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Home My WebLink About2009-00877 - addn/remodel/repair ,� , CITY OF ORONO PERMIT NO.: 2009-00877 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 12/04/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 25 CYGNET PL PIN : 04-117-23-22-0007 LEGAL DESC : SWAN LAKE ADDN : LOT 001 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 3,000.00 NOTE: FRONT STOOP APPLICANT PERMIT FEE SCHEDULE 88.50 SKOOG EXTER[ORS STATE SURCHARGE(VALUATION) 1.50 8600 GRACE LANE LORETTO, MN 55357- TOTAL 90.00 Minnesota State License#: 20451795 OWNER MCLEAN, SEAN& MARIE 25 CYGNET PL 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[his type orwork 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 80 days at any time after work has commenced. The a licant is responsible or assuring all required inspections are request�d in formance wit �e Eate Building Code.This permit may be revok8d�t any ti for due c,use. �) \ � 1 ! V � � � �� l l pli�aqt Perr��fe �gna�ur Date Issued By nature D te � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV . City of Orono Building Permit Application for New Structures or Additions Mailing Address: Permit number: �g,�,j�� PO Box 66 /�0 � �\A\ Crystal Bay, MN 55323-0066 Date received: /I ""`�` 1 I � Received b ( a �� ?�s;�� , Street Address:� Y� '�-i� �'.� �� ;'",�� 2750 Kelley Parkway Plan review fee: t�k��H�og,� Orono, MN 55356 �-- - 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: 02� /'1'� ��Q,�.� Will this be a Parade of Homes, Remodele`rs`Showcase Home or other Display Home? ❑ Yes �] No !f 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: j<_,.�_a�,- �� `-'r�--�i��:.� State License# ��.��-� � I ��-�<--- Expiration Date: Phone: , -Z �� ,, �� I � (office) '_] (y ; `�T '�-�� O�; (cell) Mailing Address: �' , �� c� L�� Cit : _; , ZIP: r-s;�-� Contact Person: _`�r>� � ��_- Applicant is: _ontract / Homeowner (CircleOne) Email and/or Fax: � � PROPERTY OWNER INFORMATION: Name: � .� �,� M�.�e:>A�� Phone (day): �'� 7_ ��i Z,�7 � Address: Z� �- �y�+vU� City: ZIP� Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP� Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & ❑ New Construction Water Supply ❑ Single Family with ❑ Residence ❑ Addition attached garage ❑ Gara e/Accesso Bld ❑ Accesso Buildin 9 rY 9• ❑ Public Sewer ry g ❑ Single Family with ❑ Deck ❑ Relocation ^ ^ detached garage ❑ Office/Commercial � Other. (specify) <��'� `��(_, ❑ Multi le Famil !Condo ❑ Private Sewer �� - ' p y ❑Warehouse ❑ Public ❑ Storage ❑ Public Water "*Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Private Well 18202 Minnetonka Blvd Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � �r�.��_,r� Last Updated: 9/29/2009 - 17 - STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction a. Length (ft.)= Number of bedrooms = ❑Wood/Frame ❑ Masonry b.Width (ft.)= Number of garage stalls: ❑ Metal Attached = ❑ Pole Bldg. Areas in spuare feet Detached = ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 1 St Story = ❑ Other(please specify): e. 2"d Story= f. '/z Story = g. Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed Applicable � ❑ 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 � ❑ Plan Review Fee � ❑ Other APPLICANT 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; • 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. � � ' �. ,\, , % �Z_. � ` a� Applicant's Signature: Date: �`._ -- \, � Last Updated 9/29/2009 - 18 - . Pian Review Checklist for New Structures / Additions Address/ PID/ Legal: Z � �.� �,r�;�r Description of work: =lLc,ti�- s ;-�;� n Septic review by: /V i�'+ Date Approved: Zoning review by: �' � Date Approved: Building review by: .