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Home My WebLink About2011-00036 - adv plan review CITY OF ORONO PERMIT NO.: 2011-00036 2750 KELLCY PARKWAY " ORONO, MN 55356- DATE ISSUED: O1/18/2011 � (952) 249-4600 FAX: (952) 249-4616 v ADDRESS : 114 CHEVY CHASE DR PI N . 36-1 18-23-41-0035 LEGAL DESC : HILL O'WAY MANOR : L4T 001 BLOCK 002 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 10,000.00 NOTE: PLGASE FILI, IN"fI lE POI,LOWING: VALUA7'ION OF PLRMI"I': $ 10,000.00 TYPE OF PGKMI'I��I'l l(S NAYMI�N"1'IS FOR: �1DDITION/RGMODGL PI�,RMI"I�#"Il IIS PRI;-P/1YMGNT IS TIED TO:20 1 1-0003 7 APPLICANT ADVANCED PLAN REVIEW 124.64 MARK D. WILLIAMS CUSTOM HOMGS, INC. TOTAL 124.64 P.O. BOX 551 WAYZATA, MN 55391- PA[D WITH CC# 5051 (612)25 I-9750 Minnesota State License#; 2049�1�103 OWNER MCLEAN, CHRISTOPHER& ELIZABETH 1 14 CHEVY CHASE DR WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT l�he work ibr��hidi this permit is issued shall be performed accordine to the approved plans and specitications,applicable City approvals.and U�c State Building Code. This permit is for only the work describcd and does not grant permission for additional or related work which rcquires separate permits. All provisions of la�vs and ordinances�overning this type of work shall be compied�vith whether or not specilicd hercin.This permit will ezpire and become null and void if cunstruction authorj�cJ�not commenced��ithin 180 days of the dat�of�issµare�e,�or ifConstruction is suspended for a period of 180days at�any-tliiie alter work has commenced. The applicant is responsible for ass��ifig all rcquired inspections are requested in coulisrmance��°ith t�e".State Building Code.This permit may be ��, revoked at ayr1�time fo��c�uise. �G�� / i : L �"��-� �/�� / � � ��I �. C`��C_�'/t � � �� Applicant Pernutee Signaturc Date Issued 13��Si�nalurc Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. . � City of Orono ' Building Permit Application for New Structures or Additions Mailing Address: Permit number: O�,L,�,�0 PO Box 66 Crystal Bay, MN 55323-0066 Date received: ��.1�� +;. a, StreetAddress:' Received by: `S� -1 � �ii��" ti �L � � �� 2750 Kelley Parkway Plan review fee: a , (L 'v�g�- �'kE6H�4� Orono, MN 55356 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: � ( ,,� �� , �r . Will this be a Parade of Homes, Remod lers Showcase Home or other Display Home? ❑ Yes No !f yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: ��,hIL D, � ' ;: �.,.,,.5 Cu��+�-� �v�es - v � State License# �a��q �w� Z Expiration Date: Phone: _��as-I —`�7�� (office) (cell) Mailing Address: �.o. °,�,�c s- � Cit : �,, z �.�� ZIP: � � i Contact Person: t'l��r 1� �� ,\\; G� S Applicant is:�ontrac � / Homeowner (Circle One) Email and/or Fax: j�d�' 11 ; �,n�� i��vv.t s � y c,�„r.c� • /�� PROPERTY OWNER INFORMATION: Name: C i��;s iM� (f� � Phone (day): �(S�� SG , a�a � Address: �l�f �I�,,.i 11,,,:,se �,f Y • City: �-Y� �c� ZIP: S5 3� � Email and/or Fax ARCHfTECT/ ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & I Water Supply ❑ New Construcfion �] Single Family with ❑ Residence i Addition � attached garage ❑ Gara e/Accesso Bld Accesso Buildin g �Y 9 ❑ Public Sewer ry g ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Other: s eci ❑ Private Sewer ( p fy) ❑ Multiple Famity/Condo ❑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) ��,y,� �`��„o�� 18202 Minnetonka Blvd Deephaven, MN 55391 � ; „�� Phone: 952-471-0590 Ir � s�� Fax: 952-471-0682 c"7/' Il�„Gf rceV� www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ _i�� ,��, �� 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. 151 Story = ❑ Other(please specify): e. 2"d StOry = f. '/ Story = g. Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed Applicable ❑ Permit Ap lication ❑ Pro osed Buildin Plans ❑ ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form � ❑ Surve meetin all re uirements � ❑ Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation(s) � ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit � ❑ Wetland Buffer Im rovement Plan � ❑ En ineered Plans for Retainin Walls 4 feet or above ❑ ❑ 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 confidenfial. Private data is information which generally cannot be given to the pubfic 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. / —��='`'� i� '� '� -�� J/q � r / � r '� / ,` !/ / Appficant's Signature: , �-��.. <�-'�� , Date: � �� Last Updated: 9/29/2009 - 18 -