HomeMy WebLinkAbout2018-00165 - addn/remodel/repair 1 1 1! I I I I II 1111111111111111111
CITY OF ORONO * 20 1 8 - 00 1 65 *
2750 KELLEY PARKWAY DATE ISSUED: 02/22/2018
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 540 BIG ISLAND
PIN : 22-117-23-42-0001
LEGAL DESC : KATE B PLUMMERS SUBD KITCHELS
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR •
VALUATION : $ 10,000.00
NOTE: SEPARATE PERMITS REQUIRED:MECHANICAL,ELECTRICAL(STATE)
APPLICANT PERMIT FEE SCHEDULE 201.32
STATE SURCHARGE(VALUATION) 5.00
WISCHMEIER,SHAWN TOTAL 206.32
2851 WASHTA BAY ROAD
EXCELSIOR,MN 55331- Payment(s)
CHECK 1272 206.32
OWNER
WISCHMEIER,SHAWN
2851 WASHTA BAY ROAD
EXCELSIOR,MN 55331-
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. 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 governing 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.
-- "`� 2 c1\ 6 A)
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Applicant Permitee Signature Date Issued By Si ure Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
W
o Mailing Address: Permit number: 201 T-oo/1p 5—
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
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2750 Kelley Parkway Plan review fee:
Orono, MN 55356 /,'_O/H(
Kf:stio
Total Fee: r2t f 3
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 be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: S.-{o ,co 1SLA(J GEL-AC) tv
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. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: SCS k Ar\-.
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) Cc\ \C-0 1..kocca �jcr y (office) C 2 ) ZZ3 ( t CU
Mailing Address: '2(6 PcS 27 City: 1.c.,2 ZIP: m 33 I
Contact Person: � wL SC\*M �� Applicant is: Contractor / omeowne� (Circle One)
Email and/or Fax: w s c_\r-,,pr\ r- 6, \� cu'v,
PROPERTY OWNER INFORMATION:
Name: � � 4wti w�5c������
Phone(day): Cc-c\ct
Address: Z q—‘ w f�Si+�A ; 2g City:E,s6 ZIP: v
Email and/or Fax: CVVV\�� er ci
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) rgrRemodel 0 Fire Damage MCWD review&permits:
❑ Re-roof,asphalt 0 Repair 0 Storm Damage Minnehaha Creek Watershed District(MCWD)
❑ 15320 Minnetonka Blvd
Re-roof,cedar
0 Restoration 0 Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) 0 Siding 0 Other:(specify) Phone: 952-471-0590
Fax: 952-471-0682
0 Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ I o
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
you refuse to supply the information,the application may not be issued.
Applicant's Signature: Date: 2- ( \'c ( a
Owner's Signature: ��`' Date: Z( t I (
Last Updated:January 2016
PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
Address: IK ,7-, /a4_0( Permit No.: Z-016
Description of work: Date Rec'd: V/91 /8
Septic review by: Date Approved:
Zoning review by: Date Approved:
Building review by: y, Date Approved: 71/4-( lg
Grading review by: Date Approved:
Zoning District: Zoning File#:
Resolution? Yes Reso#: Reso Date: Signed: Yes No Resolution I NA
Zoning: Lot Area: SF/AC Width: Structural Coverage: SF
Survey Submitted: D Yes D No Date of Survey: Revised date(?):
Landscape plan submitted? D Yes Landscaper: 0 No/ None proposed
Proposed Setbacks:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland
Side Side
Building Height Analysis:
Distance Between First Floor and defined Top of Roof* (See"building height" (a)
definition):
First Floor Elevation (from building plans): (b)
Highest Existing ground level (per survey) or 10' above lowest ground level, (c)
whichever is lower:
Difference between (b) and (c)*: (d)
DEFINED HEIGHT
*If highest existing adjacent grade is above FFE-Height is(a)-(d): (e)
*If highest existing adjacent grade is below FFE-Height is(a) +(d)
Shoreland District MCWD Permit Average Lakeshore Setback Bluff
Met?
0 Yes 0 No Permit Number: 0 Yes 0 No 0 N/A 0 Yes 0 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)
D Yes D No D Yes D No
1 2 3 4 5 Type(s): Type(s):
Updated: June 2017
z:\forms\plan review checklist 06-2017.docx
Fees to be Charged YES N
Permit
Plan Review
State Surcharge
Investigation Fee
t �' Y
Other(specify)
Square Footage $ per Square Footage
Basement X = $
1st Floor X = $
2nd Floor X = $
Garage X = $
F)
Estimated Construction Value: $ WO
Orono Inspections Required Work Requiring Separate Permits
❑ Footing ❑ Site Plumbing 0 Grading/Filling
O Poured Wall 0 Silt Fence/Erosion Control X,Mechanical ❑ Fire
O Foundation Survey I] Hardcover Removal 0 Fireplace ❑ Water Connection
❑ Framing I] Other(specify) 0 Masonry 0 Sewer Connection
❑ Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation
❑ Foundation Waterproofing 0 Other(specify) 0 Landscaping
raming 0 Septic
Insulation
❑ As-Built Survey
'nal
❑ Lathe Required State Permits
❑ Other(specify)
0 Well etc Electrical
REMARKS (in-house):
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED:
❑ See Builder Acknowledgement Form
O Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved.
Updated: June 2017
z:\forms\plan review checklist 06-2017.docx
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED �j
PERMIT NO.L C fLETE9q L[ 1_�/ 1/4
x'1}-0 _l_...-.slay
ADDRESS � Cl
OWNER TELEPHONE NO.
CONTRACTOR l
i DESCRIPTION ori yG,0? 7 )" (C",
W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
0 0 FOUNDATION DRAIN TILE 0 PLUMBING FINAL 0 TREE REMOVAL
❑ LATHE 0 MECHANICAL RI 0 SITE INSPECTION
0 MECHANICAL FINAL 0 RATED WALLS
_ ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
Q ❑ FINAL 0 WATER HOOK-UP 0 FOLLOW-UP
W ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
✓ ❑ DEMO-SITE 0 SEPTIC INSTALL
2• OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y CO MENTS:
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W 0 WORK SATISFACTORY:PROCEED 0 PROJECT COMPLETE
(Li RRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY
❑COR ECT WORK,CALL FOR REINSPECTION TEMPORARY
✓ BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN
INSPECTOR WILL RETURN
ElSTOP ORDER POSTED.CALL INSPECTOR 0 CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner#Contra on site:
Inspector: &
White Copyfnspectoes File Canary CopylSite Notice