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Home My WebLink About2017-01168 - addn/remodel/repair CITY OF ORONO * z 0 1 7 — 0 1 1 6 s * ' ` 2750 KELLEY PARKWAY DATE ISSUED: 09/26/2017 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2725 PHEASANT RD PIN : 21-117-23-23-0024 LEGAL DESC : PHEASANT LAWN : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 10,000.00 NOTE: SEPARATE PERMITS REQUIRED: ELECTRICAL(STATE) APPLICANT PERMIT FEE SCHEDULE 201.32 PLAN REVIEW 130.86 JORGENSEN, CHMICHAEL&MARGARET STATE SURCHARGE(VALUATION) 5.00 2725 PHEASANT RD EXCELSIOR,MN 55331- TOTAL 337.18 Payment(s) CHECK 337.18 OWNER JORGENSEN,MICHAEL&MARGARET 2725 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 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 rype 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. � � � __� �;' �l;� �� ' �� i�(oi l App icant Permit e Si atur D�te Issued By gnature Date City of Orono Buildir�g Permit Application for Maintenance/ Replacement/ Remodel — Residential ONLY �vs,,, � A' Mailing Address: � ?—Q Q D,y\ PO Box 66 Permit number: � ��O 0 �, Crystal Bay, MN 55323-00 �- Date received: �l v� � 7 ,i �1 � 1 � � Street Address: '�� Received by: \'� � 2750 Kelley Parkway (�I�,� Plan review fee: � �,�' Orono, MN 55356 � ._, � �kfSHO� �,�� _ __ Total Fee: � Main: 952-249-4600 Fax: 952-249-4616 v.,.,�rY 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: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No /f 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: State License# Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATIO,NJ. , Name: « ��,� � � Q Phone (day): �� ' �, �� Address � City: ��c�� ZIP: � �j � � Email and/or Fax: ��J��,� yl � �� f-� ��+ :�e . PROJECT INFORMATION: Overall ro�ect descri tion: �"';�1 � �3••c sc'wt ��r� /"�E'�� P J p S 1�'�'c' �. Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review &permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 Phone: 952-471-0590 ❑ Re-roof, other(speclfy) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 ❑Window(s) �N��• � rr�� r�3�., ��r�_i Estimated Construction Valuation of Project(excluding land) $ d4��, 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: i '��-'L`'� Date: �- Owner's Signature: ��L Date: Cl��'�l � Last Updated:January 2016 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES I ADDITIONS Address: �7�i� j�/I P�SQ�G7 d G(CL Permit No.: C��7-- �/jl�� Description of work: . �(L r�OoL /��li �ZQ�d{�,� 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#: Resolution? Yes R o#: Reso Date: Signed: Yes No Resolution/NA Zoning: Lot Area: SF/AC Width: Structural Coverage: SF % Survey Submitted: � Yes � No Date of Survey: Revised date(?): Landscape plan submitted? � Yes Landscaper: f 0 No/None proposed Pro osed Setbacks: Front(Lake) Rear(Street) ( N S E W� ( N S E W ) Other Buildings Wetland Side Side Buildin Hei ht Anal sis: Distance Between First Floor and fin Top of Roof* (See"building height" �a� � definition : First Floor Elevation from buildin ns : (b) Highest Existing ground level (per su y)or 10' above lowest ground level, �� whichever is lower: Difference between b and c *. (d) DEFINED HEIGHT "!f highest existing adjacent g de is above FFE Height is(a)-(d): (e) *If hi hesf existin ad"acent de is below FFE- ei ht is a + d Shoreland District MCWD Permit Average Lakeshore Setback g�uff Met? � 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 Pr osed Overlay District Tier Hardcover Har over Variance Required CUP Required circle one °/a and s % a d s � Yes � No � Yes � No 1 2 3 4 5 Type(s): Type(s): Updated: June 2017 z:\forms\plan review checklist 06-2017.docx Fees to be Char ed ' YES NO Permit Plan Review State Surcharge Investigation Fee SAC—Number of SAC Units Other(specify) S uare Foota e $ er S uare Foota e Basement X = $ 1 St Floor X = $ 2nd FI00� X = $ Garage X = $ J�✓ Estimated Construction Value: $ ��i ��v Orono Inspections Required Work Requiring Separate Permits � Footing � Site 0 Plumbing � Grading/Filling 0 Poured Wall 0 Silt Fence/Erosion Control � Mechanical � Fire � Foundation Survey � Hardcover Removal 0 Fireplace 0 Water Connection � Framing 0 Other(specify) 0 Masonry 0 Sewer Connection � Waterproofing/Drain tile � Mfg. 0 Lawn Irrigation 0 oundation Waterproofing � Other(specify) 0 Landscaping raming � Septic � Insulation � As-Built Survey Final � Lathe Required State Permits � Other(specify) � Well 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. 