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Home My WebLink About2009 - 00737 - addn/remodel/repair • CITY OF ORONO PERMIT NO.: 2009-00737 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 10/20/2009 (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4455 WEST BRANCH RD PIN : 07-117-23-21-0015 LEGAL DESC : GARY LINDGREN ADDN : LOT 002 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 0/S BUILDING-UNDEFINED VALUATION : $ 6,800.00 NOTE: THIS PERMIT IS FOR A FOUNDATION REPAIR INSPECTION REQUIRED BEFORE YOU POUR APPLICANT PERMIT FEE SCHEDULE 147.50 VALLEY CONSTRUCTION&REPAIR P.O. BOX 207 STATE SURCHARGE(VALUATION) 3.40 NEW MARKET,MN 55054- TOTAL 150.90 (952)461-1578 Minnesota State License#:20389919 OWNER KLINE& STEVE BELL,JANE 4455 WEST BRANCH RD MOUND,MN 55364- 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 ref -d in conformance with e State Building Code.This permit may be r yoke' at apy time f! . / awaix_ Applicant Permitee ignature :ate Ili 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: Permit number: c73609- 00737 PO Box 66 ‘C‘° Crystal Bay, MN 55323-0066 Date received: /O 02,o c7 9 A 1: 1 ., Street Address:‘ Received by: ��n Il �.' iil � �� 2750 Kelley Parkway Plan review fee: t9kE$Hpg�' Orono, MN 55356 Total Fee: //SD, 96 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: Li YSS Lk). 6ect..n�� Pd . Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YesNo If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service w"ill be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: tAx!Icy Cart frcx..+i. IL A-R�pd,'.� 2'•.c State License# 2 d 3 et? / 9 Expiration Date: Phone: 9'S� -y6j - 15-7V (office) Mailing Address: pi,.� X.D 7 City: �� (°y�-��-a�9`S (cell) X Y fJ , 01).r fZ - ZIP: SSO 5`t Contact Person: u L OH-ea/x.1. I Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: o+-1e_,Ja.l.I a /• Ce)sii. 55a-Sf 6 I- Yen PROPERTY OWNER INFORMATION:t Name: 51-cvc ne I Phone (day): 9 5-2,-y72. _ 11 417 c-J Address: 4 55 > t.', ranc k A el . City: 0 ra ne ZIP: Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): AZ./.-- Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & ❑ New Construction Single Family with KResidence Water Supply ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation t , detached garage ❑ Office/Commercial tz Other: (specify) itrla.�wK P ie ❑ Multiple Family/Condo ❑ Private Sewer p ❑Warehouse ❑ Public ❑ Storage ❑ Public Water **Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&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.orq Estimated Construction Valuation (excluding land) $ 6, 06c , aci 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 ❑ Masonry b.Width (ft.)= Number of garage stalls: ❑ Metal Attached= ❑ Pole Bldg. Areas in square feet Detached= ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 1st Story = ❑ Other(please specify): e. 2nd Story= 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 ❑ ❑ Permit Application • ■ Proposed Building Plans • • MN State Energy Code Calculations and Mechanical Code Requirements Form • ■ Survey(meeting all requirements) • ■ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation(s) ❑ 0 Septic System Site Evaluation Report ❑ 0 Access Permit ❑ 0 Wetland Buffer Improvement Plan ❑ 0 Engineered Plans for Retaining Walls 4 feet or above ❑ 0 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 alternative 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. Applicant's Signature: I �OVA /// Date: JO" 2c — mac( Last Updated: 9/29/2009 - 18 - n / /GAJ„/� TIME CITY OF ORONO CALLED_ IN I v (y INSPECTION NOTICE,,,_, SCHEDULED (O( 7/(Y? 3.Oa PERMIT NQ.0 �` 3� , COMPLETED 1 ADDRESS '4(7 �� Pyeinch OWNER CONTR. \/o . u o ,. .4 (r f TELEPHONE NO. Lo I a a 1 I on DESCRIPTION Li(fldC&skH LL, ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS Cr) ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL • ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL ' OWNER/CONTRACTOR TO MEET YOU:/ YES_NO o COMMENTS: CC W CC O CC O W CC Q W w CC d W�• I QRKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE ❑ RRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ✓ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: � ^3� I Of Inspector. l White Copy/Inspector's File Canary Copy/Site Notice