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2017-01029 - addn/remodel/repair
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North Shore Drive
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4240 North Shore Drive - 07-117-23-43-0014
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2017-01029 - addn/remodel/repair
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Last modified
8/22/2023 5:39:15 PM
Creation date
1/17/2018 10:44:47 AM
Metadata
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Template:
x Address Old
House Number
4240
Street Name
North Shore
Street Type
Drive
Address
4240 North Shore Dr
Document Type
Permits/Inspections
PIN
0711723430014
Supplemental fields
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Updated
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STRUCTURE IPlFORfVI�lTl01�: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) <br /> a. Length(ft.)= Number of bedrooms= 2. Occupancy: <br /> b.Width(ft.)= Number of garage stalls: <br /> 3. Occupant Load: <br /> Areas in sauare feet Attached= <br /> c. Basement= Detached = 4. Type of Construcion: <br /> d. 15t Story = <br /> 5. Code Edition: <br /> e.2nd Story= <br /> f. '/�Story = <br /> g.Total Area= <br /> REQUIRED SUBMITfALS: <br /> Atl of the information must be submitted in order for our application to be processed: <br /> Not <br /> Enclosed licable <br /> p O Buildin Permit Escrow A reement and Fees <br /> p ❑ Plan Review Fee <br /> ❑ O Com leted A lication Form <br /> ❑ ❑ Pro osed Buildin Plans—2 full size sets to scale and 1 reduced 11 x 17 or 8'/�x 11 set <br /> p ❑ Minnesota State Ene Code Calculations and Mechanical Code Re uirements <br /> p ❑ Surve —2 full size,to scale meetin ALL surve re uirements <br /> ❑ ❑ Hardcover Calculations <br /> ❑ ❑ Se tic S tem Certification <br /> ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> ❑ ❑ Landsca e Walls and/or Retainin Wall Plans <br /> ❑ ❑ Landsca e Plan <br /> ❑ ❑ Stormwater Pollution Prevention Plan SWPPP <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Data Privac Adviso Form <br /> APPLICANTIOWNER ACKNOWLEDGEMENT: <br /> . Agrees to provide all information required or requested by the Building Department; <br /> . Agrees to pay the City of Orono for engineering consultant review costs in excess of 5500; <br /> . Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no aNernative but to <br /> reject it until it is complete; <br /> . Acknowledges the Escrow Agreement is completed and signed; <br /> . Understands some or all of the infortnation that you are asked to provide on this application is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of <br /> the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the infoRnation,the application may not be issued. <br /> o Agrees that in the event that weather or other conditions prevent the comptetion of an as-built survey at the tlme the <br /> Certificat� of Occupancy fs requested, a temporary Certificate of Occupancy may be Issued upon recefpt of a 510,000 <br /> escrow to ensure completion of the as-bullt survey and all site improvements. <br /> `���"'���_�"� Date: � " Z�� 2�\ 1 <br /> ApplicanYs Signature: � <br /> Owner's Signature: Date: <br /> Packet Last Updated: January 2016 <br /> Page 22 <br />
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