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L��' �9 lS� CONfRACTOR / � � DESCRIPTION '� ty ❑ FOOTING ❑ DEMO-FIN ❑ SEPTIC FINAL Q � POURED WALL ❑ PLUMBING RI ❑ EXCAWGRADIN(i/FILLIN(3 �O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION ��RAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNERIFIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W �AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIOWREMOVAL _ r ❑ DEMO-SITE ❑ SEPTIC INSTALL � CWN6YCONTRACfOR T�O YEET VWl:_Y68_NO � COMMENT'� ��c. /Q�i � �d �� 7 4 rw► - �'or G•G. ��r�c. � ��C . o [1S 11'��a,•N I " �ce �e�k�t G��sN ��,��`lo•�, '' d � A'(fvrd�, /�` G/e��•e� �iot� `�� .c� i.�:. � s�' � Gof✓'e� 1�s . � � � �. /�er►,«-z aa�7-o1�87— r� - ,�'�iJ I/- �.� � L.L. G�oSsr.�+ ra/ac�t.c o?��/ /.•�t� �•i l.e�,e.�a�r d . - - . � e?�c.� � L�, � ❑wo�c sm��croRr:��j ro�.�j� ❑aAor�r�� j�jo�cr wofac a PpocE� ��Gct�3 0/ ❑ISSUE CERTIFlGTE OF OGIXJPMNCl/ 0 �O OORRECT tlMOi�(.G1LL FOFi RE�INj�PECTION C��ff��'C T9APORARII � BEFOREOOVEfqN(i /�1 GfCS`L� /��C PERIMANBVT ❑OORRECT UNSAFE OONDITION VYITHIN 4�i�j ❑PHOTO TAKEN INSPECTOR WILL RETURN o sroP oao��En.c�u.�iNsrEcroA GB r+�c t'��`��j uc'� ❑INSPECTION REOUIRED.CALL TO ARRAN(iE ACCES3. c�r�+na�t a,�cao�z�r�o�m�►�- (952) 249-4600 on sit�: Mspector: (�p�An�pse�o�s FIM Gmry Copyl811�Motie� ,� o ✓ DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDUIED _-{�1. �;d 0 PERMR NO. � COMPLETED ADDRESS o�� p�WNEp �1 .,of�[�15P�d,�TELEPHONENO.gsa-!Z�[�3 CONTRACT�OR � DESCRIPTION �✓�s• ly ❑ FOOTIN(3 ❑ DEMO-FINAL ❑ SEPTIC FINAL � ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/(iRADINO/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL Z � RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION � ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS ��`` SUI.ATION ❑ WOOD BURNEHIFIREPLACE ❑ COMPI..AINT � u F�AL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ r ❑ DEMO-SITE ❑ SEPTIC INSTALL i dINN6YCOKTRACTOR TO MEET YOU:_YES_NO � COMMENTBc � o ��v�-S G�- .-� o � � � W � � � W W � � � 4di AF—CTORY`—�EED ❑PFiOJECT WMPLETE � RRECT VYORK 8 PROCEED O ISSUE CERTIFICATE OF OCCUPANCY � ❑(�FiRECT WORK,CALL FOR REtNSPECTION T�APORARY V BEFORECOVERINO PERMANENT ❑CORRECT UNSAFE OONDITION WITHIN �1�• O PHOTO TAKEN INSPECTOR YVILL RERIRN ❑STOP ORDER POSTED.CALL INSPECTOR �pTATION ISSUED O INSPECTION REQIJIRED.CALL TO ARRAN(iE ACCESS. caq�or the next 2�t �n (952) 249-4600 on Inspector: 1Nhib sp�ctar's FlM Gn�ry Oo�f811�Notles �/�� C�`--�i � D TE TIME CITY OF ORONO cnLLED IN �� r7 INSPECTION NOTICE SCHEDULED � PERM�T NO.��f � "DI�� c eo ADDRESS o�Z�� s��%�Z��t-�l/�' , �.� OWNER TELEPHONE NO.��a�'�y�� CONTRACTOR '' DESCRIPTION ��-�1�� "�� `'`'� �1��`�- � ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLIN(3 Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT `� �INAL ❑ WATER HOOK-UP ❑ FOLLOW-UP i ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL � ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OMINERICOKTRACTOR TO MEET Y�U:_YES_NO � COMMENT'� ��- ��/I�iG — /D'oZ-7� ` 7 4 o�,,L. �Q�,,,,,,� l��k Ca �pl,e�`e - � - �'6 h� � �S •i0• � �� 6 e��o•� mld a�{� � OO � - 1 f'� ��w� • � S•,!�• duZ` S.oQe p �''ws• � - r1 e u�„ e,� 96 lov�0e G.-G • �ez��v Q 2 ��' /<<<� �u�"s•��e r w� - - � - ��l et�i�r .5 CJ• � G..b . c�,.��a�s -o� � vrJo rr� �'� ,��f"�-� - ,�..ti�� W �VMORK SATISFACTORY:PFiOCEED �ECT COMPLETE � O CORRECT WORK 3 PROCEED ❑ISSUE CERTIFlCATE OF OCCUPY►NCY W 0 ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPpRARY V BEFORE COMERINO PERAAANENT ❑CORRECT UNSAFE CONDITION WRHIN HOURS. p pHpTO TAKEN INSPECTOR WIIL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED ❑INSPECTION REW IRED.CALL TO ARRANGE ACCESS. CaN tor the next inspectfon 24 hours in advance. (g52) 249-4600 Owner/Contraator on site• Inspector: �� White CopyAnspectw's FII� Canary CopYlSib NoNa