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Home My WebLink About2017-01070 - addn/remodel/repair � "� CITY OF ORONO * z 0 1 7 - a 1 a 7 a * 2750 KELLEY PARKWAY DATE ISSUED: 09/i l/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 : $ 1,775.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) APPLICANT PERMIT FEE SCI-�DULE 70.58 AFFORDABLE EGRESS WINDOWS PLAN REVIEW 45.88 4035 APACHE DRIVE STATE SURCHARGE(VALUATION) 0.89 MEDINA,MN 55340- TOTAL 117.35 (612)6443671 Payment(s) Minnesota State License#:BUIL-BC639908 CHECK 11211 117.35 OWNER JORGENSEN,CHMICHAEL&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 dces 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.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 d c � � �� /� �� Applicant Permitee ignature Date Issued By i ature Date � � CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS �O�O Mailing Address: Permit number: � �"v��7� PO Box 66 ��-J � Crystal Bay, MN 55323-0066 Date received: � ,, Sireet Address:� Received by: y G� 2750 Kelley Parkway Plan review fee: F �qk�.SH��c. Orono, MN 55356 Main: 952-249-4600 Total Fee: / l 7• �� Fax: 952-249-4616 wwv�✓.ci.orono n�n 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: a7 as ��5��-� �� • Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes If yes,a special event permit is required wdh Police Department and Ciry Council approva160 days prior to the evenL Shunle bus service wil/be required unfess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APP C T INFO ATIO • Name: �'� � �^ S I/� State License# Expiration Date: Phone: cell . � o�ce r Mailing Address: Cit ZIP: c� Contact Person: Applicant is: ontract / Homeowner (Circle One) Email and/or Fax: r' r.L S o PROPERTY OWNER INFOR ATION: Name: Phone (day): r Address: �"�1�hp . City: ZIP: Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone(day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of pro"ect: 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑Office/Commercial ❑ Fjelocation detached garage esidence ❑ Private Sewer [�Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater ❑ Public Water **Any earth movement may also require ❑Commercial ❑Storage MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑Other(specify) 15320 Minnetonka Blvd Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www minnehahacreek.or Estimated Construction Valuation (excluding land) $ � /�J � Last Updated: January 2016 STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) a. Length (ft.)= Number of bedrooms= 2. Occupancy: � � '" � b.Width(ft.)= Number of garage stalis: 3. Occupant Load: ` Areas in square feet Attached= c. Basement= Detached= 4. Type of Construction: � �3 d. 15f Story = e. 2"d Story= 5. Code Edition: ��lG f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ � Plan Review Fee O ❑ Com leted A lication Form ❑ ❑ Pro osed Buildin Plans—2 full size sets to scale and 1 reduced 11 x 17 or 8'/2 x 11 set 0 � Minnesota State Ener Code Calculations and Mechanical Code Re uirements ❑ ❑ Surve —2 full size,to scale meetin ALL surve re uirements ❑ � Hardcover Calculations ❑ ❑ Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD) Permit or Documentation from MCWD statin no ermit is re uired ❑ ❑ Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan SWPPP ❑ ❑ Access Permit ❑ ❑ Data Privacy Advisory Form APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide alI information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; • 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 upo�failure to do so,the staff has no alternative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • Understands 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. • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a iemporary Certificate of Occupancy may be issued upon receipt of a$10,000 escrow to ensure completion of the as-built survey and all site improvements. ApplicanYs Signature: � Date: ��S/ZOI� Owner's Signature: Date: Last Updated: January 2016 ' ' ' PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: Z- 7 ��7 I�' ��C{rC�/t`� ,�iQ° ^ Permit No.: �� `—" l07(� Description of work: ��'I'��S [it/��t, C�C�G(/� Date Rec'd: l ! 