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Home My WebLink About2012-01127 - addn/remodel/repair „ CITY OF ORONO * z 0 1 2 - 0 1 1 z 7 � , 2750 KELLEY PARKWAY DATE ISSUED: 1U19/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2735 COUNTRYSIDE DR W PIN : 04-117-23-12-0018 LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN : LOT 003 BLOCK 003 PERMIT TYPE : ADD[TION/REMODEL/ REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ I5,000.00 NOTE: SEPGRA'I'E PERMI"I�S REQUIRED: PLUMBING, MECHANICAL, GLECTRICAL(S"I�ATI?) KITCHL'N RGMODEL APPLICANT PERMIT FEE SCHEDULE 265.50 JEFF HARRISON PLAN REVIEW 172.58 2984 WATERTOWER PLACE CHANHASSEN, MN 55317- STATE SURCHARGE(VALUATION) 7.50 (612)919-7984 TOTAL 445.58 Minnesota State License#:20022883 OWNER ALEXANDER, TIM 2735 COUNTRYSIDE DR W LONG LAKE, MN 55356 AGREEMEIVT AIYD SWORN STATEMENT The work for��hich this permit is issued shall be performed according to the approvcd plans and specificat�ons,applicable City approvals,and the State[3uilding Code. This permit is for only the work described and does not grant permission for addilional or related work which requires separate permits. All provisions of la��s and ordinances governing this type of work shall be compied with whether or not speciticd herein.This permit will expire and become null and void if construction authorized is not commeneed within I 80 days oC the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applican[is responsible for assuring all required inspections are requested in conformance with the State Building Code.This pennit may be revol�ed at any time tor due cause. 7 ' �_"__ �✓� /9 � / / Applica itee Signature Date Issue 3v S� nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRBED AB E. . ', .-E��" ��- � City of Orono � �'` � -� � s,� ,;, ,, ,� Building Permit Application � for New Structures or Additions Mailing Address: Permit number: ��/p�—�`� a�� .�0,� PO Box 66 / Crystal Bay, MN 55323-0066 Date received: �1`"�—! � O Y: O �::t�...::,. �',,� �"'l�� -+` ,, , Street Address:� Received by: \`� �.,fij: �ti 2750 Kelley Parkway Plan review fee: \r ' ,� '�fi'�� Orono, MN 55356 '�Esxo4`' � ,:�=_=-- ��5 5 � 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: '� 3� � a , , � C°,L� � � �� ^ L,.�;' ` r'c;v� , �� Will this be a Parade of Homes, Remodelers S owcase Home or ot er 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 unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: S�{-4-- '}��•,.,�,�. State License# Z�,�, Z��,_� Expiration Date: �<;, �� Phone: � ��- ��i q-��f3:� (office) Y�Z-��l - �(� y y (cell) Mailing Address: �,,. � Cit : � � . ,, ZIP: Contact Person: � Applicant is: C ac or Homeowner (Circle One) Email and/or Fax: � ��-(- �'�,�;�'Nt„-��,,,�,-A,cL� �v v� PROPERTY OWNER INFORMATION: Name: )-�-w� ��r`�c.y�-e� Phone (day): Address: Z 3 S C� ,. �,�., s�• � 1(]'�' � City�'L�;�. r�, ZIP: 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. Proposed Use 3. Structure Type 4. Sewage Disposal & ,_,_,/: �,,,� Water Supply ❑ New Construction �5ingle Family with �"�esidence ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer [�Other. (specify) k:��t�--�:� -�.r ❑ Multiple Family/Condo ❑Warehouse ,,,>�� ❑ Public ❑ Storage ❑ Public Water "*Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review 8�permits. ❑ Industrial �rivate Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) 18202 Minnetonka Blvd Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.orq Estimated Construction Valuation (excluding land) $ /�'� �� C�C� � STRUCTURE INFORMATION: � 1.Structure Dimensions 1. Structure Dimensions(continued) 2. Type of Construction a. Length (ft.)= I'� �/ Number of bedrooms=� �� ]d'Wood/Frame b.Width (ft.)= G � Number of garage stalls: ❑ Masonry Areas in square feet Attached = _� ❑ Metal ❑ Pole Bldg. c. Basement= 7 ��v Detached = ❑ ICF d. 1 S'Story = � ❑ On-site Prefab e.2"d Story= � ❑ Off-site Prefab f. 'h Story = ❑ Other(please specify): g.Total Area= � G�� REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclose A plicable ❑ 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 a ❑ 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. ApplicanYs Signature: � '/�' � Date: ��- - s�- !Z-- Owner's Signature: Date: - Plan Review Checkiist for New Structures / Additions Address/ PID / Legal: Z13`� (�c..