HomeMy WebLinkAbout2014-00027 - addn/remodel/repair . R
CITYOFORONO * 2014 - 0 � 027 *
2750 KELLEY PARKWAY DATE ISSUED: Ol/14/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2250 FRENCH LAKE RD
PIN : 10-117-23-22-0012
LEGAL DESC : JOHNSTONS FRENCH LAKE 2ND ADDN
: LOT 001 BLOCK 002
PERMIT TYPE : ADDITION/ REMODEL/ REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 8,000.00
NO'I'I,: SEPnRATE PI?RMiTS REQUIRGD: PLUMBING. ELF,CTRICAL(S'T'ATE)
REMODF•,L (,AiJNDRY ROOM
APPLICANT PERMIT FEE SCHF,DULE 162.25
PLAN REViEW 105.46
CRYSTAL KITCHEN CENTER STATE SURCHARGE(VALUATION) 4.00
668 N. HIGHWAY 169
GOLDEN VALLEY, MN 55427 TOTAL 271.71
(763)544-5950 Payment(s)
Minnesota State License#: BUIL-7200 CREDIT CARD 8983 271.71
OWNER
ERPELDING, MARK&GRE'I'CHEN
2250 FRENCH LAKE RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
'I�he work for which diis permit is issued shall be performed according to
the approved plans and specifications,applicablc 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
pennits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein."Chis permit will
expire and become null and void if construction authorized is no[
commenced within 180 days of Ihe date of issuance,or if construction is
suspended fbr a period of 180 days at any time after work has commenccd.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit m�y be
revoked at any time Yor due cause.
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Applicant Pcrmitee Signaturz— D� e Iss I3y Signaturc Date
T • ��������
�AN 0� 2014
Total Fee: $ Date Received: C�N OF ORONO
�;:te:ed By: __ Permit#:��� __ �>C-z� oZ�
CIT�Y OF ORU�i�u - �i.ilLD�i�� PERIYIIT APPLICATIO1���� ��
�ll information must be submitted in full before pl�n review will be starte�l.
(please p�int all informationj
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THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR �
JOB SITE ADDRESS: _ i-�j() JG��y�,�-� (,,,�j� �,�i ZIP: �j�"�'� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ��O If yes, a specinl eves�t permit rs required with Police Depar7ment anc/Citv Coimcrl appi�oval
60 dcrvs prior to the evenl. Sfnrttle bzrs seri�rce tivill be reqzrired iinless upplicnr�t demorstrn�es
szrfficierit on-site pnrking is available. Norrper»aittec!eve��ls u•rll not be nlloired.
NAMEOFOWNER: _��� �r � ���i.rAf �1�1���NE: (homej � � ����- ��
(work j
MAILING ADDRESS: �Z2� Ff'����L�{-ff.��tJ�ITY: ZIP: ��� _�/
CONTRACTOR: " PHONE: �(p���� �J�)
CONTACT PERSON: ) �N ' �ti� !,� MOBILE/PAGER: •- /Q -Ti�Z�
MAIL[NG ADDRESS: a CITY: ZIP: �j �7
STATE LICENSE: # ��',��7�� E PIRATIO_ D TE: �,--a,J'-J�
—�
ARCHITECT/ENGINEER: PHONE:
1VIAILING ADDRESS: CITY: ZIP:
NArvi�'• R�GISTRAT'ION: #
TYPE OF WORK: New Addition Accessory Structure
Move Hoine Remodel/Alteration �
PROPOSED WORK(describe in detai�: �? -
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTaCHEI� DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ���w
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APPLICANT'S SIGNATURE: DATE: `"(d �
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Sec13.04 RIGHTS OF SUBJECTS OF DATA
Subd. L "C��;,,;of da[a. The ri�hts of individuz;on whom thc dat�is store�.;�r to be stored siiall be as,ct tbrth in this,ection.
Suhd.�'. Informarion rcquircd to bc-r�.,�r,in�;�;di;;tl. An indi��idual z::ked to supply p�ivarc o:;onriu.ntial.lata conc:r.i;n���;;;s�!i'_1,u;1 bc
infomied of: (a)�he purpose and intended usc uf the requestcd da�n within the collecting,tate agcnty,political subdivision,or statcwide svstem;�b)
�ahethcr he may refuse or is Icgally rcquired to supply the requested data;(c)any known consequcncc arising from his supplying or refusin�to sup�lv
privatc or contidcn[ial data;and(d)the identity of other persons or entitics�uthorized by state or federal law to rcccive thc dam. This rcyuiremcnt sh:tll
not�ipply whcn an individunl is asked to supply invcstigativc data.pursuant to scction 13.8'',subdivisioi�5,[o u law eniorccmcnt o�Fccr.
