The URL can be used to link to this page

Home My WebLink About2009-00303 - adv plan review CITY OF ORONO PERMIT NO.: 2009-00303 „ 2750 KELLEY PARKWAY ORONO,MN 55356- DATE IssuEn: 06/10/2009 � 952 249-4600 FAX: 952 249-4616 - ADDRESS : 225 HOLLANDER RD PIN : 25-118-23-44-0007 LEGAL DESC : HOLLY ACRES 2ND ADDN : LOT 002 BLOCK 001 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 35,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: SWIMMING POOL PERMIT#THIS PRE-PAYMENT IS TIED TO:2009-00304 APPLICANT ADVANCED PLAN REVIEW 338.33 ATLANTIS POOLS TOTAL 338.33 4321 68TH AVE N BROOKLYN CENTER,MN 55429 (763)560-0103 OWNER CLOSE,JILL&LOUIS 225 HOLLANDER RD 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 pertnit is for only the work described and does not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances goveming this type of work sFtall 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 aze 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: �.,�,j� Permit number. Z�%« - - "� PO Box 66 L`'�� Q Crystal Bay, MN 55323-0066 Date received: (.,o / I U � ��:�,� �>�� 1�� `� � StreetAddress:' Received by: �1� '�'�'��'r��.� �� 2750 Kelley Parkway �3 �' lan review fee: `�fcEs�o�� Orono,MN 55356 �'Y�`; L ,�� Total Fee: �� C K" 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 retum�d. (Please print) GENERAL INFORMATION: Job Site Address: �� , � G-t k'1� f` Gx�A_ Will this be a Parade of homes, Kemodelers Showcase Home or other Dis pla y Home? ❑ Ye s � N o lf y e s,a s p e c i a l e v e n t p e r m i t i s r e q u i r e d w i f h P o l i c e Depa�tmen t and City Council approval 60 days prior to the event. Shuttle bus service will be required un/ess applicant demonslrates su�cient on-site pa�king is avaifable. Non-permitted events will not be a/lowed. CONTRACTOR/APPLICANT INFORMA�I�N: Name: _ �-�-�. E�'�e`� eiff�� -L�.�►C State License# Expiration Date: Phone: f�(s�.� _=��, -� .-�>� office Mailing Address: ' a _ �i� ��'��'2 5��r� cell =� Cit : -x ;[_ j ZIP: S �2�' Contact Person: ;iY�� i c.l�,r l S , Applicant is ntracto / Homeowner (Circle One) Email and/or Fax: �-r7;.j� � �l� � - ° �, �2 - "�� 1 • � PROPERTY OWNER INFORMATION: Name: �! i , d � . ` ` ( � ` Phone(day): s� �- ` �-( � �Z`�gf� Address: � S � . ��.z c!�-�.._ /�� Cit :v � � ZIP: � `� i! Email and/or 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 ❑Gara e/Accesso Bld ❑Accessory Building g rY 9• ❑ Public Sewer [] Relocation , ❑ Single Family with ❑ Deck [�Other.(specify) �1 � + ' detached garage ❑ Office/Commercial ❑ Private Sewer `��.� ❑ Multiple Family/Condo ❑Warehouse � ❑ Public ❑Stora e '`*Any earth movement ma re uire 9 ❑ Public Water Y q ❑Commercial 0 Other(specify) MCWD review&permits. ❑ Industnal S .; ��..;,i��•� �� private Well Minnehaha Creek Watershed District(MCWD) �Other.(speCify) 18202 Minnetonka Blvd �- Deephaven,MN 55391 ��'` ' � � �+3 "'� Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation(excluding land) $ ��`� ��-,�r ��_ Last Updated: 5/21/2009 -20- a ♦ TRUCTURE INFORMATION: .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 stalis: ❑ Metal Attached= ❑ Pole Bldg. Areas in sauare feet Detached= ❑ ICF ❑On-site Prefab c.Basement= ❑ Off-site Prefab d. 1gt 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 our a lication to be rocessed: °Not ' fnclosed licable � ❑ Permit A lication � ❑ Pro osed Buildin Plans � 0 MN State Ene Code Calculations and Mechanical Code R uirements Form � ❑ Surve meetin all r 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 5500; • 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 altemative 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 govemmental agencies required by law. If you refuse to supply the information,the application may not be issued. ApplicanYs Signature: � Date: � • Last Updated: 5/21/2009 -21 -