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CITY OF ORONO II II'' ill * 2750 KELLEY PARKWAY * 20 1 8 - 0030 DATE ISSUED: 03/23/22 018 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 3580 FREDERICK ST PIN : 20-117-23-12-0019 LEGAL DESC : NAVARRE : LOT 000 BLOCK 002 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOWS ACTIVITY : 0/S BUILDING-UNDEFINED VALUATION : $ 20,000.00 NOTE: WINDOWS AND INSULATION IN SUNROOM APPLICANT PERMIT FEE SCHEDULE 356.22 STATE SURCHARGE(VALUATION) 10.00 THOMPSON CONSTRUCTION LLC 505 COUNTY ROAD 19 TOTAL 366.22 MOUND,MN 55364- Payment(s) (952)393-5349 CREDIT CARD 0649 366.22 Minnesota State License#:BUIL-BC686985 OWNER OLSZEWSKI,BRENDAN&DENISE 3580 FREDERICK ST WAYZATA,MN 55391- 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. o(niuld edi is) Applicant Permitee Signature Date Issued By Si ature Date City of Orono Building Permit Application for Maintenance / Replacement/ Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) J O A, Mailing Address: Permit number: �a` S- ©0 5- PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: I g Received by: 2750 Kelley Parkway Plan review fee: / rono, MN 55356 �r 'tFSHO�� ,J&(0i Total Fee: 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: 3 5$O rrteJ Pr ck. ��- Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes IR 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: I hornp .=�✓► cc,„,5+ftcc * State License# Expiration Date: 3--3/-2_o2 o Lead Certification Number: A/A r Expiration Date: // —/e- 2c/9 (for work on homes that were constructed prior to 1978 Phone: (cell) y52-393---5-.3 / (office) Mailing Address: ,6-05 Coin , ' /7 City: 7/20anc=Q ZIP: M,/ 3 53E f' Contact Person: Do ri'u h • i rlo M��V� Applicant is: Contracto Homeowner (ci ie one) Email and/or Fax: ciorl'ah L% p/14/4r1,,10/6 f cow PROPERTY OWNER INFORMATION: Name: EY ern 4. /2ed7is-G Okze .5 Kr Phone(day): Address: Sly p fi / ^-P GL .sf City: &�t Y'Z R/c'i ZIP: Email and/or Fax: den,Se_ o o/�ZewSK/ tQ 9�'lgl��G�� eke 3-h. Sun bpi. /3 r',r/7•,f / p 1�er� ex-Lk �,.� • PROJECT INFORMATION: Overall project description: Jun roor\N Rer4t'c,Q - Li 1 Ad-4" S{ 14$7114:17t;47 (t Type of Project: Any earth movement may also require Door(s) I 0-Remodel 0 Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,asphalt p Repair 0 Storm Damage 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 lZ 63140wS RWindow(s) Eclrh— e-emr S www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ /ovv . G 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 suppl the information the a lication may not be issued. Applicant's Signature: I Date: 3 21 "- 2-og RECEIVEb Owner's Signature: Date: MAR 21 2018 Last Updated:January 2016 CITY OF ORONO PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: ? a /`0 ✓ed i' /C i5 Permit No.: 2 ©�3(5 © 0 Description of work: Vii 4CloUl 9- �' h' 17(9y Date Rec'd: Septic review by: Date Approved: Zoning review by: Date Approved: Building review by: 1( 2 -,,,rt Date Approved: 5/e.-5 ` V Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: Lot Coverage: SF % Survey Submitted: 0 YesNo Date of Survey: Revised date(?): Landscape plan submitted? 0 Yes 0 No Landscaper: Proposed Setbacks: Front(Lake) Rear(Street) ( S E W ) ( N S E W ) Other Buildings Wetland Side ide / Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet)= 50%= L.F. below grade • Basement? 0 Yes 0 No, Stokies 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— START WITH floor(of the basement or,cralwl space)and measure from highest existing the highest point of the rOof.