7 Septic review by: Date Approved: Zoning review by: � Date Approved: Building review by: ' Date Approved: ! y Grading review by: Date Approved: Zoning District: Zoning File#: Reso#: Reso Date: Zoning: Lot Area: SF/AC Width: I Lot Coverage: SF % Survey Submitted: 0 Yes � No Date of Su�y: Revised date(?): Landscape plan submitted? Yes � No Landsc�per: Proposed Setbacks: � Front (Lake) Rear(Street)\' ( N S E W ) ( N S E W ) Other Buildings Wetland Side Side , ,` Defined Height: Peak P�eight: FFE: FFE minus 6 feet= (Existing Contour) Perimeter(linear feet) _ � 50%= L.F. below grade Basement? � Yes � No, ', Stories , 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 crawl space)and measure from hiqhest existinp the highest point of the roof. START WITH rq ade to the highest point of the roof even if fill was brought in to elevate home. If you have a... SUBTRACTION • GABLE OR HIPPED ROOF(no Slab below grade—measure (BASED ON windows): Subtract half the distance from highest existing grade to the ROOF TYPE) between the highest point of the roof hi hest oint of the roof. to the low point of the corresponding If you have a... gable or hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF • GABLE OR HIPPED ROOF(with (BASED ON (no windows): Subtract half windows): Subtract half the distance ROOF TYPE) the distance between the between the top of the highest highest point of the roof to window and the highest point of the the low point of the roof corresponding gable or hipped roof • ALL OTHER ROOF TYPES(flat, • GABLE OR HIPPED ROOF mansard,etc):No subtraction. (with windows): Subtract SUBTRACTION Subtract the distance between the half the distance between (BASED ON basemenUcrawl space floor and the the top of the highest EXISTING highest existing grade adjacent to the window and the highest GRADES) foundation OR 10 feet(whichever is less). point of the roof �' • ALL OTHER ROOF TYPES (flat,mansard,etc):No EQUALS D med 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 g�uff Met? � Yes � No Permit Number: �Yes 0 No 0 N/A � Ye No � � 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 0 No � Yes � No 1 2 3 4 5 \� Type(s): Type(s): Fees to be Char ed YES NO Permit (�-' Plan Review L State Surcharge Investigation Fee �- SAC– Number of SAC Units Other(specify) (�/ Square Foota e $ per Square Footage Basement X = $ 1 S' Floor X = $ 2nd FIOo� X = $ Garage X = $ Estimated Construction Value: $ ( 7 �=)J�— Orono Inspections Required Work Requiring Separate Permits � Footing � Site � Plumbing 0 Grading/ Filling 0 Poured Wall � Silt Fence/Erosion Control 0 Mechanical ❑ Fire � Foundation Survey � Hardcover Removal � Septic � Water Connection � Foundation Waterproofing � Other(specify) � Fireplace 0 Sewer Connection �Framing � Masonry ❑ Lawn Irrigation 0 Insulation � Mfg. � Landscaping � As-Built Survey � Other(specify) �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 0 Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved. Updated: October 2015 �•\fnrmc\nlan ravic�u rhorklict 1f1_7(11F rinrv ' ' 2` � '� a�a S �h�e 2 sz�� d - � __ ✓' �''U n o� M 1� �J� �,� �� a�� ;d � k�a � � �R��D ��'Y � �a� S�n _ � � .�� ,�� , � � � �C ��.��.�/ �� P�,� ` �� `� � L e,�' .� �`� �' �� s ��d o� � � �� - � � � C �.��- ' ��- � i � f�-� � wv��. i s '�Y'��c � � , ; I� ' ' '. Carbon moncxide de�ector Co�e ' ' required within 10 ft. Of Revt�:�N��o� o{�con� ' a11 sleeping roo�s'. 1ia�+ce G�� Co�p C � ' ' p�,te . ; � BEDR�� 1d'J��B��W� � _� ,� F�� E)C1T �?��l�?��3 REvie�e� : � , ; ' 2�„ t��i,a. CE_�:,�� t��TN ' �-!� S�e r`n ' ''j 2�5' �'��'i��. G��:,��:t� ��1�E-il- _ � ��'� - ' �J.7 ��..a"''�. F�. I��'i�I C�PENING SFAOKEDEfECTORCOPIN�C''F�T�JASOUND- ' _ „ , �NG QEVICE CR OTHER DE;'��T�JR AUDt►�LE IN � ' � t��f�X S!LL I-�E r G�-IT sLEE�li�u AR��s.�� ' , � � - . �� b� bQ��r m,�� l�_ --�= TE TIME � cmr oF oaoNo �►��N 9-� —/ qdsPECT10N N T��_ �� scar�,�En 9 /7 % PERMIT NO. � ADDRESS � OMINER LEPHONE N �� 3 �I CONTRACTOR � DESCRIPTION �� ty ❑ FOOTING ❑ -FINAL ❑ SEPTIC FINAL � ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAWGRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION � ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑COMPLAINT � ❑ FINAL ❑WATER HOOK-UP ❑ FOLLOW-UP W ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z dIMN61lCONTMCTOR TO MEET 1fOU:_YES_NO � COMMENT� , 4 �9/'C�S L�J i ISl�f�b�. 4/ - o �- ei,�'Ccs '�-O�C '' w, v ✓� ��ev - D � � � � �../1• -,f C.d cP ��6✓5 �/i'o u ide� - W OC � ' i /¢<C kJd� G'oy`"-.O�e.7�.t - �/�*�'C �.ita�� j W ❑WORIC SATISFACTORY:PROCEED �ECi COMPLETE � O OORRECT WORK�PROCEED �ISSUE CERTIFlCATE OF OOCUPANCY W Q� ❑OORRECT YMORK,CALL FOR REINSPECTION TEMPORARI/ V BEFORECdVERINd PEqMANENT ❑CORRECT UNSAFE OONOITION WITHIN HOUR3. ❑PHOTO TAKEN INSPECTOR WILL RETURN ❑$TOP ORDER PO�TED.CALL IN3PECTOR ❑�ATION ISSUED O INSPECTION REGUIRED.C/1LL TO ARRAN(iE ACCESS. caM�u��t�z4 no„�ti��oe. 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