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Home My WebLink About2014-00344 - addn/remodel/repair 01. CITY OF ORONO * 2 0 1 4 - 0 0 3 4 4 2750 KELLEY PARKWAY DATE ISSUED: 04/22/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS 1000 WILLOW DR S PIN : 10-117-23-21-0004 LEGAL DESC UNPLATTED 10 117 23 : LOT 000 BLOCK 000 PERMIT TYPE ADDITION/REMODEL/REPAIR PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDN/REMODEL/REPAIR ACTIVITY 434-RESIDENTIAL VALUATION $ 100,000.00 NOTE: PATIN/TRIM-WINDOW REPLACEMENTS AND NEW STAIRS APPLICANT PERMIT FEE SCHEDULE 1,056.75 HOMES BY LEGACY STATE SURCHARGE(VALUATION) 50.00 P O BOX 245 PaymenTOTAL 1,106.75 CHECK EXCELSIOR,MN 55331- t(s) (612)270-6214 CHECK 1107 1,106.75 Minnesota State License#: BUIL-BC667652 OWNER KLOMBIES,LINDSAY&ANNA 1000 WILLOW DR S WAYZATA,MN 55391 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 St !Oauilding Code.This permit may be revoked at any ' for due cause. App scant Permitee Signature ate Issu y Signature Date f ' CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS O�T Mailing Address: Permit number: VO PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address:' Received by: y 2750 Kelley Parkway Plan review fee: Orono, MN 55356 Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 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: lo U d Ai) 7 (d kO r, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes X 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: is 6 c State License# &C Expiration Date: Phone: (cell) Cl,)-- A -;, e - 6 a i N (office) 5,, Mailing Address: R o u City: ZIP: SS-3 3 Contact Person: Sc t�. Za-..t- Applicant is: ontract / Homeowner (Circle one) Email and/or Fax: Seo-kQ hog.-.QST lQi c� b� ;i�lo.r cover PROPERTY OWNER INFORMATION: Name: G ,Ltd 56L Phone (day): 4l -r - S 3 S— Address: �d 0 0 �,(t t o�.- ��- So -,�L City: Olio ZIP: 5 S3 g Email and/or Fax j i� ,a r, ARCHITECT/ENGINEER INFORMATION: Name: -� Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & Water Supply ❑ New Construction Single Family with ® Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ke t--4. ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water "Any earth movement may also 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.or Estimated Construction Valuation (excluding land) $ 0010 C o. r � STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction a. Length (ft.)= Number of bedrooms= ❑Wood/Frame b.Width (ft.)= Number of garage stalls: ❑ Masonry Areas in square feet Attached = ❑ Metal ❑ Pole Bldg. c. Basement= Detached = ❑ ICF d. 1 s`Story = ❑ On-site Prefab e.2"d Story = ❑ Off-site Prefab f. '/z Story = ❑ Other(please specify): 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 re uirements ❑ ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation(s) ❑ ❑ Septic System Site Evaluation Report ❑ ❑ Access Permit ❑ ❑ Wetland Buffer Improvement Plan ❑ ❑ Engineered Plans for Retaining Walls 4 feet or above ❑ ❑ Plan Review Fee ❑ ❑ Application Escrow&Agreement ❑ ❑ Other: 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: _. �-- Date: �2 G Owner's Signature: Date: TIME CITY OF ORONO CALLED IN L� INSPECTION NOT SCHEDULED PERMIT NO. �3 COMPLETED ADDRESS 10O D 011<L DIC) Dr S• OWNER TELEPHONE NO.IP17- 2,70 CONTRACTOR DESCRIPTION Flo m/f/I W Ihd*(k) tW ❑ FOOTING ❑ PLUMBIN AL [IEXCAV/GRADING/FILLING Q ❑ POURED WALL C1MECHANICAL RI ❑ LAKESHORE/WETLANDS Co (_FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z �❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YEs_NO h COMMENTS: ocQbdve — /Yv 2 ter rf.cam! W Q Ink, -z:w- love-. i Z W Ua AAMMSATISFACTORY:PROCEED ❑PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY C ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V 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 xt inspection 24 hours in advance. (952) 249-4600 Owner tractor on site. Inspector. White Copyllnspector's File Canary CopyMe Notice sc DQE TIME CITY EC ION NO CALLEDIN �/ _ INSPECTION NOT REDUCED `. PERMIT NO "' CMPLETED ADDRESS LeOe W///&uJ A-- OWNER TELEPHONE NO.612 •a 76 6 1( CONTRACTOR DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FIWNG ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO y COMMENTS- W a .SfCII rs C�' J O �f'rQlnytd�i,cy [�l ire �s, fG7F�.e/K t .s.� eN�s W Q � 1s4�cS 2 , Wh)�Kh�� j � route� S.`J• �:.. cC� �h�iecr•�c � •4.'fs.cPe ,0►-evade Go W ❑WORK SATISFAC ORY PROCEED ❑PROJE(`'1'COMPLETE Oe-4e,,706, W ❑CORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY GJ CI BEFORE COVERING PERMANEIgo ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED A_G� ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owns Mractor o Inspector. White CopyAnspector's File Canary CopyMe Notice