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Home My WebLink About2009-00248 - adv plan review , CITY OF ORONO PERMIT NO.: 2009-00248 � 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUE�: OS/2U2009 (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2100 SHADYWOOD RD PIN : 17-117-23-31-0041 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 030 BLOCK 001 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW NOTE: ADVANCED PLAN REVIEW PAID—CK#7177 ON OS/21/09 FOR$2,474.39(HOWEVER THE AMOUNT SHOULD HAVE BEEN $2,490.64) WHICH LEAVES A DIFFERENCE OF$16.25 OWED AT TIME NEW HOME PERMIT IS ISSUED IF AMOUNT OF HOME VALUE STAYS AT$575,000.00 NEW HOME PERMIT#2009-00249 APPLICANT ADVANCED PLAN REVIEW 2,474.39 MARHULA,DAREN TOTAL 2,474.39 2100 SHADYWOOD RD WAYZATA,MN 55391— ;�� ,�:� s�, IR� .,. ...,. OWNER 'fp� H!'�: ...;E�^,itC,:;.? t*'i}'✓ :t, ri:' MARHULA, DAREN 2100 SHADY WOOD RD s�` ��';�s;� ' WAYZATA, MN 55391— ,it� •a�ced s�1ar, Fevxe� Fee �,47j�. : AGREEMENT AND SWORN STATEMENT ��R� �� 'I'he work for which this permit is issued shall be performed according to ,p��i�1't� �k3w`i ?' [he 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 _._M.._�_--... permits. All provisions of laws and ordinances goveming this type of work � shall be compied with whether or not specified herein.This permit will �.;,,�CR� �; 7S�% Gi�}?k'� expire and become null and void if construction authorized is not �.��pp. commenced within 180 days of the date of issuance,or if wnstruction is ;?4qyay� ��^!{Ula sus ended for a eriod of 180 da s at an time after work has commenced. �;��j_�, 7`' p p Y Y �1 a � �.4, � The applican[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. / / / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. • •� �,,`�(�' \� �� c�' City of Orono ��`�' Building Permit Application for New Structures or Additions Mailing Address: Permit number: GV�'O 2� g►�,� PO Box 66 0 Q�', Crystal Bay,MN 55323-0066 Date received: �j� � 1 �• rj'(� /Zt.�D Street Address: .��,,, � („�, -► Received by: � ��' � D Q 2750 Kelle Parkwa � � �. � Y y � L��, � Plan review fee:Cc�() elj Z� �1 =p,f� �gESAo�`�°' Orono, MN 55356 � pF Total Fee: p� /'�,Z5 Main: 952-249-4600 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: � `j Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No lf yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wil!be required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �Jl�CL�� M�'t�(L1�v� State License# Expiration Date: Phone: �Z— 'Z..�- --� office 2 - � — o cell Mailing Address: w, ��c,� Q Ci : — Contact Person: Applicant is: Contractor / omeowner �ci��ie a,.� Email and/or Fax: -�M �r p �,�µ,�� Cc.�n PROPERTY OWNER INFORMATION: Name: � �'E,�.� .�J�lL�V� Phone(daY): C�l2 — 4�� — (��G � Address: i-1'�7 Z \,.� . A�M QO City• ��,�}-Q� ZIP• zj �`� Email and/or Fax 1�RQ��q (� �,��L� C�M ARCHITECT/ENGINEER INFORMATION: Name: ��v� \lo �.�,—RUM Phone(day): �„lZ_ z.��0 -�1 N Gb Address: Ci . Z�P. Email and/or Fax: p�}vL.vo �s:a .�n C� A c��. GOM PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 Water Supply ew Construction �ingle Family with Residence ❑Addition attached garage Garage/Accessory Bldg. Public Sewer ❑Accessory Building ❑ Single Family with ❑Deck ❑Relocation detached garage ❑Office/Commercial ❑Other: (specify) ❑Multi le Famil /Condo ❑Private Sewer P Y ❑Warehouse ❑ Public ❑Storage �Public Water "My earth movement may require ❑Commercial ❑Other(specify) MCWD review 8 permits. ❑ Industrial ❑Private Well Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ .�'�' �= - 18- . . , STRUCTURE INFORMATION: 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction a. Length(R.)= �_ Number of bedrooms=� Wood/Frame J Masonry b.Width(ft.)= `�� Number of garage stalls: ❑Metal Attached=� ❑Pole Bldg. Areas in sauare feet Detached=�_ ❑ ICF c. Basement= � ❑On-site Prefab ❑Off-site Prefab d. 1�`Story = ( ��7 ❑Other(please specify): e.2nd SiOry= ( ' l I f. YZ Story = g.Total Area= / r REQUIRED SUBMITTALS: All of the information must be submitted in order for our application to be processed: Not Enclosed A licable � ❑ Permit A lication � ❑ Pro sed Buildin Plans � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form � ❑ Surve meetin all re uirements � ❑ Hardcover Calculation s � ❑ Se tic S stem Site Evaluation Re rt � ❑ Access Permit � � WeUand Buffer Im rovement Plan � ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ O Plan Review Fee � � Other APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all 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 upon failure to do so, the staff has no altemative but to reject it until it is complete; • Acknowledges the Escrow Agreement is completed and signed; • 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 govemmental agencies required by law. If you refuse to supply the information,the application may not be issued. ApplicanYs Signature: Date: � - 19-