The URL can be used to link to this page

Home My WebLink About2015-01308 - addn/remodel/repair CITY OF ORONO * 2 0 1 5 - 0 1 3 0 8 * 2750 KELLEY PARKWAY DATE ISSUED: 10/14/2015 ' ORONO, MN 55356- ' (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2450 COUNTRYSIDE DR PIN : 04-117-23-11-0004 LEGAL DESC : COUNTRYS[DE MANOR : LOT 002 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTNITY : 434-RESIDENTIAL VALUATION : $ 5,000.00 NOTE: SEPARATE PERMITS REQUIRED:PLUMBING,ELECTR[CAL(STATE) (REMODEL POWDER BATH&MASTER BATH) APPLICANT PERMIT FEE SCHEDULE 123.91 PLAN REVIEW 80.54 WINKLER, SHAUN&STACIA STATE SURCHARGE(VALUATION) 2.50 2450 COUNTRYSIDE DR LONG LAKE, MN 55356- TOTAL 206.95 Payment(s) CHECK 2459 206.95 OWNER WINKLER, SHAUN& STAC[A 2450 COLTNTRYSIDE DR LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The 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 permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or no[specified herein.This pemii[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 l80 days at any time after work has commenced. The applicant is responsible for assuring all required inspections aze requested in conformance with the State Building Code.This permit may be � revoked at any time for due cause. -� i /`-'— �O / I.S � � �'� '�� /�..lt�� / I�� l �� plicant Permitee Signature Dat Issued By Signature Date . CITY OF ORONO - BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS �� Mailing Address: Permit number: "�-' I r�-- l i �:�� PO Box 66 Crystal Bay, MN 55323-0066 Date received: �L� � I � Street Address:� Received by: �� y�, G�'� 2750 Kelley Parkway Plan review fee: �; �' - tqkESH�4� Orono, MN 55356 � Main: 952-249-4600 Total Fee: �'S Fax: 952-249-4616 www.ci.orono.mn.us �-- �� ' This application form must be completed in fuil and all required information must be submitted. Incomplete applications will be returned. (Please print) ��,� �.- °:,� ��C�y�� GENERAL INFORMATION: �� Job Site Address: iy � C.�.�- s�� r. 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. Shutt/e bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: 5h�vw t„1,'ti kkr State License# N�,q Expiration Date: Phone: (cell) ��Z g�co 39G9 (office) �.l�A Mailing Address: Zy o C.�cw+�• sr�v Dr. Cit : ,,.o ZIP: SS 3 Contact Person: 51�.�„n Applicant is: Contractor / Homeowne (Circle One) Email and/or Fax: 5��,,,.,�„�,,,;.=,I�lar� ho+„�,,.;1 . carn PROPERTY OWNER INFORMATION: Name: _ _5�-�- as rl5ovc.. Phone (day): Address: City: ZIP: Email and/or Fax ARCHITECT I ENGINEER INFORMATION: Name: �,J�q Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of project: Pow��r �� .w�o��, � N1�.s-f-c� $�,-ty,. (�,MoJc,,C� 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & Water Supply ❑ New Construction [�Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck ❑ Public Sewer ❑Accessory Building ❑ Single Family with Office/Commercial ❑ Relocation detached garage �Residence [�Private Sewer Q Other: (specify) �l�v►or Qs�w�o�c.A ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater ❑ Public Water *'Any earth movement may also require ❑ Commercial ❑ Storage MCWD review&permits. ❑ Industrial ❑Warehouse [�Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other:(speCify) ❑ Other(speCify) 15320 Minnetonka Blvd Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or :.J Estimated Construction Valuation (excluding land) $ i ,�,�� Last Updated: January 2015 STRUCTURE INFORMATION: • 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction . a. Length(ft.)= Number of bedrooms=� �Wood/Frame b.Width(ft.)= Number of garage stalls: ❑ Masonry Areas in square feet Attached = Z ❑ Metal � ❑ Pole Bidg. c. Basement= Detached = ❑ ICF d. 15'Story = ❑ On-site Prefab e. 2"d Story= ❑ Off-site Prefab f. '/2 Story = ❑ Other(please specify): g.Total Area= REQUIRED SUBMITTALS: Ali of the information must be submitted in order for your application to be processed: Not Enciosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ Plan Review Fee ❑ Com leted A lication Form ❑ '0' Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'h x 11 set ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ Surve —2 full size,to scale meetin ALL surve requirements ❑ Hardcover Calculations ❑ Se tic S stem Certification ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired ❑ Landsca e Walls and/or Retainin Wall Plans ❑ Stormwater Pollution Prevention Plan SWPPP ❑ Access Permit ❑ Data Privacy Advisory Form 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. ApplicanYs Signature: � Date: 9�S�S Owner's