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Home My WebLink About2017-01360 - addn/remodel/repair N 11111111 IN IN CITY OF ORONO I Iz 0 1 7 - 0 1 3® 2750 KELLEY PARKWAY DATE ISSUED: 10/30/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS 1669 NORTH FARM RD PIN 27-118-23-44-0008 LEGAL DESC THE FARM AT LONG LAKE LOT 007 BLOCK 001 PERMIT TYPE ADDITION/REMODEL/REPAIR PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDN/REMODEL/REPAIR ACTIVITY 434-RESIDENTIAL VALUATION $ 15,000.00 NOTE: SEPARATE PERMITS REQUIRED: ELECTRICAL(STATE) NOTE: PRIOR TO RELEASE OF ESCROW MONEY AN AS-BUILT SURVEY AND HARDCOVER CALCULATIONS MUST BE SUBMITTED AND APPROVED. INITIAL: APPLICANT PERMIT FEE SCHEDULE 278.77 STATE SURCHARGE(VALUATION) 7.50 KEENAN& SVEIVEN,INC. TOTAL 286.27 15119 MINNETONKA BLVD. Payment(s) MINNETONKA,MN 55345- CREDIT CARD 0048 286.27 (952)475-1229 Minnesota State License#: BUIL-7252 OWNER BEENDERS&PETER MONTGOMERIE,ANTOINETTE 1669 NORTH FARM RD LONG LAKE,MN 55356- 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 revok a Meorca e. b ( W, 6 13c) 11 A c t Petmitee Signatu � Date I Issued 139 Signature Date CITY OF ORONO <a . BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS Mailing Address: Permit number: l V PO Box 66 Crystal Bay, MN 55323-0066 Date received: �q /7 Street Address:' Received by: 2750 Kelley Parkway Plan review fee: :6 "-2 o &AF lAkESH� Orono, MN 55356 a.o013 9 Main: 952-249-4600 16 Total Fee: Fax: 952-249-4616 V"www.ci.orono.mn.us C��0-#7 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: Will this be a Parade of Homes, emodelers 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/APPLICANT INFORM TI N: Name: xeeo a oo ffG State License# *x-5'J..; Expiration Date: Phone: cell office '2 - 2Z Mailing Address: Cit ZIP: Contact Person: Applicant is: ontrac" M / Homeowner (Circle One) Email and/or Fax: N0 PROPERTY OWNER INFORMATI0 Name: Phone (day): — V Address: City: akyft ZIP: Email and/or Fax /Yle ce ARCHITECT/ENGINEER INFORMATION: Name: SAW Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description ofproject: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage Deck ❑ 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) ❑Other: (specify) ❑ Other(specify) 15320 Minnetonka Blvd Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www rninnehahacreek.or Estimated Construction Valuation(excluding land) $ Last Updated: January 2016 STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) a. Length(ft.)= f��3 / Number of bedrooms= 2. Occupancy: b.Width(ft.)= Number of garage stalls: 3. Occupant Load: Areas in square feet Attached= c. Basement= Detached= 4. Type of Construction: d. 1 st Story = e. 2nd Story= 5. Code Edition: f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ ❑ Building Permit Escrow Agreement and Fees ❑ ❑ Plan Review Fee ❑ ❑ Completed Application Form ❑ Proposed Building Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/2 x 11 set ❑ W Minnesota State Energy Code Calculations and Mechanical Code Requirements ❑ ❑ Survey—2 full size, to scale(meeting ALL survey requirements) ❑ ❑ Hardcover Calculations ❑ ❑ Septic System Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD stating no permit is required ❑ ❑ Landscape Walls and/or Retaining 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 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 Signatur . Date: o —1 L 11 6001 Owner's Signature: Date: Last Updated: January 2016