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CITYOFORONO * 20 13 — PJ0532 *
� 2750 KELLEY PARKWAY DATE rsSUE�: 06/24/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616 �
ADDRESS : 2670 KELLEY PKWY $Z` 203
PIN : 33-118-23-12-0051
LEGAL DESC : STONEBAY OF ORONO CONDOMINIUM
: LOT 121 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 62,600.00
NOTF,: SEPARATF,PERMI"I'S REQUIRED: PLUMBING,MECHANICAL,F[REPLACE,ELECTR[CAL(STATE)
LTNIT#203 INTERIOR FINISH
APPLICANT PERMIT FEE SCI-IEDULE 779.25
GORDON JAMES CONSTRUCTION PLAN REVIEW 506.51
5159 MAIN STREET E
P.O. BOX 306 STATE SURCHARGE(VALUATION) 31.30
MAPLE PLAIN, MN 55359- TOTAL 1,317.06
(763)479-31 l 7
Minnesota State License#: 20531961
OWNER
Citizens Independent Bank
5000 36TH ST W
ST LOUIS PARK, MN 554]6-
AGREEMENT AND SWORN STATEMENT
"I'he work for which this permit is issucd shall bc performed according to
the approved plans and specifications,applicable City approvals,and thc
State Quilding Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permi[s. All provisions of laws and ordinances goveming this type of work
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 davs of the date oY issuance,or if construction is
suspended fbr a period of 1 AO days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requeste in confor ance with the S[ate Building Code.This permit may be ���'/ / �����
revok t any ti for e c e. �,
i tr-'1 ~l 2�S/ 7�/ (�')/j^ (�t� l l �
l�car� Permitee Signat Date Issued Qy S gnature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
T -. '' �,�Zl--d 3
City of �rano
I, Suilding P rmit Application fa�Mainter�ance/ Renovation
windows, doors,sidin , re�rot�#, etc.
e;r
A�AdGa9,8&' Permii ns�nber a��/ � rJ �--
•%Q� �Q,, cn�mi aer,�N�23-oass tr��+�a: �-�9- �
t! �,
�;� �.�� sueerAad.ess: ��d��
�,�\ ' �'` 275q Kelley Parkway Ptan�w
\\ p�'� Orono�MN 55358
�' ��,F�:� ► 3 i�7.
F�fain: 9�'.a2-2 F�x: 952-2d9-4&16 w,ru�.::i oronG.mr us �
This a mu4#be c�n�eied in fuuK and aR riec�rired informa6on m�be submit�t,
kic appttcat#a�s wiH b�rotwnned. (Pteese priM}
GENERAp,lNFORMATtON:
Job Site A�ddreas: � p-:1?�}RL�W�_ tl�3T L��
Will this be a Parede of R �Show+�ase Hot�or other Disp ayl Haane? Y� o
7Y��9 I�OeC�I eV9At pen►dt ls Wr9d rYittt Pvlka�l�verfnterd and Gity Gourrdf apprwe!BO dsya pior to N�a eveeq Sttlstlie btis s6wfCe hB
rsWir�Q un�s a &�M o�a paik�y is av�. Nor�perm�ed e�#s wAF rrot be eMowed.
CONTFiA TOR t APPtdCAl�l IAIFORII�AT1t'�'i:
Name: � y�q�-�W
S'iate lJce # C 1 Q t Exp}ratlort Qate:
Lead Ce ' Gation Number: Expiration Date:
f1w on t�that pYlw to i978
i�twr,e: , It c�1 '2..- (��)
M�ifttita f1d�d�Ss: Z,.-Svi}s.�iU t? C�tY� P:
Contact P n: Apptica�Is: Nameowner a,e►
Ema�an��x: --3 .C.�� ' .•5
t 0
FRDPE flWt�tE#t�l 7'lOid:
N817t8: '' i'' ��i�?" � r
�101i6 t� �� ��
Address: �biT CitY;�''�,s''�'.l.a€� p�ZIP:
Emaii an F� ��}-- t
PROJE INFOROAA
�Ya�� ����
p ooa(s)'' � p F'ire aamage �re�ear a
�a Creelc Ur�[tis�t }
❑Re-roof,aspt�akt '� j�S6�am C►ama9e 18202 �d
❑Re-roof,ice�dar ❑WaDer'Damage ��+,i�i 5538!
PhWu: 952-4T't-Q590
❑Re-roor,omer t+a•�r► �r�s C3 cn�:t��r) F� s52-a��-ass2
�rtdow(s} �
�.vww.,�,Ennetrahscre,sk.�s�a
orerat�Pr�O�t Dessxiptio�► 203
Estimatec�Construction Va at ex tset� 6?.�(�jo.�-
ARPttC ACKNOWLE EMENT:
• t0 provide�i tequEred or requeated by the 8sriiding Depa�hner,� �
• Ce�ifiea that the in 'o�supplied is true end cared to ihe he�K of hislh�knowled�. The applicarrt recogn"¢es Ymt they�
b
�a�saialp rssponsible submit�ng a canpiete�Gcation being aware fhat t�ors fadure to do so,the at�f has tao mative
but I�1eJect�Imt�it i.5 ;
� a�of the' th�t y�xt ana aslced to prowide«�4fi�s a �dassi�d by Sta�e Iew�eiU+er ' or
Ef#, PtivaOa �i�(oirr�suoa wt�gerie�aliy ca�mot be���#u�c tx�t can ve�h�� ' oP u�e
. cc�ftde�ial is i�tormation wi�Cn gener�ly cannot bs given�e�tcex the�c or th.�jeCE cd e,e . ow
arnf Nt�a��ded afi tltis Iitiom�on�La atxul8�y t�date au�rec�'ds a►�ci records at�9ow�tal �
i8w. t tlte trra r�be�ted. __..
