The URL can be used to link to this page

Home My WebLink About2017-01343 - addn/remodel/repair CITY OF ORONO * Z 0 1 7 — 0 1 3 4 3 * ` 2750 KELLEY PARKWAY DATE ISSUED: iUi3/2017 ORONO,MN 55356- � (952)249-4600 FAX: (952) 249-4616 ADDRESS : 530 SANDHILL DR PIN : 33-118-23-24-0020 LEGAL DESC : ORONO PRESERVE : LOT 1 BLOCK 2 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTMTY : 434-RESIDENTIAL VALUATION : $ 60,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) BASEMENT FINISH. PLUMBING AND MECHANICAL ISSUED WITH MAIN PERMIT. APPLICANT PERMIT FEE SCHEDULE 794.72 DAVID WEEKLEY HOMES STATE SURCHARGE(VALUATION) 30.00 12800 WHITEWATERDRNE#20 TOTAL 824.72 MINNETONKA,MN 55343- Payment(s) Minnesota State License#:BUIL-BC697545 CHECK 2'747601 824.72 OWNER OPS Orono LLC 15250 WAYZATA BLVD#101 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 dces not gant permission for additional or related work which requires separate , pertnits. All provisions of Iaws 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 suthorized 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. - !i�/3/� S-� //� !3 � �Z Applic itee Signature Date Issued B ignature Date CITY OF C�RONO �� BUILDING PERMIT APPLICATION �� n��' � FOR NEW STRUCTURES OR ADDITIONS OA, Mailing Address: Permit number: �(j/ 7-�� `V , PO Box 66 � l',,.; ,,%� ,/r��- � Crystal Bay, MN 55323-0066 Date received: d —/ 7 �� '�'�� I�`�� Received by: �� Street Address:� ��, G� 2750 Kelley Parkway Pian review fee: � ��P`5Z lqkf S H�� Orono, MN 55356 �/��7�Lf�/ Main: 952-249-4600 Total Fee: 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: , ,,,,,,,r,:,, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutt/e bus service wil/be required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: r�: ��,�J��h��;�i�:�a��„ . State License# ec�y�sas Expiration Date: Phone: (cell) s�2.��s.zs2� (office) Malllftg�1dd�@SS: 12800 Whitewater Drive,Suite?_0 Cjty: Minneionk�:� Z�P: .�:;;,-�3 COntBCt P@t'S011: Kevin Cummins Applicant is: Contractor / Homeowner �c�.��.o�e> EfT181�8t1C��01'FaX: kcummins��dwhcme�-ccro PROPERTY OWNER INFORMATION: Name: •�a�rr��S,zG��,vt� PllOtl@�CIBy�: Melissa Johnson 612.4u2.693� Addt'ess: *same as Abo�e* City: ZIP: Email and/or Fax mjohnson@dwhomes.com ARCHITECT/ENGINEER INFORMATION: Name: M�,ine�n&K��F Phone(day): Zis.6a�.sooi AC�C�f@SS: 20 Socth(�{;�ple St�eet Sui.c�1�0 �ilt�/: Arribler,r� Z�P: 19002 Email and/or Fax: PROJECT INFORMATION: Descri tion of pro'ect: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� Water Supply �New Construction ❑ Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck 0 Public Sewer ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage � Residence ❑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) ❑ Othe�: (speCify) ❑ Othel'(SpeCify) 15320 Minnetonka Blvd �i n tS}� (�t�.�,,,,�� Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ �;o,000 f�ECEIVED UCT 1 �7 ZU1I Last Updated: January 2016 �ITY OF ORONO STRUCTURE INFORMATION: " 1.Structure Dimensions 1.Structure Dimensions(coirtinued) 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: d. 1°�Story = e.2"�Story= S. Code Edition: f. '/Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for our a lication to be rocessed: Not Enclosed A Ncable ❑ ❑ Buildin Permit Escrow A reement and Fees ❑ ❑ Plan Review Fee O 0 Com leted lication Form ❑ 0 Pro sed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'�x 11 set ❑ 0 Minnesota State Ener Code Calculations and Mechanical Code R uirements ❑ O Surve —2 full size,to scale meetin ALL surve r uirements ❑ ❑ Hardcover Calculations ❑ ❑ Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is r 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 all information required or requested by the Building Department; • Agrees to pay the City of Orono for engineering consultant revlew costs in excesa 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 upon failure to do so,the staff has no altemative but to rejed it until it is complete; • Adcnowledges the Escrow Agreement is completed and signed; • Understands some or all of the info�rnation that you are asked to provide on this application is Gassified by State law as either private or confiderrtial. 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 weathe�or other conditions prevent the completlon of an as-built survey at the tlme the Certlflcate of Occupancy is requested, a t�emporary Cerdficate of Occupancy may be Issued upon recalpt of a$70,000 eacrow to ensure completlon of the as-built survey and all site ImprovemerKs. ApplicanYs Signature: Date: Owner's Signature: Date: Last Updated: January 2016