��U�LjS i�t:. f�� Description of work: �� , T�i,,,�.� ��.�, �:��e � Septic review by: ,�c.t i��- Date Approved: Zoning review by: fV'�f�4 Date Approved: Building review by: ��1�2wv�-- Date Approved: (/- � - Z-C, � Grading review by: �/✓� Date Approved: Zoning File#: Resolution#: Resolution Date: � oning District � Fire Department Post Office School District .� Zoning: �Lyat Area: SF/AC Width: Dep . Survey Submitted: �� ❑ Yes � No Date of Survey: Proposed Setbacks� Front (Lake) Rear��,Streetj ( N S E W ) ( N S E W ) O er Buildings Wetland Side Side Building Defined Height: � Building Peak Height: #of Stories Ok?: 0 YES FOR A BUILDING WITH A BASEMENT OR CRAWL&PACE: FOR UILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/crawl ART the distance between the stab and the highest space floor and the highest roof peak,the top of ITH 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 o� 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 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 floo��rawl,\ ADD the distance between the slab and the highest space floor and the highest existing gr�de within�, existin rade within the foundation � the foundation or 10 feet, whichever�i's less. �`� EQUALS I Defined buildin hei ht EQUALS Defined buildin hei ht ` � Lot Coverage: /` SF \� % `. Shoreland District MC D Permit Received Ave,cage•Lakeshore Setback Bluff . ❑ ,�'es 0 No ❑ N/A � ❑ Yes ❑ No ❑ Yes ❑ No � ❑ Yes��, ❑ No ❑ N/A ,�ermit Number: '�� Setback: Hardcover Zones Existin Proposed Variance quired CUP Required 0-75' � ❑ Yes No � Yes ❑ No 75-250';', ' � TyPe�S�. TYPe�S�: : 250-�00' 5�d0-1000' � REMP,rf�KS (in-house): �l'� � j-f--v4NG 2� Updated: 09/11/2009 z:\formslpfan review checklist.docx Fees to be Charged YES N0 ~ Pecmit - :;+ � ' Plan Review �- V State°:Surcharge _ ;� �,�.`'', Investigation Fee � 'MS�AC ..:�Nurriber�f-SAC:Uriits °:,� �,�� z:� ��, �: ,� � µSewer Connection .�1'Na#�er�� + , t, ,µ ��.�_ � �, �� s - _,�, ?a'll;CfJ��n.Il �,�''�.�-��'�fr�w�;.+�•�C��*�,�'�. ..�:� Park Fee .�i#e�Fns�ec�Eion��fi�,�� . �'��.. w ��, `� . � '�. ��, :� � s�, �; .�� JOther(specify) �lYlasce�ila�r�eous�Fees�x��`.��:�...5`u��a:��`��.�,�� ti, � �, � � � r _ :x7'Wt�Y 3'��f.M,.. �4Mr "R'a''4, A��'xj'.�F� Calculated By: S uare Foota e $ er Square Foota e Basement X = $ 1 S' Fioor X = $ 2nd Flool' X = $ Garage X = $ Estimated Construction Value: $ 1 � , �L`i �� Orono fnspections Required Work Requiring Separate Permits Required State Permits 0 Site Plumbing ❑ Grading / Filling ❑ Well 0 Hardcover Removal Mechanical ❑ Fire .{�'�'Electrical 0 Footing � Septic ❑ Water Connection 0 Poured Wall ❑ Fireplace � Sewer Connection 0 Foundation Survey 0 Masonry � Lawn Irrigation ❑ Radon Rock Bed � Mfg. Framing � Other(specify) ❑ Insu{ation � 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 PERMIT) Updated: 09/11/2009 z:\forms�plan review checkfist.docx S�� DA TIME �/ CITY OF ORONO CALLED IN r I � INSPECTION NOTICE SCHEDULED ��-Z7- d�--� PERMITNO.°��a ' ��f Z� COMPLETED ADDRESS o27��S �D l�V �lJ OWNER TELEPHONE NO.IP� Z�l� �9�7' CONTRACTOR �� C �; DESCRIPTION r��'�-��vt � � ❑ FOOTING ❑ PLUMBING FI L ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � � O a � O � W � Q � Z W � W � � �a RK SATISFACTORY:PROCEED C� PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CARRECT 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.CALLTOARRANGE ACCESS. Call tor the next inspection 24 hours in advance. (952� 249-4600 Owner/Contractor on site: � , :,�� -^� / Inspector. '✓`✓ �-" — White Copyllnspector's File Canary CopylSite Notice � ?�� TE � TIME , / CITY O ORONO <!�aLLED IN � � I � INSPECTION NOT E SCHEDULED ___�� . PERMIT N '�? � COMPLETED ADDRESS "� � �`-� �`��' �t�-I S I�� Z (;(� . OWNER TELEPHONE NO. � ��' � I� ��y CONTRACTOR �G� �C7�1� � CiV�S� �: DESCRIPTION '`� �� t � ` �� f �i��'h � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING�/�fi Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS "U! 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 Q ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SE,P71Q�FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:��YES_NO � COMMENTS: � . W C � J O a � O � W � Q � Z W � W � � d W� ❑WORK SATISFACTORY:PROCEED y�ROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContractor on ite: Inspector. � �� - � White Copyllnspector's File Canary CopylSite Notice