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HomeMy WebLinkAbout2016-01375 (Cancelled) CITY OF ORONO III III I I I I II 11111111111111111111111111111 * 2 0 1 6 - 01375 * 2750 KELLEY PARKWAY DATE ISSUED: 11/15/2016 ORONO,M2 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1125 PINE VIEW DR PIN : 28-118-23-42-0007 LEGAL DESC : PINE VIEW : LOT 1 BLOCK 1 PERMIT TYPE : ACCESSORY STRUCTURE PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : POOL HOUSE ACTIVITY : 328-OTHER NONRESIDENTIAL BUILDINGS VALUATION : $ 25,000.00 NOTE: DETACHED POOL HOUSE NOTE:PRIOR TO RELEASE OF ESCROW MONEY AN AS-BUILT SURVEY MU T BE ACED AND APPROVED. INITIAL: / ' AIP & 1011 0 a� APPLICANT PERMIT FEE SCHEDULE 433.67 STATE SURCHARGE(VALUATION) 12.50 OUTDOOR EXCAPES,INC. TOTAL 446.17 2345 DANIELS STREET Payment(s) LONG LAKE,MN 55356- CREDIT CARD 4948 446.17 (952)926-6899 Minnesota State License#:BU -20630819 WNER NYQUIST,MATT I. &JENNIFER 6126 MAIN SIRE. W MAPLE PLAIN, 55359- 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 does not grant permission for additional or related work which requires separate permits. All provisions of laws 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 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 due cause. iso'v*AbA 45i Applicant '11111111-e Shure Date Issued ii Signature Date is. it r, 4 417"*1 CITY OF ORONO BUILDING PERMIT APPLICATION , FOR NEW STRUCTURES OR ADDITIONS "0 A) Mailing Address: Permit number: c .0 1 V -C I 37 , tiWPO Box 66 Crystal Bay, MN 55323-0066 Date received: 1 012-8 l i (G StreetAddress:' — Received by: � Oron Kelley Parkway O ( - � Plan r viewfee: , r : •K�sHo4Orono, MN 55356 1 (=f� Main: 952-249-4600 To al Fee: Fax: 952-249-4616 www.ci.orono.mn.us 7‘/V. ri This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) y v,<, . GENERAL INFORMATION: � : Job Site Address: 1�2 .S f;, �jt ,1-� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No if yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANTt� INFORMATION: Name: QV:T&._ Ec ..e2 State License# fie—CeS3 `i5-3,/ 0 Expiration Date: 5/3(4$' Phone: (cell) 7(a S-2 -- 2-(29 (office) ` S 2-9 ..(DS1 x•)( Mailing Address: 2311Ter.-1" City: Lo L„,-, ZIP: .SS 3.5to Contact Person: AS • '-e Applicant is: ontrac )/ Homeowner (Circle One) Email and/or Fax: k is -c .164 testy ._ w,,.` PROPERTY OWNER INFORMATION: � � Name: ncr' 4 - ; 'TJ--Phone(day): '7 "2- 22/ 'r2 Address: ►\25 ;.-cv, S �:v City: Oce ZIP: SS `L, Email and/or Fax rty,s_( exp.,,;1.ce,"--. ARCHITECT/ ENGI=INFORMATION: Name: L.G32 Phone (day): cls 2--a -C 7---9`i 7 7-- Address: °`ZD-(c btAn;z� -- City: (...or, ZIP: sc i , Email and/or Fax: yta4z E?0,.„ r.e._ tct(►eS.c� PROJECT INFORMATION: Description of project: Po© I H OU Se. (pe-0 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ❑ New Construction 0 Single Family with :_- .. : /Garage ❑Addition attached garage ❑ Deck 0 Public Sewer ,Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage 0 Residence 0 Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo 0 Retaining Wall(s) 0 Public 4-feet or greater 0 Public Water **Any earth movement may also require 0 Commercial 0 Storage MCWD review&permits. 0 Industrial 0 Warehouse ❑ Private Well Minnehaha Creek Watershed District(MCWD) ErOGh�er: (specify) ❑ Other(specify) 15320 Minnetonka Blvd t Alcr Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.org Estimated Construction Valuation (excluding land) $ �0 Last Updated: January 2016 - STRUCTURE INFORMATION: 1. Structure Dimensions 1.Structure Dimensions(continued) ��-- 1.1., a. Length (ft.)= Number of bedrooms= 2. Occupancy: .�-I�G-� b.Width (ft.)