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Home My WebLink About2010-01040 - accessory building CITY OF ORONO PERMIT NO.: 2010-01040 2750 KELLEY PARKWAY r ORONO, MN 55356- DATE ISSUED: 10/2U2010 " (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3800 DICKSON EXTENSION PIN : 17-117-23-31-0020 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 001 BLOCK O10 PERMIT TYPE : ADVANCED PLAN REV[EW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 1,800.00 NO"CF: PLI;ASE FILL IN"I'l IF,FOLLOWING: VALUA"r[ON OF PERMI"r: $ 1800.00 I'YYF,OF PF,RMI��THIS YAYMEN"I'IS FOR: nN ACCGSSORY BUILD[NG TI IIS PRG-PAYMENT IS TIED TO: 2010-01013 APPLICANT ADVANCED PLAN REVIEW 43J1 ADAM BLAIR, KELLY HARRISON/ TOTAL 43.71 3800 DICKSON EXTENSION SPRING PARK, MN 55384- OWNER ADAM BLAIR, KELLY HARR[SON/ 3800 DICKSON EXTENSION SPRING PARK, MN 55384- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be perYormed according to the approved plans and specifications,applicable City approvals,and thc State Building Code. "�his pennit is for only the work described and docs not grant permission for additional or related work which requires separate permits. nll provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.'I�his permit will expire and become null and void if construction authorized is not commenccd within 180 days of thc date of issuance,or if construction is suspended for a period of I 80 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with U�e State[3uilding Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued{3y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. D �� ' � City of Orono � Buii in � d g Permit Application ��,� for New Structures or Additions Mailing Address: � � � }� �� O�(,L,O,�O PO Box 66 Permit number: � Crystal Bay, MN 55323-0066 Date received: � � d Q��`,�- Received by: � � s. StreetAddress:' ..�„�a �'� �'�'.� �~ 2750 Kelley Parkway Plan review fee: ��j •Z � t�kESH�4'� Orono, MN 55356 Total Fee: a�� /� � / Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and ail required information must be submitted. Incomplete applications wili be returned. (Please prrnt) GENERAL INFORMATION: Job Site Address: � � �d ��c�s� E�f Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o If yes, a special event permit is required with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLI�INFORMATION: Name: /„�j/qiY' State License# Expiration Date: Phone: 2/f�-3¢3 - 6gS� (office) (celi) Mailing Address: o D��is �tve E7rf Cit : S n Rw% S'S �- Contact Person: App(icant is: Contractor I (Circle One) Email and/or Fax: PROPERTY OWNER INF R ATION: Name: �� g�9'/Y Phone (day): 2 (g -3¢3.�gSS Address: � Oo ��'�.�rs�vr E� City: S��^} ��'/� ZIP: S S 3 $� Email and/or Fax q�(A�,�6(q,r C� 9��' � � ARCHITECT/ 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 8� Water Supply ❑ New Construction ❑ Single Family with ❑ Residence ❑ Addition attached garage '�`6�rage/Accessory Bidg. ❑ Public Sewer �Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multipie Famity/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water `"Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ fndustrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ,�Other: (specify) 18202 Minnetonka Blvd i S'far�� w�� Q✓¢� qr(a �`f"x �¢' Deephaven, MN 55391 �si►� ¢x,s,yt� ��p.,n/, Phone: 952-471-0590 ��d� � ��,�d Fax: 952-471-0682 �M 6� www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ p0 �-� Last Updated: 9/29/2009 - 17 - STRUCTURE INFORMATION: ,� 1.Structure Dime�sions 1. Structure Dimensions (continued) 2.Type of Construction ' , a. Length (ft.)= ��- Number of bedrooms = ❑Wood/Frame ❑ Masonry b.Width (ft.)= �Z' Number of garage stalls: ❑ Metal Attached = ❑ Pole Bldg. Areas in square feet Detached = ❑ ICF ❑ On-site Prefab c. Basement= ❑ Off-site Prefab d. 152 Story = ❑ Other(please specify): e. 2"d Story= f. '/2 Story = g.Total Area= REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed Ap licable � ❑ Permit Ap lication ❑ �d 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 � g Wetland Buffer Im rovement Plan � � En ineered Plans for Retainin 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. ApplicanYs Signature: ! Date: !�/z��v Last Updated: 9/29/20Q9 - 18-