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Home My WebLink About2017-01501 - 2nd story addition � � CITY OF ORONO * 2 0 1 7 - 0 1 5 0 1 * 2750 KELLEY PARKWAY DATE ISSUED: 1]/2?J2017 ORONO,NIN 5535Cr (952)249-4600 FAX: (952 249-4616 ADDRESS : 4064 NORTH SHORE DR PIN : 07-117-23-44-0085 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 2,200.00 NOTE: 2ND STORY ADDITION APPLICANT PERNIIT FEE SCHEDULE 92.89 PLAN REVIEW 6038 JANET M OBRIGEWITSCH,DAN H PHIPPS& STATE SURCHARGE(VALUATION) 1.10 4064 NORTH SHORE DR MOUND,MN 55364 TOTAL 154.37 Payment(s) CHECK 8086 15437 OWNER JANET M OBRIGEWITSCH,DAN H PHIPPS& � 4064 NORTH SHORE DR MOIJND,MN 55364 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specificarions,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional ar related work which requires separate permits. All provisions of laws and ordinances governing this lype 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 construcrion is suspended for a period of 180 days at any time after work 6as commenced. The applicant is responsible for assuring all required inspections are reqaested in co w� Building Code.This permit may be revoked at any e for due cause. ` �� a � -�� !l , �z , i7 App' ermitee Signa ate Issued By i ahue Date , ,.� CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS �O� \ MailiPO Boxr66. Permit number: � 7�a� / O '� Crystal Bay, MN 55323-0066 Date received: /—/ '/7 i � Received by: � ,, Street Address:' �F �� 2750 Kelley Parkway Plan review fee: lqkESH�� Orono, MN 55356 /J Main: 952-249-4600 Total Fee: `��, �/ 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: �O<o� ,�'_cj�-1l�' � Will this be a Parade of Homes, Remodelers Showcase Home or other Display ome? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will e required unless applicant demonstrates su(ficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: ��i .,��`� State License# Expiration Date: Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: � " Name: � �.,� � 5 Phone (day): " t 2., Address: (] (;� �-� - � c,�U�L �JL City: c�,2[.��,f� ZIP: �5 �� Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: � ,.� �J ��Z.� Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of ro�ect: 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& Water Supply ❑ New Construction ❑Single Family with ❑Accessory Bldg./Garage �.Addition attached garage ❑ Deck �Public Sewer ❑Accessory Building � Single Family with ❑Office/Commercial ❑ Relocation detached garage ❑ Residence ❑ Private Sewer ❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater ❑ Public Water "Any earth movement may also require ❑Commercial ❑Storage MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) 15320 Minnetonka Blvd Z 1✓C'� �jl��r2,� Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ ��U �� Last Updated: January 2016 i� � STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions(continued) a. Length(ft.)= Number of bedrooms= � 2. Occupancy: �/�(� � � b.Width(ft.)= Number of garage stalls: 3. Occupant Load: Areas in sQuare feet Attached= c. Basement= Detached= 4. Type of Construction: � � d. 15f Story = � ,„D e.2"d Story= 5. Code Edition: _ �� f. 'h Story = g. Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ ❑ Plan Review Fee ❑ ❑ Com leted A lication Form ❑ ❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'h x 11 set ❑ ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ ❑ Surve —2 full size, to scale meetin ALL surve requirements ❑ ❑ Hardcover Calculations ❑ ❑ Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired ❑ ❑ Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan SWPPP ❑ ❑ Access Permit ❑ ❑ Data Privacy Advisory Form APPLICANT/OWNER 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 aiternative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands 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. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site improvements. / � ,. ApplicanYs Signature: \ Date: ( � � l � - I l Owner's Signature: \ �z v=-�C�>:.�1 �� Date: � ( �� 1 �� — � � � � Last Updated: January 2016 � ~PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: �/'� CJ� �'��QI/'�� j�m/'� �v°l v(/Permit No.: Z�l�"� ///�✓�_ Description of work: �2''CS�Q��'`�� Q/"�'l r� Date Rec'd: Septic review by: Date Approved: Zoning review by: Date Approved: Building review by: Date Approved: � Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: Lot Coverage: SF % Survey Submitted: � Yes 0 No Date of Survey: Revised date(?): Landscape plan submitted? 