HomeMy WebLinkAbout2015-00353 - addn/remodel/repair " � � CITY OF ORONO * 2 0 1 5 - 0 0 3 5 3 *
2750 KELLEY PARKWA►Y DATE ISSUED: 04/03/2015
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 4215 NORTH SHORE DR
PIN : 07-117-23-43-0006
LEGAL DESC : ORCHARD BEACH
: LOT 002 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTMTY : 434-RESIDENTIAL
VALUATION : $ 80,000.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE)
(KITCHEN REMODEL)
APPLICANT PERMIT FEE SCHEDULE 952.24
STATE SURCHARGE(VALUATION) 40.00
MALESKA CUSTOM BUILDERS TOTAL 992.24
10282 HAWTHORNE RD NW Payment(s)
RICE,MN 56367- CREDIT CARD 4031 992.24
(320)251-7898
Minnesota State License#:BUIL-BC109531
OWNER
WALDOCH,DOUGLAS&DIANE
4215 NORTH SHORE DR
MOLTND,MN 55364
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 1'his 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.l'his 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.
1'he appiicant 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.
� /� J/�
Applicant e itee Signature Date ssue y Signature Date
� . �ga , �-�
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel
. �. ;� . .:� .�,_ . .
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:.� �s'i.a 4..��.';.st,L ,.:�..e •e � ` -_-, : - . _. � . �. _ �. �. - _ . �
. . _�.... . �.� ..__. �
O Mailing Address: lr` 7 Permit number: ``' —
� �TO PO Box 66 L� ��\ 1 __
Crystal Bay, MN 55323-0066 Date received:
� � Street Address: �� e��
ti� � 2750 Kelley Parkw y� L � r,-1 Plan review fee: 9C�� •
t � Orono, MN 55356 Z�< <
�KfSH��� Total Fee:
Main: 952-249�600 Fax: 952-249-4616 ��:�r u=
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: , ,� l
Job Site Address: ����' °V '7�1���G �'�C ��v�� V�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No '
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be
required unless applicant demonstrates sufiicient on-site parking is availab/e. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFOR�ATION: _,
Name: r� ��'�� c� v����-t.h -,���i ��C�r-S
State License# L �' "�3 ' Expiration Date: .3 --�) —) ��
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office) �� "�>) - �`� �
Mailing Address: � �j'� ,�;, ,�� ,��� City: '' : ZIP: � '� �
Contact Person: ' Applicant is�__Contractor:�/ Homeowner (Circle One)
Email and/or Fax: � ��-,r� � �✓ :j� t-�,���
PROPERTY OWNER INFORMATION: � �,�c ` A 1�'�
Name: ; r:, . ;;1,� , V�
Phone(day): � — � Q " � 2.� n
Address: ��) `~j U�-�'h S��(. /�,�, ✓�P City: �����,,�yil ZIP: �S �J(-��
Email and/or Fax:
PROJECT INFORMATION: Overall ro�ect description:
Type of Project: � Any earth movement may also require
��'�'��'��►"'� MCWD review&permits:
❑ Door(s) �.Remodel ❑ Fire Damage
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) ^;�rr�v.m�nnenahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ ? 7�
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 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
ou refuse to su I the information,the a lication ma not be issued.
ApplicanYs Signature: '� Date: 63� � �/5
� � 1 �
Owner's Signature: �Ll 1-,! �,�(i�i ,�(�(:�Y'1 Date: ;l�(i��/`)
Last Updated:January 2015
: _
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��� ��v��w ���c��'��r ��� ��� ���uc����� � �����on�s
� Adc6res�: `�� !,� ������3'S'�� ��a� Permit No.:_��� m ����'� :
� .
I Descri�sti�n of v�ork: �� t; �, Da#e R�c'd: �����l�'
_ ,
.
S�p�ic revi�wr b�►: 6�� D�t��lppr�ved: : _
Zon6n�r�view by. � � ,�,_' D�4e Appraveci.
