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Home My WebLink About2010-00193 - adv plan CITY OF ORONO PERMIT NO.: 2010-00193 2750 KELLEY PARKWAY ," ORONO, MN 55356- DATE �ssuEn: 04/06/2010 , 952 249-4600 FAX: 952 249-4616 ADDRESS : 2200 SHADYWOOD RD PIN : 17-117-23-42-0006 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 013 BLOCK 001 PERMIT TYPE . ADVANCED PLAN REVIEW ii: K71iey r'ar�,:_,; PROPERTY TYPE . RESIDENTIAL - '++�� PiN �;3�� _. _ . CO1vSTRUCTION TYPE : ADVANCED PLAN REVIEW ��=��'lp� �o: 3.(i[?��._ VALUATION : $ 15,000.00 ;: �ilij,r-_ ` NOTE: PLEASE FILL IN"1'I IE FOLLOWING: VALUATION OF PERMIT: $ 15,000.00 i1��j_��; ; � � ,i. : Rd _ TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION OF SCREENED PORCH iJi-S�►�#1� !=•lan Check/5ite Exart� _ PERMIT#THIS PRE-PAYMENT IS TIED TO:2010-00192 - ---�------- �tal: �72.;:��. `.;;-ed i t Card --____�,.----, r^ayor: ` 3horzline 6uilder�s `atal Applied: t';:,'__ ------_._.. _. _ _ ._ -_ ,=r�ed: . .. i.i(.,',_ . _ ..-,. APPLICANT ADVANCED PLAN REVIEW 172.58 SHORELINE BUILDERS TOTAL 172.58 2184 SHADYWOOD RD WAYZATA, MN 55391- PAID WITH CC# 7736 (763)506-0629 Minnesota State License#: 20630814 OWNER SWANSON, KARI&ZACK 2200 SHADYWOOD RD WAYZATA, MN 55391- AGREEMENT A1vD 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 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 l3uilding Code.This permit may be revoked at any time for due causc. - ��_) �/ " �r' - 1 C' / / �--�� - `.�= � C C�l} Z tC'�c i l / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . City of Orono � � Building Permit Application for New Structures or Additions � Mailing Address: i �'��V PO Box 66 � Permit number: ��C:� �� '--(�C�� `��_ , 0 �„ �� Crystal Bay, MN 55323-0066 Date received: i' �f' � (o )Q � i �y�;�; �'� I�'`"�s;-,%'-- � �. �� - s,: � �., Street Address:' Received by: �� t'�'��fy�„ ��/ 2750 Kelle Parkwa r 5�4 � �� o Y Y cL V �lG � Plan review fee: ��2 ' S$ "��:j�i� �kEsxo4"�/ Orono, MN 55356 � Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us i Total Fee: 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: �,�� s � Will this be a Parade of Homes, Remodelers Sh case Home or other Display Home? ❑ Yes ❑ No If yes, a specral event permit is required with Po/ice Department and City Counci/approval 60 days prior to the event. Shutfle bus service will be required unless app/icant demonstrates sufficient on-site parking is available. Non-permitted events wil/not be al/owed. CONTRACTOR/APPLICANT INFORMATION:�` � � Name: v - State License# E piration Date: - Phone: of ice ' � a�j (cell) Mailing Address: � w�J 1 Cit_�_____ .-� �; ZIP: ,(f Contact Person: - -- Appl�cant i : ontractor� / Homeowner (Circle One) Email and/or Fax: � ;. , PROPERTY OWNER INFORMATION: ,� � � �i Name: /� �� '�/-�l�/� .�(,�/,�.� ��l Phone (day): Address: Cit : ZIP: Email and/or Fax ARCHfTECT/ ENGINEER INFORMATION: Name: Phone (day): Address: Cit : ZIP: Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3. Structure T e Yp I 4.Sewage Disposal 8� ❑ New Construction Water Supply ❑ Single Family with ❑ Residence ❑ Addition ��b' �� attached ara e 9 9 ❑ Gara e/Accesso Bld ❑ Accesso Buildin , � ' � i�� 9 n' 9 ❑ Pub(ic Sewer � rY 9 ��E ��. �. ❑ Single Family with Deck � C�LI' 1•� �,��C. ' � ❑ Relocation ,, �.� c 4�tr detached garage , ffice/Commercial ❑ Private Sewer ❑ Other. (specify) '�C�� ❑ Multiple Family/Condo ❑ Warehouse ❑ Public ❑ Storage ❑ Public Water '*Any earth movement may require ❑ Commercial ❑ Other(specify) j MCWD review& permits. ❑ Industrial IMinnehaha Creek Watershed District(MCWD) ❑ Private Well 18202 Minnetonka Blvd ❑ Other: (specify) Deephaven, MN 55391 I Phone: 952-471-0590 I Fax: 952-471-0682 www minnehahacreek.or G� Estimated Construction Valuation (excluding land) � � 1 Last Updated: 9/29/2009 - 17 - STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction � � a. Length (ft.)= �% Number of bedrooms = �Wood/Frame • b.Width ft. = t� ❑ Masonry ( ) Number of garage stalls: ❑ Metal Attached = ❑ Pole Bldg. Areas in sauare feet Detached = ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 1 S'Story = ❑ Other(please specify): e. 2"d StOry= f. '/2 Story = g. Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed A licable � ❑ Permit A lication � ❑ Pro osed Buildin Plans � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form � ❑ Surve meetin all re uirements � ❑ Stormwater Pollution Prevention Plan � ❑ Hardcover Calculation s � ❑ Se tic S stem Site Evaluation Re ort � ❑ Access Permit � ❑ Wetland Buffer Im rovement Plan � ❑ En ineered Plans for Retainin Walls 4 feet or above � ❑ 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 governmental agencies required by law. If you refuse to supply the information,the application may not be issued. '. v n�� ApplicanYs Signature: Date: � e Last Updated: 9/29/2009 - 18 -