`‘ START WITH grade to the highest point of the \ roof even if fill was brought in to If you have a... elevate home. SUBTRACTION • GABLE OR IPPED ROOF(no Slab below grade—measure (BASED ON windows): ubtract half the distance from highest existing grade to the ROOF TYPE) between a highest point of the roof highest point of the roof. to the to point of the corresponding If you have a... gable hipped roof • SUBTRACTION • GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF(with (BASED ON (no windows): Subtract half winc)bws): Subtract half the distance ROOF TYPE) the distance between the highest point of the roof to betkeen the top of the highest `; the low point of the widow and the highest point of t'he rof corresponding gable or hipped roof • ALL OTHER ROOF TYPES(flat, • /mansard,etc):No subtraction. GABLE HIPPED ROOF (with windows): Subtract SUBTRACTION Subtract the distance between the half the distance between (BASED ON baslement/crawl space floor and the the top of the highest EXISTING hig est existing grade adjacent to the window and the highest GRADES) fo ndation OR 10 feet(whichever is less). point of the roof • ALL OTHER ROOF TYPES (flat,mansard,etc):No EQUALS D ned building height subtraction. Defined building height EQUALS Updated: October 2015 z:\forms\plan review checklist 10-2015.docx • Shoreland District MCWD Permit Average Lakeshore Setback Bluff Met? Permit Number: 0 Yes 0 No 0 N/A 0 Yes 0 ❑ Yes ❑ No 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) ❑ Yes ❑ No ❑ Yes ❑ No 1 2 3 4 5 Type(s): Type(s): Fees to be Charged YES NO Permit Plan Review State Surcharge L/ Investigation Fee SAC—Number of SAC Units Other(specify) Square Footage $ per Square Footage Basement X = $ 1 sc Floor X = $ 2nd Floor X = $ • Garage X = $ Estimated Construction Value: $ Si 000 Orono Inspections Required Work Requiring Separate Permits ❑ Footing 0 Site 0 Plumbing 0 Grading/ Filling ❑ Poured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire ❑ Foundation Survey 0 Hardcover Removal 0 Septic 0 Water Connection ❑ Foundation Waterproofing 0 Other(specify) 0 Fireplace 0 Sewer Connection ❑ Framing 0 Masonry 0 Lawn Irrigation Insulation 0 Mfg. 0 Landscaping ❑ As-Built Survey 0 Other(specify) Final ❑ Lathe Required State Permits ❑ Other(specify) 0 Well 0 Electrical REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: ❑ See Builder Acknowledgement Form ❑ Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 7.\fnrmc\nlan rovioMA,rhorklict 1 n_9r11 ri rinry 6-wee,a ( ,�co�a6 0 Reviewed for Code Compliance City of Orono Date 2- / /r.et/ c- too►^ Reviewer ORONO COPY �/Z oG, � �xi5f7 L✓ih� f <ge t,-e- Gk<S7r �q ffo oa - f Oji c� ����e_ 7e)i-4 '` c39 ver �ePf a c £(/^59> / < G�1 /.I S u 4._7504-‘ C lv C�C( S .-G 7�4#3.i — 3 c: -• e 2/ /< h 6 Gcfdr k- ph e%41; /91/ye fi �- �3 U /a4A, 6,� i 1.4) _Sirs,"41 c,�f I`—/ter ti/ /‘4s4:2"€-!�'ei-a SO4— ,1) D DATE TIME CITY OF ORONO CALLED IN I `, INSPECTION N -pD ?, CHEDULED PERMIT NO. �� . , ED �// i; : ... > ADDRESS A✓ Qfrco ' ® ' ' "Q� OWNER - - TELEP O NO._ �✓5-�'�i�!e3M CONTRACTOR /1 Agf ki - DESCRIPTION W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING C ❑ FOUNDATION DRAIN TILE 0 PLUMBING FINAL 0 TREE REMOVAL Z ❑ LATHE 0 MECHANICAL RI 0 SITE INSPECTION _ 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS Is INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT Q 0 FINAL 0 WATER HOOK-UP 0 FOLLOW-UP i ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL ❑ DEMO-SITE 0 SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO 93 .. COMMENTS: 5 ad . -6v✓ ex, l`J r„,,,a. _,4 di -. -Ia e 4' cue i' 49 emus, .� ,.zsaL. - Pao• - G lose o e/l .3�pre y f�.v1 i•fesg,c. - 0 l O/�/y 4/s�Irt., ,S l 6/4.r, et Ala ise‘rrc CC Q %s4Vye /e`- //otri4Sp 42✓e45 - -d MP/0 ,nrs 2 k/,N&Gsfs- �i N ext.5 b.e f .6/0,y:5 • W - f 4-sh. /r,5k.�t, "5 w itsJO '- - A 4 5/. cc ,ravtoced, — 6 K 76 Ca.410166 W 0 WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ` RRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector: 9.iiv ,(1--- White White Copy/nspector's File Canary Copy/Site Notice