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Home My WebLink About2009-00331 - ad plan review CITY OF ORONO PERMIT NO.: 2009-00331 , 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE 1SSUEu: 06/17/2009 � 952 249-4600 FAX: 952 249-4616 ADDRESS : 3235 GRAHAM HILL RD PIN : OS-117-23-14-0068 LEGAL DESC : GRAHAM HILL PRESERVE : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 680,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME PERMIT#TH[S PRE-PAYMENT IS TIED TO:2009-00332 APPLICANT ADVANCED PLAN REVIEW 2,831.89 THOMAS BREN HOMES TOTAL 2,831.89 2073 WAYZATA BLVD. W. #50 WAYZATA, MN 55391 PAID WITH CC# 9364 (952)475-6777 Minnesota State License#: 20128144 OWNER KILL, BOB &COURTNEY NORTH ARM LANE (NONE), 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. � City of Orono Building Permit Application for New Structures or Additions �� Mailing Address: �r�c� _ �;�-�3 %g, ,�\, PO Box 66 Permit number: '� C stal Ba �Q Q\,, ry y, MN 55323-0066 Date received: / /' � �� Received by: �v�� .y., a, i Street Address:' �� cn �' f''� ��;� 2750 Kelley Parkway �� 'pl n eviewfee: ::r� ��/. �j� � �q 4�/ Orono, MN 55356 ��c �1 �Y'�� \�ESHo�i —� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 wvwv.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: SZ�,S (�TL,�-�,�-1►�t {-� (LG �� WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No lf yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil/be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: N am e: T�OM A�S '�"�E Nl �f-��+��.s � C nf� State License# Z.c+t��i ��}�{ Expiration Date: 2 c� f t5 Phone: ��Zs475 - 4��7`7�7 (office) �iZ -75z�— Sf�,10 (cell) Mailing Address v73 �'J t;�A-yC,¢T�4- Wc) �f Cit :,C��F� �,�-K..� ZIP: 53S(c. Contact Person: �"d�Y i'��Q�y' Applicant is: ontrac o / Homeowner (Circle One) Email and/or Fax: ,E,�resr ��ti6,y.t�.s,6� �,tief�r s c,c��i, PROPERTY OWNER INFORMATION: Name: Qa� .� �v.;,rL1T�'�y ,�/�L Phone (day): ` Address: �/p/�� ,¢� G j�' City �r/,��7 ZIP Email andlor Fax 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 & �"New Construction Water Supply [�Single Family with �Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Re�ocation detached garage ❑ Office/Commercial ,�Private Sewer ❑Other: (specify) ❑ Multiple Family J Condo ❑ Warehouse ❑ Public ❑ Storage ❑ Public Water **Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review 8�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 vdww.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � , �-u Last Updated: 5/21/2009 -2� - STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) 2. Type of Construction a. Length(ft.)= �Z�� Number of bedrooms= 7 (�Wood/Frame � ❑ Masonry b. Width (ft.)= �_ Number of garage stalls: ❑ Metal Attached=_,� ❑ Pole Bldg. Areas in spuare feet Detached= ❑ ICF �On-site Prefab c. Basement= I��3t5 ❑Off-site Prefab d. 15`Story = �� ❑Other(please specify): e. 2nd StOry= .1 377 f. '/z Story = g.Total Area= (p� �i REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable � ❑ Permit A lication � ❑ Pro osed Buildin Plans ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form � ❑ Surve meetin all re uirements � 9 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 EscrowAgreement 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: �`f l� � /.. Last Updated: 5/21/2009 -21 -