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Home My WebLink About2014-01267 - bath remocel � - CITY OF ORONO 2750 KELLEY PARKWAY * Z 0 1 4 - 0 1 2 6 7 * DATE ISSUED: 1 U04/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2680 PHEASANT RD PIN : 21-117-23-23-0020 LEGAL DESC : PHEASANT LAWN : LOT 020 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 89,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,ELECTRICAL(STATE) BATH REMODEL APPLICANT PERMIT FEE SCHEDULE 974.25 C N OSTROM AND SON INC PLAN REVIEW 633.26 23400 PARK ST STATE SURCHARGE(VALUATION) 44.50 PO BOX 758 TOTAL 1,652.01 EXCELSIOR,MN 55331- Payment(s) Minnesota State License#: BUIL-1907 CHECK 15329 1,652.01 OWNER DOLLIFF,MATTHEW&KATHY 2680 PHEASANT RD 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 Ihe 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 aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. , . � � �//�/'��f � � � / / � Applicant Permitee Signature Date Iss By Signature Date � � City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �` �''� Mailing Address: � ��N � PO Box 66 Permit number: �/ -�� 0 � Crystal Bay, MN 55323-0 6� Date received: /d aZ9 !� Street Address: Received by: y �;1 2750 Kelley Parkway '�I��1� Plan reviewfe � � Orono, MN 55356 l��fSH��/ �'"�7 ___ � Total Fee: � �.;.J�h� �� Main: 9 5 2-2 4 9-4 6 0 0 F a x: 9 5 2-2 4 9-4 6 1 6 w w w.ci.o r o n o.m n.0 s � �/ This application form must be completed in full and all required information must be submitted. Incomplete applications will be retumed. (Please print) GENERAL INFORMATION:�, Job Site Address: ;.l-ts��(.� P1-f�r4�i"t' <<`.�.� ��.'L.��>> c.2 �(;2�;r�c �s ,.�� ) Will this be a Parade of Homes, Remodelers Showcase Home or o her Display Home? Yes �No If yes, a special event permit is required wrth Police Department and City Council approval 60 days prior to the event. Shuttle bus serv�ce will be required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATrON�N , ' �� Name: �i� ��('►�1r-'� State License# pjG, � ��1 Expiration Date: ? 31 � � ta Lead Certification Number: ��-r- co < '-f��(-� Expiration Date: �f� �_5 (for work on homes that were constructed prior to 1978 Phone: (cell) �-;�,- ��.- q�Gc% (office) �i�2� �?��- ��-{�L Mailing Address: ��;�,; (�j�� S�r City: � ��S��,� ZIP: S 3'-�� Contact Person: �-f,c/ �� Applicant is: , ntractor / Homeowner (Clrcle One) Email and/or Fax: ,��-rj-f-� � ��(G_`�fi��M •C�h PROPERTY OWNER INFORMATION: Name: /��(-�-/t�vv� �" �/kT��C.�-x� �C��-1 F(� Phone(day): C��,�- �11 -f�:•7� Address: �(��b Qt�L-tE�r4av ��` �q /� City: ��G2 ZIP:5S�,j� Email and/orFax: j��p�l �Q D�w F�- �c:h �/�t't3� f�n��-+ �=f=C�G,�7�kr�. �17 PROJECT INFORMATION: Overall ro�ect descri tion: Type of Project: Any earth movement may also require ❑ Door(s) �emodel ❑Fire Damage MCWD review&permits: ❑ 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) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ oOt>, APPLICANT ACKNOWLEDGEMENT: • Agrees to provide a�l 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 altemative 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 e a lication ma not be issued. ApplicanYs Signature: . Date: lr %� � i�� , �. ��a��- Owner's Signature: � Date: � Last Updated:03/06J2013 . �'LAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS AddresslPermitNumber: Z6�� I�1�1�-'��^�`� � Description of work: �✓�� IL,�'�-�9,0-r�c-- Septic review by: /`�l/1 Date Approved: Zoning review by: �� Date Approved: Building review by: Date Approved: l� 3��1 Grading review by: �/� Date Approved: Zon' District: Zoning File#: Reso#: Reso Date: Zoning: L Area: SF/AC Width: Lot Coverage: SF °/ Survey Submi d: 0 Yes 0 No Date of Survey: Revised date ? : � Proposed Setbacks. Front(Lake) Re (Street) ( N S E W ) ( N S E W ) Other Building Wetland Side Side Defined Height: Peak eight: FFE: FFE minus 6 fe = (Existing Contour) Perimeter(linear feet)= 50 = #of Stories Ok? 0 YES FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: The distance between the lowest FOR A BUIL G ON A SLAB FOUNDATION: START WITH proposed Floor(of the basement or cr I space)and the highest point of the roof. START WITH The distance between the top of slab and If you have a... the highest point of the roof. If