The conmiissioner of revenue mav olace the notice rcquired under this subdivision in the individuai income t�x or�ronc�tv t��r�fiind
instructions mstead of on those fonns.
Subd.3. Acecss to data by individual. Upon request to a responsible authority,an individual shall bc inlonned whedier he is the,ubjcct of
stored data on individuals,and whether it is classified 2s public,private or confidential. Upon his further request,an inclividual who is thc su�ject oF
stored private or public data on individuals shall be shown the data wi[hout any charge to him and,if he desires,shal I be infonned of die cuntcnt and
meaning of that data. After an individual has been shown the private data and infomied of its meaning,the data need not be discloscd to him for six
months thereafter unless a dispute or action pursuant to this section is pendino or additional data on the individual has becn collected or cre�tc�l. Thc
respunsible authority shall providc copics of the privatc or public data upon requcst by the individual subjert ol the data. The responsibic authority
may rcquire thc requesting person[o pay the actual costs of making,certifying,and compiling Ihe copies.
Thc responsible authority shall comply immcdiatcly,if possible,with any request made pursuant to this suhdivision,or�vithin five da��s of
the date of the request,e�cluding Saturdays,Sundays and Icgal holidays,if immediatc compliance is not possible. Ifhe cannot eomply with the requcst
within diat time,he shall so infom�the individual,and may havc an additional five days within�vhich to comply with thc rcquest,cscluding Saturdays.
Sundays and legal holidays.
Subd.4. Procedurc when data is not accurate or complete. An individual may contest the accuracy or completeness of public or privatc data
conccrning himself. To exercisc this righr,an individual shall notify in writing the responsible authority dcscribing the naturc of thc disa��rcement. Thc
responsible authority shall within 30 days eithcr. (a)correct the data found to be inaccurate or incomplctc and attempt to notify past reci��icnts oF
innccurate or incomplete data,including recipien[s named by the individual;or(b)notify the individual that he bciieves the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreement is included with thc disclosed�ata.
The detern�ination of the responsible authority may be appealed pursuant ro the provi;ion,of the administrati��e p�ucedw�e�ict relatin��ti�
contcstcd cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inforn�you that your request
for a pernlit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential infonnation.
You are notified that:
I. The information you fiu-nish wil� be used to detennine your qualification for the pennit or license
requested.
2. You may refuse to supply data,but refiisal inay require that the City deny the permit or license.
3. The infonnation may be shared with other local, state or federal agencies to the eatent necessary to
process the pennit or license.
4. If your requested pennit or license requires Council action to approve, soine inforn�ation may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to review private data on }�ourse(f.
6. Your full name is required to process this application or pennit.
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Firs Middle Last
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PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
Address/Permit Number: �.SO �/1,�7°�� �>� 1w��
Descriptionofwork: �D� �'-7����-
�' Septic review by: /V/� Date Approved:
Zoning review by: Date Approved:
Buildin review b : Date A roved: �- �� � �O f�
-- ------ -----g---y— _ _ - --- - - ------- pp
Grading review by: /1�'/� Date Approved:
�" Zonin istrict: Zoning File#: Reso#: Reso Date:
�,
�6 Zoning: Lot ea: SF/AC Width: Lot Coverage: _ SF _%
'
Survey Submitte � � Yes 0 No Date of Survey: Revis date ? :
Pro osed Setbacks:
Front(Lake) Re (Street) ( N S E W ) ( N S E W ) Ot r Buildings Wetland
Side Side
�:
Defined Height: Pea Height: FFE: FFE inus 6 feet= (Existing Contour)
Perirneter(linear feet) _ % _ #of S ries Ok? � YES
FOR A BUILDING WITH A BASEMENT OR CRAWL SPA E:
The distance between the lo st FO A BUILDING ON A SLAB FOUNDATION:
START WITH proposed floor(of the baseme or crawl
�; space)and the highest point of th roof. START WITH The distance between the top of slab and
k: the highest point of the roof.
� If you have a... 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
n'PE) 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 tion. mansard,etc:No subtraction.
ADDITION Add the distance between the top of slab
SUBTRACTION Subtract the distance betw n the (BASED ON and the highest existing grade adjacent to
(BASED ON EXISTING basemenUcrawl space fl r and the EXISTING the foundation.
