HomeMy WebLinkAbout2009 - 00350 - adv plan review * " CITY OF ORONO PERMIT NO.: 2009-00350
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 06/23/2009
(952) 249-4600 FAX: (952)249-4616
ADDRESS : 70 WEAR LA S
PIN : 04-117-23-21-0019
LEGAL DESC : ROLLING MEADOWS 4TH ADDITION
: LOT 002 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 350,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT IS TIED TO:2009-00351
APPLICANT ADVANCED PLAN REVIEW 1,661.89
GORDON JAMES CONSTRUCTION TOTAL 1,661.89
5159 MAIN STREET E
P.O. BOX 306
MAPLE PLAIN,MN 55359-
(763)479-3117
Minnesota State License#:20531961
OWNER
PFEIFFER,JASON&JONI
P.O.BOX 196
CRYSTAL BAY,MN 55323-
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.
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
A w
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Permit number: 2-CC'q -CC (`
Og,0,� PO Box 66
Crystal Bay, MN 55323-0066 Date received: (_( - i`3- DC)
Receive y: Jul
a a Street Address:' Pod /Z
���, i?(+, 'l "' ctiti 2750 Kelley Parkway 11-` q -- OC�O p'lah review fee: I �+(r1 . Rcl
P()
\\\� og� Orono, MN 55356 1
fix Total Fee:
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: 70 WEA is LiM'E
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes $1 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 INFORMATION:
Name: GoitboA) 5'cir'tE5 Co.4STR(ACT.ro•J
State License# o?OS 3 t 96, I Expiration Date: "MCA/ .2010
Phone: O?c.3)£4' -3/1 7 (office) (cell)
Mailing Address: 5is9 Om LA) sT E P9.BoX 3o 6, City: "'PIE P[Ar.c) ZIP: 5.5.359
Contact Person: "ToE elcPNErtso-✓ Applicant is: Contractor / Homeowner (Circle One)
Email and/Or Fax: Joo gprdein- .i.r.,rs. cern 4'993)'474- 3g g
PROPERTY OWNER INFORMATION:
Name: �44 5 S ?FE S FF F IZ
Phone (day): (gsay'7(-a?144
Address: City: ZIP:
Email and/or Fax J •
en(;wso., Q yalcoo . covi
ARCHITECT/ENGINEER INFORMATION:
Name: 4dol.o.vayA4be pE5r6•v 6RouP
Phone (day): (4s.2) .?4o - 9S43
Address: /84,S3 PO4)6E40SN CT. City: IAEA, P.tgsesE ZIP: SS34`7
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
igNew Construction Jg Single Family with igResidence
❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial g Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
**Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review&permits. ❑ Industrial y[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.orq
Estimated Construction Valuation (excluding land) $ 350,o o —
Last Updated: 5/21/2009
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•
STRUCTURE INFORMATION:
1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction
a. Length (ft.)= 76 'C. " Number of bedrooms= g Wood/Frame
„ �OdER+►(E E Masonry
b.Width (ft.)= 144 Number of garage stalls: ❑ Metal
Attached = 3 E Pole Bldg.
Areas in square feet Detached = Q( ❑ ICF
E On-site Prefab
c. Basement= /, 53.1 ❑ Off-site Prefab
d. 1st Story = /t 53-1 ❑ Other(please specify):
e. 2nd Story= /,Sl'-I
f. %Story = or.VR
g. Total Area= 1, C?8
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
Not
Enclosed Applicable
0 Permit Application
,Q' ❑ Proposed Building Plans
O +k ❑ MN State Energy Code Calculations and Mechanical Code Requirements Form
0 Survey(meeting all requirements)
O if Stormwater Pollution Prevention Plan
O ye X 0 Hardcover Calculation(s)
.� ❑ Septic System Site Evaluation Report
❑ 1ff Access Permit
O Wetland Buffer Improvement Plan (EVA tv►ATroiv/bRpwxa1G Co'"PPETeb - SEE SaevEY)
O Engineered Plans for Retaining Walls 4 feet or above
❑ ❑ Plan Review Fee
❑ 1$ Other
It( SuitautRAc1oR (ova_ Su1401 z T
14( NOT NEEbEA ?ER ?REvsoas compettsArro..i w/ci rY
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 alternative
but to reject it until it is complete;
• Acknowledges the Escrow Agreement is completed and signed; <OWA/E'/t cosCC. $RTti6 7o crTY')
• 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.
Applicant's Signature: ./UC Date:
Last Updated: 5/21/2009
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