Signature: Date: 9��5�,5 Last Updated: Janua 2015 PLAIV REVIEIIII CHECKLIST FOR hIEW �TRUCTUI�ES / ADDITIONS Address: _ � �� (J�f,�yPyr,Ll'�� j(� permit No.: Description of work: Date Rec'd: � Septic review by: Q e -t,�� ate Approved: l� Zoning review by: � Date Approved: Building review by: Date Approved: � Grading review by: _ ,� � Date Approved: Zoning District: ZQning File#: Reso #: 12eso Date: Zoning: Lot Area: SF ' C Width: Lat Coverage: gF o�o : Survey S�bmittecl: ❑ Yes � No Date of Survey: Revised date ? : i Pro osed Setbacks: _ Front(Lake) Rear(Street) � � S E W ) ( N S E ) Other Buildings Wetland Side Side Defined Height: Peak H ight: FFE: FFE minus 6 feet= (Existing Contour Perimeter(linear feet) = 5 %= L.F. below grade #of Stories FOR A BUILDING WITH A BASEMENT OR CRAMIL PACE: FOR A BUILDING ON A SLAB FOUNDATION: The distance betwe n the lowest proposed The distance between the top of START WITH floor(of the baseme t or crawl space)an START WITH slab and the highest point of the the highest point of t'e roof. roof. If you have a... If you have a... GABLE OR HIP ED ROOF(n • GABLE OR HIPPED ROOF • windows): Subtr ct half the stance (no windows): Subtract half between the high st point the roof the distance between the to the iow point of he corr sponding highest point of the roof to SUBTRACTION gable or hi the low point of the ' pped ro f corresponding gable or �i (BASED ON . GABLE OR HIPPE OF(with SUBTRACTION hipped roof ROOF TYPE) windows): Subtract alf the distance (BASED ON . GABLE OR HIPPED ROOF between the top of highest ROOF TYPE) (with windows): Subtract � window and the h' h�St point of the ' half the distance between roof the top of the highest • ALL OTHER OF TV�PES(flat, window and the highest mansard,et :No subtr�ction. point of the roof • AlL OTHER ROOF TYPES SUBTRACTION Subtract the dis nce between,the (flat,mansard,etc):No (BASED ON basemenUcra�space floor an�i the subtraction. EXISTING highest exist'yhg grade ad�acent�to the ADDITION Add the distance between the top GRADES) foundation�DR 10 feet(whichev�r is tess). (BASED ON of slab and the highest existing EQUALS Defined uilding height EXISTING grade adjacent to the foundation. GRADES �h EQUALS Defined building height � Shoreland District MCWD Permit ' �verage Lakeshore Setback g�uff � �et? � Yes p No Permit Number: "� ❑ Yes � No 0 N/A 0 Yes 0 No , � N/A—see attached � Setback: a Stormwater Quality Pr�posed Overla Qistrict ��sting Hardcover y (%and s� Hardcover Variance Required CUP Required Tier circie one %and s � � Yes � No � Yes � No 1 2 3 4 5 ype(s): Type(s): Updated: January 2015 � z:lforms\plan review checklist 2015.docx �,:,.. ,�,,..:. �....,, . _ . . . . . .,,_<. . .. . - . .r.�,:. . ,. . .�, - � ...- -- .-._, ,.�.-�,.,; � REMARKS (in-house): Fees to be Char ed YES NO Permit � Plan Review v� State Surcharge � Investigation Fee V�� SAC-Number of SAC Units �� Other(specify) ` '` S uare Foota e $ er S uare Foota e Basement X - $ � 151 Floor X = $ 2nd FIOo� X - $ i Garage X - $ .: Estimated Construction Value: � � Qrono Inspections Required Work Requiring Separate Permits Required State Permits ; � Site �Plumbing ❑ Grading/ Filling 0 We�� Silt Fence/ Erosion Control ❑ Mechanical 0 Fire �Electrical ❑ Hardcover Removal 0 Septic 0 Water Connection ❑ Footing � Fireplace 0 Sewer Connection ` C! Poured Wall 0 Masonry 0 Lawn Irrigation 0 Foundation Survey � Mfg. 0 Landscaping 0 Foundation Waterproofing � Other(specify) � Radon Rock Bed ' � Framing '; P'�Insulation � As-Built Survey +' �Final ❑ Other (specify) REMARKS (in-house): � Other Reviev+r: Reviewed by: Date Approved: � � Access: Existing: � YES � NO New: Q YES � NO �_ OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND tNITIALLED ��`` { � Updated: January 2015 € z:\forms\plan review checklist 2015.docx � �..: , , _. ��.. , s_. .. _ , �., . r .� _ .�: � . - . ;. .. _.. ,. �� y/� DATE TIME CITY OF ORONO CALLED IN //-�7—/S_ INSPECTION NOTICE SCHEDULED //-�9-/.5 �✓.� PERMIT NO. �.2�1✓��1��COMPLETED ADDRESS a�� OWNER ��ifll��;�/�C� TELEPH NE NO�z-�`Lo-.?!' 1`lv� CONTRACTOR � � DESCRIPTION ry ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: a� W � � J O � � O � W � Q � 2 W � W � GW ORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � C RECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CAII FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WFIL REfURN ❑STOP OFDEH POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours i dvance. 5 OwnerlContractor on site: Inspector. White Copyllnspector's Ffle Cenary CopylSfte Notice