HomeMy WebLinkAbout2010-00410 - addn/remodel/repair � r CITY OF ORONO PERMIT NO.: 2010-00410
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 06/10/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1815 FAGERNESS POINT RD
PIN : 17-117-23-22-0033
LEGAL DESC : MAPLEGATE INLET
: LOT 001 BLOCK 001
PERMiT TYPE : ADDITION/REMODEL/REPA[R
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIY TYPE : ADDN/REMODEL/REPA[R
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 30,000.00
NOTE: SEPERATB PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE)
PLAN REVIEW FEE COLLECTED 6/1/]0 $30339 2010-00409 �`�
.r �
ANY FURTHER EXPANSION ON THE PROPERTY WILL LIKELY REQl1IRF,AN UPDA'1'ED SURVEY�- � �'� (INITIAL)
BUMP OUT OF STRUC"1'URE ON EXISTING DECK.
APPLICANT PERMIT FEE SCHEDULE 466J5
KMS ASSOCIATES LLC STATE SURCHARGE(VALUATION) 15.00
2216 COUNTY ROAD D TOTAL 481.75
ROSEVILLE, MN 55112-
(6]2)242-7898
Minnesota State License#: 20634045
OWNER
MCKEE, MR. & MRS. MELVIN
1815 FAGERNESS PT RD
WAYZATA, MN 55391-
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 related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specitied 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 for assuring all required inspections are
requested in conformance with[he State Building Code.This permit may be
revoked at any time for due cause.
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�Applicant Permitee Signature Date Issue Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
, , � / ��
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C it of �v � '�
y Orono �
� ��
Bu�lding Permit Application ..� � ,
for New g
Structures or Additions
Mailing Address:
/�'�+�.� POBox66 Permitnumber: 07��o'Qb�f/0
0 �� Q� Crystal Bay, MN 55323-0066 Date received: lo "�— ��
� �'` ?��'�y � Street Address:' Received by: ��v
`� ,' �:..�> C
� , �� �� 2750 Kelley Parkway 303 39 �� �
Plan review fee: i
t9kE6Ei�g'� Orono, MN 55356 �O/D –QD O ��
Totai Fee:
Main: 952-249�600 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 wiil be returned. (Please printJ
GENERAL INFORMATION: �� �
Job Site Address: ����->' �- �SS 7�a��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If yes, a special event permit rs required with Police Department and City Councr/approval 60 days prior to the event. Shuttle bus service wil/be
required unless applrcant demonsfrates sufficient on-site parking rs available. Non-permitted evenfs wil!not be allowed.
CONTRACTOR/APPLICANT INFORMATION: ��
Name: ' ' - �: c.�A� — Kl�S SSOG[�z�5
State License # o`�,Q�'3 Expiration Date: 3 j
Phone: �(�--- �2--- ��3c� � (office) (v5(- �1'� �5oa (cell)
Mailing Address: !P �j Cit : '�ZoS�v'( C1.� ZIP: (I �
Contact Person: ,�2L��S S Applicant is: Contractor / Horneowner (Circle One)
Email and/or Fax: �-�' _ "� _-7 scs S- G c�r � � q� �c-�r s , L�-,,�,�
PROPERTY OWNER INFORMATION:
Name: ����� ' `� �G
Phone (day):
Address: l�',�� �,����s� ��, �D City �`j p�-�1a 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 &
Water Supply
❑ New Construction �Single Family with �Residence
❑ Addition attached garage ❑ Garage/Accessory Bldg. [�Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation � detached ara e
❑ Other. (specify) �'�•- ��ASc�v� g 9 ❑ Office/Commercial ❑ Private Sewer
❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
*'Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review 8� permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify)
18202 Minnetonka Blvd
Deephaven, MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ '3�
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=� J�]Wood/Frame
❑ Masonry
b. Width (ft.)= Number of garage stalls: ❑ Metal
Attached =?� ❑ Pole Bldg.
Areas in spuare feet Detached = ❑ ICF
c. Basement= 0���� ❑ On-site Prefab
❑ Off-site Prefab
d. 15t Story = I Oo� ❑ Other(please specify):
e. 2"d Story =
f. '/Story =
g. Total Area= ZGC�
REQUIRED SUBM(TTALS:
All of the information must be submitted in order for your application to be processed:
N ot
Enclosed 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
� Cl Hardcover Calculation(s
❑ ❑ Se tic S stem Site Evaluation Re ort
❑ ❑ Access Permit
� ❑ Wetland B�ffer Im rovement Plan
❑ � En ineered Plans for Retainin Walls 4 feet or above
� ❑ I 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 tne 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.
ApplicanYs Signature: Date: _� l�—/�
�
Last Updated: 9/29/2009
- 18 -
Plan Review Checklist for New Structures / Additions
Address/ PID/ Legal: � ���j ���.����V ►" ��� I � �
Description of work: �v v !�� 5����1 pj�/ � y"
Septic review by: N j �� Date Approved:
Zoning review by: Date Approved: ('r — �'1 -1 C�
Building review by: ��� Date Approved: � `t - ( o
Grading review by: >�l i u�� 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 �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 highest roof peak, the top of 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 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 floor/crawl ADD the distance between the slab and the highest
space floor and the highest 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: SF %
Shoreland District MCWD Permit Received Avera e Lakeshore Setback Bluff
� Yes 0 No � N/A � Yes 0 No
� Yes 0 No ❑ Yes � No 0 N/A
Permit Number: Setback:
Hardcover Zones Existin Proposed Variance Required CUP Required
0-75' � Yes 0 No � Yes � No
75-250' Type(s): Type(s):
250-500'
500-1000'
REMARKS (in-house): ���n^�D �J� d � S-tyLv�'�-J►�1,� �•,�l �s--x t�;-�,•�;� � �C l�
Updated: 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 Square Foota e
Basement X = $
1 St Floor X = �
2nd Floo� X = $
Garage X - $
Estimated Construction Value: $
Orono Inspections Required Work Requiring Separate Permits Required State Permits
� Site �Plumbing 0 Grading / Filling � Well
0 Hardcover Removal �Mechanical 0 Fire �Electrical
� Footing 0 Septic ❑ Water Connection
� Poured Wall � Fireplace ❑ Sewer Connection
0 Foundation Survey � Masonry 0 Lawn Irrigation
0 Radon Rock Bed 0 Mfg.
�raming ❑ Other(specify)
,�Insulation
0 As-Built Survey
�inal
❑ Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access:Existing: 0 YES 0 NO New: 0 YES ❑ NO
REMARKS (TO BE NOTED ON PERMIT AND INITIALLED BY PERSON PULLING PERMIT)
� _ ,
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- � _ !'��
Updated: 09/11/2009
z:\forms\plan review checklist.docx
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kee existin kitchen faucet and reverse osmosis �sher y�M/3015 F3` ✓1239 F �. i
addn ew ch ome soa dis enser drill hole for ��� new dish� � 4 �-new outlet � ,
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install to de determi eda ���_o. - c o new composite floor-permastone to bow 12"out at peak o y
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I�'� � o y � B15-R����� 2B30 �815-L , new light fixture to be installed(n�c�iling;fan) �. ; ��� a
;i o 9� a � i (��... to be supplied by anna ''., E I . � �� ..:. �
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used cabinet doors from above the stove 3 S � ��.
for microwave cabinet °c�� ; '
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paint �w
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Because product will be uninstalled and reinstalled �
there is a risk of material damage.
I Contractor will verify with customer ma[erial is in satisfactory condition Paint pepper spice by BEHR 250E-6 semigloss .
for instalL �
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adjustment to fit job conditions. has been paid or job order placed.
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