you have a... • GABLE OR HIPPED ROOF(no . GABLE OR HIPPED ROOF(no windows): Subtract half the windows): Subtract half the distance distance between the highest point between the highest point of the roof of the roof to the low point of the to the low point of the corresponding SUBTRACTION corresponding gable or hipped roof SUBTRACTION gable or hipped roof (BASED ON ROOF . GABLE OR HIPPED ROOF(with (BASED ON . GABLE OR HIPPED ROOF(with TYPE) windows): Subtract half the ROOF TYPE) windows): Subtract half the distance distance between the top of the between the top of the highest highest window and the highest window and the highest point of the point of the roof roof • ALL OTHER ROOF TYPES(flat, • ALL OTHER ROOF TYPES at, mansard,etc:No subtraction. mansard,etc):No subtra on. ADDITION Add the distance between the top of slab SUBTRACTION Subtract the distance betw n the (BASED ON and the highest existing grade adjacent to (BASED ON EXISTING basemenUcrawl space fl r and the EXISTING the foundation. GRADES) highest existing grade djacent to the GRADES foundation OR 10 f (whichever is less). EQUALS D med building height EQUALS Defined buildi height Shoreland District MCWD Permit Received Avera e Lakeshore Setback Met? Bluff � Yes 0 No 0 N/A � Yes � No 0 Yes � 0 Yes 0 No � N/A Permit Number: Setback: Stormwater uality Existing Proposed Variance Required CUP Required Overla District Tier Hardcover Hardcover 0 Yes 0 No � Yes 0 No Type(s): Type(s): Updated: January 2013 v:\forms\plan review checklist 2013.docx REMARKS (in-house): Fees to be Charged YES NO Permit � Plan Review State Surcharge `�'"� Investigation Fee ! SAC—Number of SAC Units Other(specify) Square Foota e $ per Square Foota e Basement X = $ 1 S`Floor X = $ 2nd Floo►' X = $ Garage X = $ Estimated Construction Value: $ 9�,�� Orono Inspections Required Work Requiring Separate Permits Required State Permits 0 Site Plumbing 0 Grading/ Filling 0 Well � Hardcover Removal � Mechanical � Fire �Electrical 0 Footing � Septic � Water Connection 0 Poured Wall � Fireplace 0 Sewer Connection 0 Foundation Survey 0 Masonry � Lawn Irrigation 0 Radon Rock Bed � Mfg. Framing � Other(specify) � Insulation �=Built Survey Final 0 Wetland Buffer 0 Other (specify) REMARKS (in-house): Other Review: Reviewed by: Date Approved: Access: Existing: 0 YES � NO New: � YES � NO OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED Updated: January 2013 v:\forms\plan review checklist 2013.docx �/�� DATE p�T ME � CITY OF ORONO CALLED IN �'' I I l. o-�� INSPECTIO 4 SCHEDULED ��pp1�1 l� �`.� PERMIT NO��` '[ 2�� connP��Eo T � ADDRESS 2 �� j%�,��R{7 � OWNER TELEPHONE NO�j� �-q�'�� CONTRACTOR '� �� US'�'`�C�w�{ SunS � DESCRIPTION r��`� � � ❑ FOOTING ❑ PLUMBING F L ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � �FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL O SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTFiACTOR TO MEET YOU:_YES_NO y CGMMENTS: � W a � J O �. � O � W � Q � 2 W � W � j W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERT�FICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 ho in adv nce 52 j 249-46�0 OwnerlContractor on site: Inspector. White Copylinsp.ector's Ffle Canary Co ylSite Notice �/ �� DATE IME CITY OF ORONO CALLED IN INSPECTION T E � SCHEDULED PERMIT NO. ' COMPLEfED - - � ADDRESS �� ?� OWNER TELEPHONE NO�� Z `�� CONTRACTOR C IV� ��T�rY1 �J�'► � DESCRIPTION ��-� �� /��f ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � ' FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY WER HOOK-UP ❑ HARD COVER REMOVAL v ❑ DEMO-SITE EPTIC INSTALL ❑ FOUNDATION/REMOVAL Z �NNERICONTRACTOR TO MEET YOU: YES_NO y COMMENTS: � �/�� '�� /'y��,�� t 0 �l!• ��rl�C/ - �`� � �J� � �• � "� �'O A-� b i' /p v . '1 � ° � �oi v wc /e� W � Q � WZ � � �r�/e� c r Wt.r r � J � ❑WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE � ❑CORRECT WqiK 8 PROCEED �ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT VY�1K,CALL FOR REINSPECTION TEMPORARY V BEFORE CONERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTDR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED_CALL TO ARRANGE ACCESS. C ne • Ion 2a twurs�n advance. (952) 249-4600 rttractor on site: �11S�CtW: • • White Copyllnspector's File Cenary CopylSfte N�ke