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HomeMy WebLinkAbout2016-00247-VOIDED .� � i� i r�d Z/��/r� . er �n � , '. City of Orono Building Permit Application for New Structures or Additions Mailing Address: Permit nu er: ���� �- ; Z,` PO Box 66 � � �0 Crystal Bay, MN 55323-0066 Date rec ed: 1 l��-- l L, Street Address:� eceiv by: �'-� -- ,� 2750 Kelley Parkway ,�-- —� � �j �� L` Orono, MN 55356 � �!��� �C,'l ��' Clan eview fee: t�j , � qkf5H0�� Main: 952-249-4600 _ C ___— _ � T al�8e-_— Fax: 952-249-4616 :�.�:�z�v,�_ci ororio.�Tin us This application form must be completed in full and all required inf ation must be submitted. Incomplete applications will be returned. (P ase print) GENERAL INFORMATION: Job Site Address: 53 � Ly r� j c /a�t ��� M � � Will this be a Parade of Homes, Remodelers Showcase Home or er isplay Home? ❑ Yes 0 No If yes, a specia/event permit is required with Police Department and City Council approv 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-per ed events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: r � IZ State License# a Expiration Date: i Phone: cell f� � - y _ y �� office Mailing Address: � v ,4 .� ,�P„ d . Cit : M �,,, d ZIP: 5 � Contact Person: 4,,,� „ ,- d Applicant is: Contractor / Homeowner �c���ie o�e� _Email and/or Fax: ti ,.. s,d r� .. r►� PROPERTY OWNER INFORMATION: Name: I:��; d Phone (day): - - 1 Address: �bo I � Cit : M ,,,,. ZIP: SS � Email and/or Fax �:t�;r. � rh 2�- .. .. ARCHITECT/ ENGINEER INFORMATION: Name: /� „ ��,,, Phone (day): y o - �ty -o Address �� U `^�f i �`M�,- - • i ' � Cit : C� � ZIP: i Email and/or Fax: u � 2 �.,.� � - o e -� PROJECT INFORMATION: Descri �on of project: ������'.�-�-� �-' �:"��r�`14�- 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& Water Supply [�New Construction (�Single Family with ❑Accessory Bldg./Garage ❑Addition attached garage ❑ Deck � Public Sewer ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage �Residence ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater � Public Water "`Any earth movement may r uire ❑ Commercial ❑ Storage MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well Minnehaha Creek Watershed Dis ct(MCWD) ❑ Other: (specify) ❑ Other(specify) 15320 Minnetonka Blvd Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � 0 Q i v o p � Packet Last Updated: January 2015 Page 20 �,: � �, t �>ry 8 ,. "'° -. 5 �'P�T�R� INFORM,A'�TIbM� � ���` `_,.� ��:�°;��� � � ,��� a �'�� ,. ,,,� � ' 1.Sfr�wcture Di ensions 1.Structure Dimensions(con ued) 2.Typ� on ru tion ' � I � a. Length (ft.)= �)� Number of bedrooms= ' ' �Wood/Frame b.Width(ft.)= J� � Number of garage stalls: ❑ Masonry Areas in square feet Attached = 3 ❑ Metal ❑ Pole Bldg. c. Basement= i�I V�% Detached = ❑ ICF d. 1s'Story = I ' I (�� ❑ On-site Prefab e.2"d Story= l, l�� ❑ Off-site Prefab f. '/z Story = ❑ Other(please specify): g.Total Area= �y� REQUIRED SUBMITTALS: All of the information must be submitted in order for your application to be processed: Not Enclosed A licable ❑ ❑ Buildin Permit Escrow A reement and Fees � ❑ Plan Review Fee m ❑ Com leted A lication Form � ❑ Pro osed Buildin Plans-2 full size sets,to scale and 1 reduced 11 x 17 or 8'h x 11 set � ❑ Minnesota State Ener Code Calculations and Mechanical Code Re uirements �] ❑ Surve -2 full size, to scale meetin ALL surve re uirements ❑ Hardcover Calculations ❑ � Se tic S stem Certification ❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or Documentation from MCWD statin no ermit is re uired ❑ ❑ Landsca e Walls and/or Retainin Wall Plans ❑ ❑ Stormwater Pollution Prevention Plan SWPPP ❑ ❑ Access Permit K�7 ❑ Data Privac Adviso Form APPLICANTIOWNER 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; • Understands 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. . Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site improvements. 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