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Home My WebLink About2009-00555 - - VOIDED ' ' • CITY OF ORONO PERMIT NO.: 2009-00555 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEn: 952 249-4600 FAX: 952 249-4616 PRINTED WITHOUT ISSUING 1 1/3/2009 ADDRESS : 770 NORTH ARM DR PIN : 06-117-23-43-0009 LEGAL DESC : AUDITOR'S SUBD.NO. 362 : LOT 006 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DECK DETACHED ACTIVITY : 434-RESIDENTIAL NOTE: THIS PERMt"I'WAS VOID-NGW PLAN AND APPLICATION WAS SUI3MITTED TO LYLE. APPLICANT CARLSON,JEFFREY 770 NORTH ARM DR TOTAL MOUND, NIN 55364 PAID WITH CASH PAID WITH CC# RECEIPT NUMBER: OWIVER CARLSON,JEFFREY 770 NORTH ARM DR MOUND,MN 55364 AGREEMENT AND SWORN STATEMENT The wark for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry 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 l80 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 applican[is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked a[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: Permit number: !/[J — �,�,�. , PO Box 66 (,/O �,,, Crystal Bay, MN 55323-0066 Date received: 2 � i' �,`� �' Received by: '�,� �_;y �,�i Street Address:� �'S',F, + �ti� 2750 Kelley Parkway Plan review fee: � �� Orono, MN 55356 `�xEsso4`' i I 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: �,1 � �„/�� Job Site Address: `� �7,C-� ,�(c�+�"� �� 1 ��. �'��C`'G' •�'�'�, '�✓� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes .� No If yes, a special event permit rs required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates su�cient on-site parking rs avarlable. Non-permitted events will not be allowed. CONTRACTOR 1 APPLICANT INFORMATION: ---. Name: .;��-�-�.?.�~e ,.�j��p r1 �q �- C�o t'�,�� "�'"C_,. State License# Expiration Date: Phone: (�'i �� .� �office) (cell) Mailing Address: � City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: � Name: " .L Y'� � J- Gt/1�f GC�t'i � Phone (day): 95'� �- �o � /27') �r�G'"'/ Address: � �j,� P�` , �-Q„W� , �'7 � City: �'1��Cu,n.� ZIP: � Email and/or Fax ARCHITECT/ ENGINEER INFORMATION: /� Name: S ��--e � ��«� � "� �- w f�I"CI IJ5 -+� 1` Phone (day)� t,� � Z �i �-��J �..�q�( Address: City: (�' ,�� Email and/or Fax: I�`� c� �� -�� PROJECT INFORMATION: 1. Type of Project 2. Proposed Use " � �r � il 8 � ' ❑ New Construction ❑ Single F ��`t�'�� I ❑ Addition attache � �UQ� t r�~� �ssory Bldg. �Public Sewer �I ❑ Accessory Building ❑ Single F ❑ Relocation detachE ��i,,�,� �� rcial ❑ Private Sewer �, ❑ Other: (specify) �ti. �}t. ❑ Multiple f � �� ! ❑ Public ll ❑ Public Water � **Any earth movement may require ` ❑ Commerc (t�� MCWD review& permits. ❑ Industrial pl��o �75� ❑ Private Well Minnehaha Creek Watershed Distnct(MCWD) ❑ Other: (sp �rA.�,t.s 18202 Minnetonka Blvd i Deephaven, MN 55391 � I Phone: 952-471-0590 i Fax: 952-471-0682 www.minnehahacreek.orq � ! Estimated Construction Valuation (excluding land) $ �l , pQ(� �- Last Updated 6l22/2009 - 19 - STRUCTURE INFORMATION: 1. Structure Dimensions i 1. Structure Dimensions (continued) i 2. Type of Construction � a. Length (ft.)= i Number of bedrooms= I �Wood/Frame Masonry b. Width (ft.)= Number of garage stalls: ❑ Metal I Attached = i ❑ Pole Bldg. � Areas in square feet I Detached = ❑ ICF � � ❑ On-site Prefab I c. Basement= �� ' ❑ Off-site Prefab d. 15t Story = � ❑ Other(piease specify): � e. 2nd Story= I f. '/z Story = g. Total Area= � I REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: N ot Enclosed A licable ❑ ❑ Permit A lication ❑ ❑ i Pro osed Buildin Plans ❑ ❑ ! MN State Ener Code Calculations and Mechanical Code Re uirements Form O ❑ I Surve meetin all re uirements ❑ � ❑ ' Stormwater Pollution Prevention Plan ❑ ❑ Hardcover Calculation s � ❑ ❑ I 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 ❑ i ❑ 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 appfication 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 I 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. i ApplicanYs Signature: Date: Last Updated: 6/22/2009 -20 -