Builc�ing redie�nv I�y: Date�Pr�v�d: � f �� - � o��. ,
�r�dfng"review bY: ��'� � D�te Approved: ; _
� ; Zanie�g Disfirict:, Zoni�ng �il�#: R�so#; Reso Dat�:
�' Z�n g:Lot l�r�: �F!AC Width:��� ; Lot Coverage: SF `% ;
' �urvey ubrriiif�: 0 Yes : � No Da�e cef'Survey: Revised dat ? :
Pro osee� b�cicsr. _ :
� �ront(��6s� F2ear(�treet) � :�d � E W � f; A1 S E W ) 0�her.�uildin �letl�nc9
Sid� ,- . S1d� '
�ef�n�d Height: Peak He6ght:�, .;F��: - F�IE minua�fee; = (F�ci$�in�Corstoa�r
� E�erprn�ter{lin�a°f�t)m 50°l0= r l� . belaw gr�d� �of 5tories `
�OR A BUILDI6VG V►11TH/A��EAIIEId'I'OFt W�SPA.CE: �OR A'BUILDIRIG 0(� SLL�F011IdD,�Tl0�1:
The dfstan een the lowest proposed - The dfstance tietvreen the top of
START W ITH 'floar(of the b� ment or crauuF.space)and START W ITH stab ar�d the highest polnt o'f the
� , #he Mfghest polnt the roaf. . : roof. < ',
ff you have a... tf'you have a...
GABLE OR HI�'P RAOF(no ' • 'GABLE OR HtPPED ROOF
� � wiritlows): Subtra alf the tlfstance (no windows): Subtract haff
betweert the highest nt of the roof fhe distance ltetw8en t�te
W the;Ipw poini of�e co.espondirtg hlghest,point of the roof to
flte lowi potnt of the
SUg'fRACTI�N gabte or hipped-rAof corresponding gabie or
(BASEE)ON . GABiE OR HIPPED ROOF( ' SUBTRACTION hipped roof i
ROOF TYPE) windows): Su6tract haif the dis ce {BAS�D ON �� GABLE OR FffPPED ROOF =i
between#he'top of fhe Mighest � ; ` ROQF TYPE) (w3tfi wfrtdows): Subtract
;- wlndow and 3he hfghest point of , heif the distance between
. , roof ; - tl�e tnp�of the highest ,
• ALL OTHER ROOF-TYPES windovr ar�c9 the highest
mansard,etc}:No subtra n. ' Point of the roof
+ ALL 0'T'HER ftOOF TYPES ,
SUB7RACTION SubVacf the dis#a��betw the (flat,mansard,etc):'No '
(BASED OM basement/erawl space r and the ' ` ' subhaa on.
EXISTING hl9hest e�sthtg grade jacenf to the AUDITION Adc1 the dlstance between t�1e fop:
' GRADES) ` four�daUon OR 10 f (wfiich�ver is fes�). ,: (BAS�D QN ` of slab anrl the highest existlng,
EQU/1L3 ` peflned'bu01d1 heigMt EXISTING grade adJacent to the foundaUon.
. ,. ;:: ; . GRADES ,
, = ':; ELIUJILS Defined building�aeight
s�hore9and D#stric� tdIC1�YD�'en�ei:t �►verage L�Ic��hore tbaa� �IufF
119�t?
,: � Yes � N Perntit hlumb�r. � Yes � 'No '[] q Yes � 'No
, ` � N/A-see a�tached ' ` ; Setbaak: ..
3taemarater C� lit�r �isfile�g iiarticover Prapo��d
f)verlay D rict o F9�rd�over Vaeianc�r R�talre¢d, �Requir�d
! Ti�r ci e one (/°an�� °/a and :
� � Yes � No C� Yes � No
i - , ,
! 1 ' 2 3 4 5 : ;. , T Y P e{s}: ' T y p e(s); . ,
( lipdated: January20�5
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