HomeMy WebLinkAbout2016-00057 - addn/remodel/repair , CITY OF ORONO * 2 0 1 6 - 0 0 0 5 7 *
, 2750 KELLEY PARKWAY DATE ISSUED: OU29/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3444 NORTH SHORE DR
PIN : 08-117-23-43-0022
LEGAL DESC : LYDIARDS PARK LAKE MTKA
: LOT 017 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 25,000.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE)
FINISH BASEMENT&LAUNDRY ROOM,BATHROOM&BEDROOM
APPLICAI�IT PERMIT FEE SCHEDULE 433.67
LEE LUMENDAL,DEBORAH PLAN REVIEW 281.89
3444 NORTH SHORE DR STATE SURCHARGE(VALUATION) 12.50
WAYZATA,MN 55391- TOTAL 728.06
Payment{s)
CHECK 6509 728.06
OW1vER
LEE LUMENDAL, DEBORAH
3444 NORTH SHORE DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for wnich 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 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 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 the State Building Code.This permit may be
revoked at any time for due cause. ��
7 �''Li �1��_.�b�� l L C �
/ � /(�
Applicant Permitee Signature Date Issued By Signature Date
City of Orono
Building Permit Application for Mait�tenance / Replacement / Remodel
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
�O�O Mailing Address: Permit number. `�(� t�� -- {;,�- J
PO Box 66
Crystal Bay, MN 55323-0066 Date received: f •- `� -f(_-,
� Street Address: Received by: ' � � ,,��}
ti�, � 2750 Kelley Parkway Plan review fee: �;.Ul ZQ .`t'+.- �„i��+?r� f�l
t�kESHO �"G Orono, MN 55356 � .
R
Total Fee: � ' `-�� f�'�,'
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 b,e submitte�l.
Incomplete applications will be returned. (Please print) �-���ti-� ;° � �'�������_
GENERAL INFORMATION: , I ,
Job Site Address: ���1 (� , ��'�c%,(� C
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus rvic will be
required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non permitted events will not be allowed.
CONTRACTOR/APPLI�INF0�2MATION:
Name: �f,�.,�q—� ,,.,,�,. 1
State License# � Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFO RMATION:
Name: �yjlit'��1 1.�1�n� (
Phone (day): U . —
Address: � � v e City: ZIP:�53� �
Email and/or Fax: � �. ��
PROJECT INFORMATION: Overall pro'ect descri tion: ` 11 � ( — � KL��' ti ' f M
Type of Project: Any earth movement y also require
❑ Door(s) �emodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,cedar 15320 Minnetonka Blvd
❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) r� yyWniv mi.,..,.�_�-- ' •�
J
Estimated Construction Valuation of Project(excluding land) $ ,�r, - - "' _
f - C,; ✓`l`' - - ,
a ��� :
APPLICANT ACKNOWLEDGEMENT: �, `
• Agrees to provide all information required or requested by the Building Department;
• 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;
• Some or all of the inforrnation 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
ou refuse to su I the information, the a lication ma not be issued.
ApplicanYs Signature: Date:
� `'
Owner's Signature: " Date: � —��� —��'�
Last Updated:January 2015 ��;r/� ��� / /�� /� `_
�- � � / � cu
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������: ,3��� �l��i �'�i��� ,�i�iv� ������ ��.:
��scri�tioe� �#���4ortr: --- D��� ��c'c@:
��ptBc rebie�+by: J (�(/'�o^ �Y f�r/�• /( �ate�ppr�v�ae�:
ZonE�� r��si�e�b�+:,� �ag�Approv�d:
�ui6e�st�g revi�w€by: �ate e�pprov�d: , �l f
�r�e�6erg re�ie�s by: _- Da�e�,ppro���€:
�ac�Era� �?is�cEc�: �oroi�� FE6��: 6�e�o�: �eso D�t�:
Z�nir��: t�o��.rea: SF/AC tR�ie6�h: �.c��Cav���e: SF
��re0y Su�sr�Et�ec9: �Yes � No ����m4'Sucvc��: / Revised date(?)�
��c�d�c��a��ia�subm��tecR? � Yes � No 9..a�ec�g���r: �
E�ro o�ed �e��scP�ss:
�eonf�i�at��j 6t�ar�Stre�t� � � � � �,' ) �� � E �p � �ther�u`Ed�n�s lff�'etl�r��i
�ide � �ic�e
���n�i�eEght: �e�:��ieigh�: F�E: F��enir�u� 6$e�t= (�x€€�i�g Ca��t�
,,
F��e@cnefiee�(€inear feet�� 0% L.�. be6ow�gr�d�
Basennen�? f�Yes � No, Stor6
�OR Et BUiLDIPEG Ih�ITFi�►BASENiEMT OR CItAWL SPA : FOR�►BUILDtPIG OPi Ae SLA$FOUAlDATIOW:
The dfstanca the I west proposed Slab at or above grade—
START WlTH fleor(of the ba or cr wJ space)and measuie from htahest exlstlna
the highest point the roof. START WITH �tO�highest poirrt of the
roof even if fill was brought in to
lf you have a.. elevate home.