0 Yes � No Landscaper: Proposed Setbacks: Front (Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) = 50% = L.F. below grade Basement? 0 Yes 0 No, Stories FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION: The distance between the lowest proposed Slab at or above grade— floor(of the basement or crawl space)and measure from hiqhest existinq START WITH the highest point of the roof. ra ade to the highest point of the START WITH roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR HIPPED ROOF(no Slab below grade—measure (BASED ON windows): Subtract half the distance from highest existing grade to the ROOF TYPE) between the highest point of the roof hi hest oint of the roof. to the low point of the corresponding If you have a... gable or hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF(with (BASED ON (no windows): Subtract half windows): Subtract half the distance ROOF TYPE) the distance between the between the top of the highest highest point of the roof to window and the highest point of the the low point of the roof corresponding gable or hipped roof • ALL OTHER ROOF TYPES(flat, . GABLE OR HIPPED ROOF mansard,etc):No subtraction. (with windows): Subtract SUBTRACTION Subtract the distance between the half the distance between (BASED ON basemenUcrawl space floor and the the top of the highest EXISTING highest existing grade adjacent to the window and the highest GRADES) foundation OR 10 feet(whichever is less). point of the roof • ALL OTHER ROOF TYPES (flat,mansard,etc):No EQUALS Defined building height subtraction. Defined building height EQUALS Updated: October 2015 z:\forms\plan review checklist 10-2015.docx J' • • Shoreland District MCWD Permit Average Lakeshore Setback Bluff Met? � Yes 0 No Permit Number: � Yes � No � N/A � Ye No � 0 N/A—see attached Setback: Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required (circle one) % and sf % and sf 0 Yes 0 No � Yes 0 No 1 2 3 4 5 Type(s): Type(s): Fees to be Char ed YES NO Perm it C./� Plan Review State Surcharge � Investigation Fee SAC— Number of SAC Units (/' Other(specify) Square Footage $ per Square Footage Basement X = $ 1 S� Floor X = $ 2nd FIOo� X = $ Garage X = $ Estimated Construction Value: $ / �� Orono Inspections Required Work Requiring Separate Permits � Footing 0 Site 0 Plumbing � Grading/Filling � Poured Wall � Silt Fence/Erosion Control ❑ Mechanical � Fire � Foundation Survey � Hardcover Removal � Septic 0 Water Connection � Foundation Waterproofing � Other(specify) 0 Fireplace � Sewer Connection � Framing 0 Masonry 0 Lawn Irrigation � Insulation 0 Mfg. 0 Landscaping � As-Built Survey � Other(specify) Final 0 athe Required State Permits � Other(specify) ❑ Well 0 Electrical REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: � See Builder Acknowledgement Form 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 ��\fnrmc\nlan ravia�u rhorklicf'I fl_9(11 F rinrr F---___--7 v DAT TIME CITY OF ORONO -b /50/CALLED IN O! —/- /7 INSPECTION NST E7 (3L Sh�SCHEDULED //-o2a/7 o' 3.6 PERMIT NO. �1(v//� / IIJJ COMPLETED ADDRESS .- 9 2 -2/ ' --5hGY _' OWNER I S Pail TELEPHONE NOb/��a7-7 9 CONTRACTOR' � DESCRIPTION /9` d g /tck& W ❑ FOOTING 0 Q660-FINAL 0 SEPTIC FINAL Q0 POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING Q ❑ FOUNDATION DRAIN TILE �LUMBING FINAL 0 TREE REMOVAL ❑ LATHE 0 MECHANICAL RI 0 SITE INSPECTION Q 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS • ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT vFINAL 0 WATER HOOK-UP 0 FOLLOW-UP W ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 4- 7Q�- ❑ FOUNDATION/REMOVAL ✓ ❑ DEMO-SITE 0 SEPTIC INSTALL // - / it-....1 _.1 f 5 OWNERICONTRACTOR TO MEET YOU:_YES_NO • COMMENTS: a u- • &% r .j,J!— cc Lu -Fore 4/ 5 - 5 e_4 , - 5 eti. •- o • If( !Uv,rk‹. Cb r pliaZ - dpe4-.,1--- g � )... CC Q - S4..-5/ e-4.tr -I--s fee.E � r6S — d, r S'. 6_ -4. co ..Pe. - -6w - zif// iva' €- �� 0 ED WORK SATISFACTORY:PROCEED Oi 2aQJECT COMPLETE CCW 0 CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ✓ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p PHOTO TAKEN INSPECTOR WILL RETURN El STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. <-: ---//,-, 7r-- White Copyllnspector's File Canary Copy/Site Notice