GRADES) highest existing grade jacent to the GRADES
foundation OR 10 fe (whichever is less). QUALS Defined building height
� EQUALS Defined building eight
�
�'` Shoreland District WD Permit Recedved Avera e Lakeshore Se ack Met? Bluff
� Yes 0 No � N/A 0 Yes 0 No
`'' � Yes 0 No 0 Yes ❑ No � /A
� ermit Number: Setback:
x
Stormwater Quality Existing Proposed Variance Required CUP quired
Overla District Ti Hardcover Hardcover
�:
� Yes 0 No � Yes � No
` Type(s): Type(s):
�
� Updated: Janua 2013 � A� ��y,� „ `/ �S
v:\formslplan review checklist 2013.docx �� % ! ��v ��
„F�ai� wc�;:� .,i*. i�f�<�rv, _
11 REMARKS (in-house):
Fees to be Char ed YES NO
Permit
� Plan Review
State Surcharge
-- - --- _ _ - _ _ __ _ __ _ - _ _ _ - - --- --- - - -
Investig�ti�r� ee _ - ___ F
SAC-Number of SAC Units
Qth�c��p��if�� ';
S uare Foota e $ er S uare Foota e
Basement X = $
1 S`Floor X = $
2nd Floo� X = $
Garage X = $
Estimated Construction Value: $ �m����
Orono Inspections Required Work Requiring Separate Permits Required State Permits
` 0 Site Piumbing � Grading/ Filling 0 Well
. 0 Hardcover Removal � Mechanical 0 Fire lectrical
R 0 Footing � Septic O Water Connection
0 Poured Wall 0 Fireplace � Sewer Connection
0 Foundation Survey � Masonry � Lawn Irrigation
0 Radon Rock Bed 0 Mfg.
aming 0 Other(specify)
Insulation
� -Built Survey
Final
� Wetland Buffer
0 Other(specify)
REMARKS (in-house):
Other Review: Reviewed by: Date Approved:
Access: Existing: � YES � NO New: 0 YES � NO
' OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED
}
�:
Updated: January 2013
v:\forms\plan review checklist 2013.docx
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INSPECTION NOTICE
DATE TIME.
CITY OF (} 1^O N1'� CALLED-IN /
SCHEDULED
PERMIT NO. o�Z�/S/- d�oaT COMPLETED ia_�o.fy
ADDRESS ���5 O F�a,a�ti La�� 7��.
OWNER/CONTR.
❑SITE INSPECTION ❑MECHANICAL RI ❑ REINSPECTION
❑CONC SLABS ❑ MECHANICAL FINAL ❑ FOLLOW-UP
❑ FOOTING ❑INSULATION ❑ COMPLAINT
❑ POURED WALL ❑ RATED ASSEMBLY ❑ FIREPLACE
❑ FOUND. DRAINAGE `�BUILDING FINAL ❑SPRINKLER SYSTEM
❑ FRAMING 17 SEPTIC INSTALL ❑
� ❑SHEATHING ❑SEPTIC FINAL ❑
❑ PLUMBING RI ❑S&W HOOKUP ❑
� ❑ PLUMBING FINAL ❑GAS LINE MANOMETER ❑
o COMMENTS:
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� FURTHER CORRECTIONS MAY BE REQUIRED �ERMIT FINALED
� ❑WORK SATISFACTORY: PROCEED ��❑ P�I-OTO TAKEN
O ❑ CORRECT WORK& PROCEED
U ❑ CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
❑ CORRECT UNSAFE CONDITION IMMEDIATELY.
❑ STOP ORDER POSTED. CALL INSPECTOR
❑ INSPECTION REQUIRED. CALL TO ARRANGE ACCESS.
TO SCHEDULE YOUR INSPECTIONS
PLEASE CALL: (763) 479-1720
Metro West Inspection Services Inc.
Owner/Contr. on site:
Inspector: �
�i �D �� DATE TIME �
CITY OF ORONO CALLED IN "Z--..3
INSPECTION NOTI E SCHEDULED � ;
PERMIT NO. -'���z 7 COMPLEfED
ADDRESS � �Y�'�- L
OWNER TELEPHONE NO.��Z 9/D Z�9 Z
CONTRACTOR �f�� ��
� DESCRIP 10����N "J�n����
�
� ❑ FOOT G ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ PO ED WALL ❑ MECHANICAL RI ❑ IAKESHORENVETLANDS
y ❑ AMING O MECHANICAL FINAL
� ❑ TREE REMOVAL
Z INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q � DON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
Q ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� ORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY
� BEFORE CWERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pf{OTOTAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor on site:
Inspector.
White Copyllnspector's File anary CopylSite Notice