�r �-- Date Approved: I Z -`/-�I Grading review by: Date Approved: Zoning File#: Resolution#: Resolution Date: Zonin District Fire Department Post Office School District Zoning: Lot Area: SF/AC Width: Depth: Survey Submitted: ❑ Yes 0 No Date of Survey: Pro osed Setbacks: Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Building Defined Height: Building Peak Height: # of Stories Ok?: ❑ YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: START WITH the distance between the basement floor/crawl START the distance between the slab and the highest space floor and the highesf�roof peak,ihe top of WITH roof peak,the top of the comice 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 and 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 flobr/crawl ADD the distance between the slab and the highest space floor and the ttighest existing grade�within existin rade within the foundation the foundation or 10 feet, whichever is less`., EQUALS Defined buildin hei ht EQUALS Defined buildin hei ht �� Lot Coverage: i"� SF �\ % Shoreland Distri�t MCWD Permit Received Avera e Lakeshore Setback Bluff '� 0 Yes ❑ No ❑ N/A ❑ Yes ❑ No � Yes '�0 No 0 es ❑ No ❑ N/A Permit Number: Setback: Hardcover Zones Existin Pro osed Varia e Required CUP Required 0-75' � Yes � ❑ No ❑ Yes ❑ No 75-250' Type�S�. , TYPe�s): . 250-500' 500-1000' REMARKS (in-house): U pdated: 09/11/2009 z:\forms�plan review checklist.docx Fees to be Charged YES NO , Permit � Plan Review � �/ State Surcharge � Investigation Fee SAC- Number of SAC Units Sewer Connection Water Connection Park Fee Site Inspection Other (specify) Miscellaneous Fees Calculated By: Square Foota e $ per S uare Foota e Basement X = $ 1 St Floor X = $ 2nd Floo� X - $ Garage X = $ Estimated Construction Value: $ �;OC� � vu Orono Inspections Required Work Requiring Separate Permits Required State Permits ❑ Site � Plumbing ❑ Grading / Filling ❑ Well ❑ Hardcover Removal � Mechanical 0 Fire 0 Electrical �Footing � Septic ❑ Water Connection 0 Poured Wall � Fireplace ❑ Sewer Connection � Foundation Survey 0 Masonry 0 Lawn Irrigation � Radon Rock Bed ❑ Mfg. ❑ Framing ❑ Other(specify) ❑ Insulation ❑ As-Built Survey �Final ❑ 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) Updated: 09/11/2009 z:\forms\plan review checklist.docx DATE TIME ✓ CITY OF ORONO CALLED IN � INSPECTION Iy,OT CE SCHEDULED ��-1 D/D �� " PERMIT NO. a� —�� COMPLETED �� I � ADDRESS Gl�� 9 1t o�" CT � _ OWNER TELEPHONE NO.�I Z,'�`7d '��7 CONTRACTOR a5 A . �: DESCRIPTION ��'�-` �� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAtNT. ❑ 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 4 � J O a � O � W � Q � Z W � W � � d W ❑WORK SATISFACTORY:PROCEED ��E�'PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ^ ISSUE CERTIFICATE OF OCCUPANCY W � ❑ CORRECT WORK,CALL FOR REiNSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITH�N HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN '�CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR � INSPECT�ON REQUIRED.CA�L TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (J52� 249-4600 OwnerlContract on site� � Inspector. White Copyllnspector's File Canary Copy/Site Notice � � DATE TIME CITY OF ORONO �Q 7�ALLED IN I�-�I INSPECTION NOTICE v � SCHEDULED � — -D .OD PERMIT NO. ��1�� DO�COMPLETED ADDRESS �5 C�l G� P� OWNER CONTR. � �'� TELEPHONE NO. �O�a �D -��/8 � DESCRIPTION 4�� ❑ FOOTING ❑ MECHANIC L I ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT Q ❑ DEMO-FINAL ❑ SEPTiC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o v v r a�— � UQ--� � � 0 � w � Q � z W � W � � d ORK SATISFACTORY:PROCEED I� PROJECT COMPLEfE W ❑C RRECT WORK&PROCEED '_' ISSUE CERTIFICATE OF OCCUPANCY � ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. J PHOTO TAKEN INSPECTOR WILL RETURN '7 CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR � INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ OwnerlContractor on ite: Inspector. /� White Copyllnspector's File Canary CopylSite Notice