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Home My WebLink About2014-01072 - adv plan review CITY OF ORONO * z B 1 4 - � 1 a 7 2 * �� 2750 KELLEY PARKWAY DATE ISSUED: 09/22/2014 � ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2565 NORTH SHORE DR PIN : 09-117-23-41-0004 LEGAL DESC . UNPLATTED 09 1 17 23 City ot Orono 2750 Kel ley �'ai icway : LOT 000 BLOCK 000 Oruno MN �'�356 952-249-46U0 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE . RESIDENTIAL Receipt No: 3.011'0'36 Sep 22. 2U14 CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 1,000.00 ANURADE, JEFFkEi' & MELISSA NOTE: PLEASE FILL IN THL�: FOLLOWING: Previous Balance: .00 VALUATION OF PGRMIT:$ _1000.00 Permit� p2014-01072 26.81 T'YPE OE�PERMI"I'"I�fiIS YAYMFN'I'IS FOR: SHGD 101-34410 Plan Check/Site Exam Fees PERMI"I'#"I'HIS PRF,-NAYMENT IS"f[F,D TO: 2014-01073 Total: 26.81 Check Check No: 6087 26.81 Payor: ��F .IEFFREY & MELISSA 26.81 APPLICANT ADVANCED PLAN REVIEW 26.81 ANDRADE,JEFFREY L& MELISSA L TOTAL 26.81 Payment(s) 2565 NORTH SHORE DR CHECK 6087 26.81 WAYZATA, MN 5�391- OWNER ANDRADE, JEFFREY L& MEi.ISSA L 2565 NORTH SHORE DR WAYZATA, MN 55391- AGREEMEIYT AND SWORN STATEMENT The work Yix��hich this permit is issued shall be perfonned according to the approved plans and specitications,applicable City approvals,�nd the S[a[e Building Code. This permit is for only the work described and does not grant pennission for additional or related work�chich requires sepnrate permi[s. All provisions of laws and ordinances governing[his type oY work shall be compied��•ith whether or not specified herein.This permit�vill expire and become null and void if construction audiorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 dlys at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in confomiance with the State Building Code.This pennit may be revoked at anv time for due cause. / / Applicant Permitce Signature Date Issucd Ry Signaturc Date � � �"V�lT"V� � /Y �� CJ I i "V � ��% �� ✓ �lY� �L/� v CITY OF ORONO BUILDING PERMIT APPLICATION FOR NEW STRUCTURES OR ADDITIONS �O�O Mailing Address: Permit number: 2(��' �10� PO Box 66 Crystal Bay, MN 55323-0066 Date received: G��•� Street Address:' Received b : y �` 2750 Kelley Parkwa ��(��b � Plan review fee: �� -�� " F �' Orono, MN 55356 t�kESHO�� 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: Job Site Address: �-�� ,/, {j�,�;��_ , ;n ,�__ �_{�,u''L� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle 6us servi "will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: (.�.��,V e:,i� State License# Expiration Date: Phone: (cell) (office) Mailing Address: City: ZIP: _ Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATI ' Name: -� ��1)vYK� /�lY��,'�L�� — Phone (day): � � � � Address: �. — ,J,2-� Cit : � ZIP: �`�'`,'/ _ Email and/or Fax �- ��y,,,n-�-,nf�,t1�,�. C� L !3 �cJ<,�)JErt . U�—. ARCHITECT/ENGINEER INFORMATION: Name: r'��C��._>� Phone (day): Address: City: ZI P: Email and/or Fax: PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & Water Supply ❑ New Construction ❑ Single Family with ❑ Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer �Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public �Storage ❑ Public Water **Any earth movement may also require ❑ Commercial O r(s ecify) 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 www.minnehahacreek.or :aca Estimated Construction Valuation (excluding land) $ i �L�� w- � '� . � , . � ! STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions (continued) 2.Type of Construction a. Length (ft.)= 3 �'� �I Number of bedrooms= �Wood/Frame b.Width (ft.)= ��.• T � Number of garage stalis: ❑ Masonry Areas in square feet , Attached = ❑ Metal ❑ Pole Bldg. c. Basement= Detached = ❑ ICF d. 15t Story = �� ❑ On-site Prefab e.2"d Story= ❑ Off-site Prefab f. '/z Story = ❑ Other(please specify): g.Total Area= 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 ❑ ❑ 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 ❑ � Application Escrow&Agreement ❑ ❑ Other: APPLICANT/OWNER 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. f I � �( i Applicant's Signature: Date: Owner's Signature: z - Date: � Z�E� i�� r . . , . � City of Orono Building Permit Application for New Structures or Additions Mailing Address: .�Q A,.O PO Box 66 Permit number: f w Crystal Bay,MN 55323-0066 Date received: Street Address:' Received by: -� 2750 Kelley Parkway �.� ,G� Plan review fee: c? Orono, MN 55356 �'�kFgyO�� Main: 952-259-4600 Total Fee: 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: �/ Job Site Address: �� c�Q� �!2 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. ShutNe bus se�vice i e required unless applicant demonstrates su�cient on-site parking is available. Non-pem►itted events will not be allowed. CONTRACTOR/APPLICANT INFORMAT Name: c�� s � Ib� State License# Expiration Date: Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORM ION: Name: �1{� q✓�'/ V�q �/`-- Phone(day): .C�CL �I U — �(o2lt Address: ��v Cit : V ZIP: sS3�l'� Email and/or Fax � y� Q v � v►�t,_. ARCHITECT/ENGINEER INFORMATION: Name: Q w�E�-- Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of pro'ect: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� Water Suppty ❑ New Construction ❑ Single Family with ❑ Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer '�Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public �Storage � Public Water *"Any earth movement may require ❑ Commercial Other(specify) MCWD review&permits. ❑ Industrial � Private Well Minnehaha Creek Watershed District(MCWD) �`Other: (specify) 18202 Minnetonka Blvd p � Deephaven, MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ t�v0��' Packet Last Updated: 04/19/2013 Page 22 of 23 � Y • �. � , STRUCTURE INFORMATION: 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length (ft.)= �� Number of bedrooms= � �Wood/Frame b.Width (ft.)= _� Number of garage stalis: ❑ Masonry Areas in square feet Attached= � ❑ �etai ❑ Pole Bldg. c. Basement= Detached=� ❑ ICF d. 15t Story = � ❑ On-site Prefab e. 2"d Story= ❑ Off-site Prefab f. Y2 Story = ❑ Other(please specify): g. Total Area= Z� REQUIRED SUBMITTALS: All of the information must be submitted in order for your apptication 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 ❑ ❑ Stormwater Pollution Prevention Plan ❑ Hardcover Calculation s ❑ ❑ Se tic S stem Site Evaluation Re ort ❑ ❑ Access Permit ❑ O Wetland Buffer Im rovement Plan ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above ; ❑ ❑ Minnehaha Creek Watershed District Permit s ❑ � