 `qkFSN�� Total Fee: l p��,� 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: JobSiteAddress: 2y��5 � :�� s;�� Q , v�.i�;��: �✓1 ` Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No If yes,a specia/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 applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: LEMME�Y1.�Iv �i.^IVy"T. .�ti�=. State License# B�j�s,i�,a y Expiration Date: ��3� � �.�y,�f Lead Certification Number: M,4.7 -/2(o3�cf --1 Expiration Date: Z,7 Ju�.J 2ot7 (for work on homes that were constructed prior to 1978 Phone: (cell) 763— 224� 2 3100 (o��) S�ME Mailing Address: 90 7 Co. Rn. I? SE Ciry:�-No ZIP: �5'32g Contact Person: 70� Applicant is: ontractor / Homeowner (ClrcleOne) Email and/or Fax: L,E,vtCon�IntL � ��p�?iE►Z, coh PROPERTY OWNER INFORMATION: Name: �EF� � Ar.��jR�,A �U u.E�rt_-�o ►�1 Phone(day): Q52 ..ci��..Q 2D0 Address: SAHE A-5 A-�3aVE City: ZIP: Email and/or Fax: �'e��_ ,bencl�,Mctrkexecu��ve . Co�l PROJECT INFORMATION: Overall ro ect descri tion: Type of Project: Any earth movement may also require ❑ Door(s) �Remodel ❑ Fire Damage MCWD review 8 permits: ❑ Re-roof, asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 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.orq Estimated Construction Valuation of Project(excluding landj $ 55�� — 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 compfete; • Some or atl 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 subjed 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 informatio e a lication ma not be issued. ApplicanYs Signature: Date: 3 3U►� I'j Owner's Signature: /''��7!�' ` -�/ Ir`� - r --` Date: .� � �� last Updated:03l06/2013—_��_" � P'LAN REVIEW CHEC�CLIST FOR �EW STRUCTURES / ADDITIONS � Address/Permit Number: �-� �� v`'��`�t C�� l��`�� }:. �,. � Description of work: ��/+'��'� � 6Ri��S�IrVI L�� f''�N iS j"� � �� Septic review by: d�o � Date Approveci: � Zoning review by: �+{J Date Approved: Buiiding review by: Date Approved: �"l � �' E j Grading review by: (� Date Approved: ning District: Zoning File#: Reso#: Reso Date: Zonin • Lot Area: SF/AC Width: Lot Coverage: F _% Survey Su itted: � Yes 0 No Date of Survey: Revised da � : Pro osec! Setb ks: Front(Lakej Rear(Street) ( N S E W ) ( N S E W ) Qfher B ' dings Wetland Side Side ,,� Defined Height: ak Height: FFE: FFE min 6 feet= (Existing Contour) Perimeter(linear feet) = 0% _ #of Stori Ok? Q YES fi FOR A BUILDING WITH A BASEMENT OR CRAWL S CE: The distance between the I est FOR UILDING ON A SLAB FOUNDATION: START WITH proposed floor(of the baseme or crawl space)and the highest point of t roof. START WITH The distance between the top of slab and lf you have a... the highest point of the roof. If you have a... • GABLE OR HIPPED ROOF(no . GABLE OR HIPPED ROOF(no windows): Subtract half the windows): Subtract half the distance distance between the highest point between the highest point of the roof of the roof to the low point of the to the low point of the corresponding SUBTRACTION corresponding gable or hipped roof SUBTRACTION gable or hipped roof �. (BASED ON ROOF . GABLE OR HIPPED ROOF(with (BASED ON . GABLE OR HIPPED ROOF(with TYPE� windows): Subtract half the ROOF TYPE) windows): Subtract half the distance distance between the top of the between the top of the highest highest window and the highe window and the highest point of the � point of the roof roof • ALL OTHER ROOF TYP (flat, • ALL OTHER ROOF TYPES(flat, mansard,etc):No subtr ction. mansard,etc:No subtraction. DDITION Add the distance between the top of slab SUBTRACTION Subtract the distance betw en the SED ON and the highest existing grade adjacent to (BASED ON EXISTING basemenUcrawl space fl r and the E TING the foundation. GRADES) highest existing grade djacent to the GRA S foundation OR 10 f (whichever is less). EQUAL Defined building height EQUALS Defined buildin eight Shoreland District CWD �ermit Received �.vera e Lakeshore Setback t? Biuff Yes 0 No � N/A � Yes � No 0 Yes 0 No � Yes � No 0 N/A Permit Number: etback: Stormw�ter Qual' Existing Proposed �ariance Required CUP Requirec! Overla [�istric ier Harcicover Hardcover � Yes � No � Yes C1 No Type(s): Type(s): Updated: January 2013 v:\forms�plan review checklist 2013.docx �. REMARKS (in-house): Fees to be Char ed YES NO Permit � Plan Review State Surcharge Investigation Fee � SAC-Number of SAC Units Other(specify) S uare Foota e $ er S uare Foota e Basement X - $ 15i Floor X - $ 2"d Floo� X - $ ' Garage X - $ U ' Estimated Construction Value: $ �5;�� Orono Inspections Required Work Requiring Separate Permits Required State Permits � Site �Plumbing � Grading/ Filling 0 Well � Hardcover Removal 'Mechanical � Fire E0`Electrical � Footing 0 Septic � Water Connection � Poured Wall 0 Fireplace 0 Sewer Connection 0 Foundation Survey 0 Masonry 0 Lawn Irrigation 0 Radon Rock Bed � Mfg. ,�Framing 0 Other(specify) Insulation � As-Built Survey ,O�Final r 0 Wetland Buffer O Other(specify) REMARKS (in-house): �r�� '"...�Ucv�. ��=,-7� +°'� w.1� � C��t:��f1i�� " Si`71 s? � � �Jvt/��«�...P'°G„�-s� %�S'� �%�i 7`7�<"'� !s/�= � '��'�.1��.��'` i/� �N1S i��.Pt�.P- Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES � NO New: � YES 0 NO OFFICIAL REMARKS -TO BE NOTED ON PERMIT ANQ INITIALLED Updated: January 2013 v:\forms�plan review checklist 2013.docx DATE TIM� CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. ��3 -�y5 e"Z COMPLETED �� ADDRESS oZ�f�s �tsK�iSiDG D�'� OWNER TELEPHONE NO. CONTRACTOR L�irrnt�ii+�r��r �rl�� DESCRIPTION ��•�v'`�e � r'e�Qi-,— � ❑ FOOTtNG �,PLUMBING FINAL�Q�3.�pJrp3 ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL O MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ' ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ', p WATER HOOK-UP ❑ PROGRESS � �FINAL�, ' ❑ SEWER HOOK-UP ❑ COMPLAINT v DEMO-SITE ,❑ SEPTIC MAINT. ,�',FOLLOW-UP _ ❑ DEMO-FINAL �7 SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI �] SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERfCONTNACTORTOMEETMpU:_YES_NO � COMMENTS: � � � ao/ �Dd Sr�� Dei..�. 6 Sea � x o"�or3 ' ��J� �� f'bl�[.tlf`�✓.��L��.S j • •e •�, c«r,..t , aP�., p�sta�',��l� -� P��`��`'�� o ; , , � Gh�re✓tb G �lti��c%tG �'�.,s G W � P��,�� e P�r�G�,. W�.�..� �a� ��.�, d��, � Q � z ' � _/k3 *c�o•� d� �v� Der.�•r�Z �a� wcW C � j __��'L� , d W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECT�ON TEMPORARY V BEFORECWERING PERMANENT �CORRECT UNSAFE CONDITION WITHIN '' HOURS. ❑ PHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR ', ❑CITATION ISSUED �NSPECTION REQUIRED.CALL TO ARRANG�ACCESS. ✓ ' Cali forthe next inspection 24 hours in advance. (952� 249-4600 OwrterlC tractor on site: �I1�r 1+�. F• Inspector.��M-- � ''} White Copyllnspector's File Canary CopylSfte Notice r� ,/ DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE l.� �f�S �EDULED y�-Z-�,�Z"—� 3"30 PERMIT NO.., fl�'; �� I S � COMPLETED ADDRESS Z��,� Cdl��,�� S� �',� I�`l�� OWNER TELEPHONE NO.�� LZ� ��(� CONTRACTOR ��II� ��Yll�u��'Y�C6� i� >; DESCRIPTION �� l � � � �� ❑ FOOTING [] PLUMBING INAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL C'� MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING [� MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSUTATION ❑'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 � ❑ PLUMBING RI ❑ S�PTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YO�:_YES_NO � COMMENTS: � W C � J O � O � W � Q � � Z W � W � � � d � �RK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTIOM TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECT UNSAFE CONDITION W�THIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 2�,hours in advance. �95Z� Z49-46�� OwnerlContractqr on s' e: 'I Ins'ector. � , White Copyllnspector's File Canary CopylSite Notice �� C� DATE TIME V CITY OF ORO�O —w ��,-�3 INSPECTION NO IC SCHEDULED �=1-�Z � PERMIT NO. �� COMPLETED . ADDRESS OWNER TELEP ONE N0.7�3��y"�� CONTRACTOR � L— �—l'Y!�! � DESCRIPTION ��!�dG[.e�(,�L/�U ��L�� 7�'!?/�-/L � � ❑ 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 _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL i' 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � 2 J O � � � �l ��1� r� � /'� O � W � Q � 2 W � W � � � � �RKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALI INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cal1 for the next inspection 2a hours in advance. (g52) 249-4600 OwnerfContractor on si Inspector_ � ��,� White Copyllnspector's Ffle Canary CopylSite Notice