SUBTRACTION a GABt R HIPPED R OF"(no glab belo�sr grade,_measure
(BASED OM w(ndo ): Subtract ha the distance from fiighest existinp prade to the
ROOF TYPE) n the highest po of the roof hi hest int of the roof.
to th low point of the rtesponding B you have a...
ga or hipped roof SUBTRACTION ° ��E OR HIPPED ROOF
� G LE OR HIPPED R F(with (BASED ON (��ndows): Subtract half
wi dows): SubVact half distance ROOF TYPE) �e distance between the
tween the top of the h hest highest polnt of the roof to
ndow ar�the highest .M of the tl�e low point of tt►e
f correspondtng gable or
a lL OTHER ROOF TYP S(flat, �����
F GABLE OR HIPPED ROOF
ansard,etc):No subt ' n. (with avindows): Subtract
SUBTRACTION Su the distance between half the distance between
(BASED ON base ent/crawl space floor a the tha top ef the highest
EXISTING high st existing grade adJacent o 4�e window and the highest
GRADES) foun ation OR 10 feet(whichev r is less). pofnt of the roof
o ALL OTHER ROOF TYPES
EQUALS D�ff eci buitdtng height (flat,mansard,etc)�Np
subVactioo,
DefEned building heigM
E�UALS
i
Updated: October 2015
a:\forms\plan review checklist 10-2015.docx
Avera�� f aE:e��°mcs:^����i�acE: �,l�aff
Shorela�c� �istr'sc�: €�RG�D E�e�rrtit hRet�
� Yes I�
� Yes � �o Permit I�umber: � Yes � i�o � N/A �o
� N/A-see attached Setback:
Stor-mw�ter���fity ���sting Propased
Overlay Distri�t�'ier E�arcEco�s�r E�arcic�v�r �fariance i2ege�ired C�lP R�auired
circle one %and s % and s
CP Yes C� No � Yes � No
1 2 3 4 5 jYPe�S)� Type�s�:
Fee�to be Char ed �'�� ��
Perm9t
�iar� Re��iew �
Sta#e S�abcharge �/'
�RN@S�1$8tlbt'1 F@8
S1�C-I��rr�ber of S��t��its 1/'
Otiner(specify)
S uar� Fo�ta e � er S uare Foota e
Basement X - �
1�Fioor X � $
Z�d FI00� X = $
Garage � - $
Estirna�teci Censtruction l4�lue: � ��s��V
Orone tnspections itequireci �'Joric Requieing Separa4e Pecmits
0 Footing � Site Plumbing , � Grading/Filling
[� Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire
� Foundation Survey Q Hardcover Removal i� Septic Q Water Connection
� Foundation Waterproofing � Other(specify) C� Fireplace � Sewer Connection
Framing � IVlasonry � Lawn Irrigation
�insulation Qi Mfg. t� Landscaping
� As-B�uFlt Survey � Other(specify)
Finai
6 Lathe Reauired State Per�nits
� Other(specify)
Q Weli �Electrical
REII�IARl4S (in-house):
Sy��'IC!/�L R�F�l��tt��-'f0 �E td0`���I O� P�E��,�E�',�6Pl� E�ETff�.�LLC�:
� Se�E��itc�er�cK:�o�+tee�g�mert�ForrvQ
� Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved.
Updated: October 2015
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� �� TIME
DATE
CITY OF ORONO � CALLED IN
INSPECTION NOTICE � SCHEDULED / (� __���1
PERMIT NO. ��(,�.'/fc( ��i�OMPLETED
ADDRESS .��l � l-U_�.� .. _��✓I�i'�E' �/�' , —
CO T ACTOR ���� C • TELEPHONE NO. �����D/��
� DESCRIPTION� �� " ��� �
W ❑ FOOTING ' ❑ DEMO-FINAL ❑ SEPTI NAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ ADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q�MING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ E ER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑�TIC INSTALL
2 OWNERICONTRACTOR TO MEET YOU:���YES_NO
� COMMENTS: � /P1.. �P�� � /1� � �
W
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DATE TIME
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Cail forthe next inspection 24 hours in advance. (952) 249-4600
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