Applican�s',Signature: Date: . �"'� /" �
�astuv�+�:�1 os�s-2o�t
� P�LAN I�►EVlEW CHECKLIST FOR NEUV STRUCTURE� / AD ITIONS
Address/Permit'Nu Iber: b O L LL."' ���� �
�
Description of work:' � =
Septic revie�by: 1v 1 V� Date Approvetl:
Zoning revie�r by: (A Date Approved:
I ��
Building revi�w by: Date Approved; �'a� w'
Grading revi�w by: A///�- Date Approved:
Zoning District: Z�ning file#: Reso#: Reso ate:
Zonin • Lot Area: ' SF/AC Width: Lot Coverage: S _%
Survey S mitted: �I 0 Yes � No Date of Survey: Revised d ? :
Pro osed Se acks:
Front{Lake) � Rear(Street) ( N S E W ) ( N S E W ) pth uiidings Wetland
Side Side
'De�ned Height: �' Peak Heigl�t: FFE: fF inus 6 feet= (Existing Cvntour)
�
Perimeter(linear feet�= 50%_ #o ories Ok? GYES
FOR A BUILDING WITH A�ASEMENT L>R C ' l.SPACE;
The disTance betw n the lowest OR A BUILDING ON A SLAB FOUNDATIO :
START WITH j proposed floor(of th asement or crawl
space)and the highest int of the roof. START WITH The distan between the!op of slab and '
If you have a... the highest int of the roof.
1f you have .-.
. GABLE OR HIPPED R F(no . GABL OR HIPPED ROOF(no
window§j: Subtract halFt wind s): SubVact half the distance
i distance between the high o' n the hiphest point ofthe roof
� of the roof to ihe low point of i torthe ow point of the coResponding
SUBTRACTION � corresPonding gable orhipp f SUBTRACTION gable rhipped roof :
(BASED ON ROqF . GABLE OR HIPPED RO (with (BASED ON . GABL OR HIPPED ROOF(with
NPE) windows): Subtract ha e ROOF TYPE) wind ): Subtract haif the tlistance
distance between th p of the betw n the top ofthe fiighest
highest window an e highest wind and the highest point of the
, point of the roof roof
. ALL OTHER OF'TYPES(flat, • ALLA HER RDOF TYPES(flat, `
' mansard, :No subtraction. man ,etc."No subtraction.
ADDRION >Add the dis nce between the top of slab
SUBTRACTION Subtract the ' tance between the (BASED ON and the high exisGng grade adjacent-to
(BASED ON EX15�1'ING basemenU wl.space floor and the . EXISTING the foundati n.
GRADE$) highest e 'ng grade adjacent to the GRADES
found ' n OR TO feet(whichever is less). EQUALS Defined bui ding height"
fQUALS D ed building heigM
;
�
Shoreland Distr MCWD Permit Received Avera e Lakeshore #back Met7 Bluff
� Yes 0 No G N/A Yes 0 No
� Yes �lo � Yes 0 No N/A
Permit Number: etback;
Stormw er Qualit� Existing Proposed yariance Required CU uired
Overl District Ti r Hardcover Hardcover
� Yes � No 0 s 0 No
TYP�(S)� TYPe(S)�
Updated: January 2013 '
v:lforms�plan review checkiis4 2013.docx
, - �
REMARKS (in-house): �
���Fees�+o be�Char�ed � ` .=� �� � �
Plan Review �/
lnvestigation Fee ✓'
°Other(specify) �
S uare Foota e a er S uare Foota e
Basement X = $
1�Floor X = $
2nd Floo1' X = $
Garage X = $
Estimated Construction Value: S la2,lac90 oa
> Orono Inspections Required Work Requiring Separate Permits Required State Permits
D Site �Plumbing � Grading/Filling � Well '
� Hardcover Removal Mechanical 0 Fire �Electrical
G Footing � Septic 0 Water Connection
� Poured•Wall Fire lace � Sewer Connection
G Foundation Survey �Masonry � Lawn Imgation
G `Radon Rock Bed 0 M#g.
Q Fcaming` G Other(specify)
0 tnsulation
G As-6uilt'Survey
` �Final
fl 1Netland Buffer
O Other(specify)
REMARKS(in-house):
Other Review: Reviewed by; Date Approved:
Access: � Existing: � YES 0 NO :New: � YES � NO
OFFICIAL REM�►RKS-TO BE NOTED ON PERMIT AND INITIALLED
Updated: January 2013
v:\forms�plan review chedclist 2013.dopc
�/t D E TIME V
CIN OF ORONO �D IN -
INSPECTION NOTICE SCHEDULED ! - �
PERMIT NOc�OI'S-GZ�rZ-�COMPLETED
ADDRESS a �d �
OWNER EPHONE N0.7.�Ia O��S"a7�
CONTRACTOR `
� DESCRIPTION - C'�Cv� D.3
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADiNG/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREM/EfLANDS
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
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
Z OWNERICONTRACTOR TO MEEf YOU:_YES_NO
y COMMENTS:
�
W
a
� �1 /�t�9- 1 /�' Ul �
0
�
0
�
W
�
Q
�
2
W
�
W
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W� ❑WORK SATISFACTORY:PROCEED �OJECT COMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (g52) 249-46�0
OwnerlContractor on site:
Inspector. ����
White Copyllnspector's File Canary CopylSite Notice