= Number of garage stalls: 3. Occupant Load: Areas in square feet Attached= c. Basement= Detached= 4. Type of Construction: . /tyC d. :: : ry 20I' ,i,q,Ve. 2"n 5. Code Edition: f. '%Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ El Building Permit Escrow Agreement and Fees ❑ ❑ Plan Review Fee ❑ El Completed Application Form E l ❑ Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8' x 11 set ❑ ❑ Minnesota State Energy Code Calculations and Mechanical Code Requirements ❑ ❑ Survey—2 full size,to scale(meeting ALL survey requirements) ❑ 0 Hardcover Calculations ❑ 0 Septic System Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD) Permit or Documentation from MCWD stating no permit is required O 0 Landscape Walls and/or Retaining Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan (SWPPP) ❑ ❑ Access Permit ❑ 0 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 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 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 temporary 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. Applicant's Signature: lay Date: /®`- 28-'10° Owner's Signature: Date: ��Z7/Ac Last Updated: January A 16 PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS Address: I(2.. l7inOA/V t Vt _ Permit No.: 2.010i� - 01375 Description of work: -R4)01 kleitt.VI ./ Date Rec'd: 10 •2 •/(,Q Septic review by: 0.1..1 &::724,44A4 Date Approved: /( / Zoning review by: e_ Date Approved: • I i Building review by: Date Approved: I!/ /�i 1 Grading review by: N A Date Approved: ------- Zoning District: Zoning File#: Resolution? Yes Reso#: Reso Date: . Signed: Yes No Resolution/ NA Zoning: Lot Area: 4:(00 LSF AC Width: ' Structural Coverage: SF Survey Submitted: ,0 Yes 0 No Date of Survey: ID 1t E( Revised date(?): Landscape plan submitted? 0 Yes Landscaper: eP CA1T OC V 0 No/ None proposed Proposed Setbacks: No a t pun (Akin 144. DtArli. 1 Front(L e) Rear(Str ) (0 S E W ) ( N t5 1 E W ) Other Buildings etlandl Side ` ide SI✓((t --- - 157 i N, . . Building Height Analysis: Distance Between First Floor and defined T (a) Roof* (See;`building height" definition • First FloorElevation (from bui . g plans): (b) Highest Existing grou evel (per survey) or 10' (c) above lowest gr d level, whichever is lower: Difference ween (b) and (c): (d) fined Building Height (a) - (d): (e) Shoreland District MCWD Permit Average Lakeshore Setback Bluff Met? Permit Number: 0 -513 0 Yes 0 No JAN/A 0 Yes 0 Yes No / No 0 N/A-see attached r5 pepni Setback: Stormwater Quality Existing Proposed Overlay District Tier Hardcover Hardcover Variance Required CUP Required (circle one) (% and sf) (% and sf) 1 2 3 4 5 / 0 Yes ,2'No 0 Yes /(No 5-eMp Type(s): Type(s): Updated: October 2016 v:\forms\plan review checklist 10-2016.docx Fees to be Char.ed � NO Plan Review Li my tigation Feer '.., Other(specify) 111111111 Square Footage $ per Square Footage Basement X = $ 1st Floor X = $ 2nd Floor X = $ Garage X = $ Estimated Construction Value: $ ST 6200 r— Orono Inspections Required Work Requiring Separate Permits .24FPooting O Site 0 Plumbing 0 Grading/Filling 0 oured Wall 0 Silt Fence/Erosion Control 0 Mechanical 0 Fire O Foundation Survey 0 Hardcover Removal 0 Fireplace 0 Water Connection O Framing 0 Other(specify) 0 Masonry 0 Sewer Connection O Waterproofing/Drain tile 0 Mfg. 0 Lawn Irrigation 0 Foundation Waterproofing 0 Other(specify) 0 Landscaping X.Framing O Insulation b\-As-Built Survey anal 0 Lathe Required State Permits O Other(specify) 0 Well )(Electrical REMARKS (in-house): OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED: 0 See Builder Acknowledgement Form rior to release of escrow money an as-built survey must be submitted and approved. Updated. October 2016 v:\forms\plan review checklist 10-2016.docx Permit Application: Self-Checklist for Completeness Please note, the applicant must initial in the boxes below to acknowledge the minimum required information is included with the submittal. If not, the application will NOT be accepted. Call 952.249.4620 to schedule a meeting with staff if you have questions on application submittal requirements. C V- 10 Completed Application Plan Review Fee Paid f„,,,y11 1 S tl �9C b t 3L1 . � [I�� 2 C1 b Signed Escrow Agreement & Escrow Payment O" (R' /t),/ � r yes I pcinil Y Building Plans (to scale) x2 OV-,/ Certificate of Survey (to scale) showing the proposed project & El meeting all requirements x2 V i ..(2sild Frr crn ce. Hardcover Calculations (if applicable) l -1- I am aware that Orono will not issue a building permit without a till l( 6 / copy of MCWD permits (or documentation from the MCWD stating eta x the proposed project does not trigger their permitting requirements). I will contact the MCWD at 952-471-0590 regarding this project. Signed by: 4,4466 itibs Address: //2 - //v,sr, 5 re_____ Permit #: D I 4. _ o 13--15 Last Updated: January 2016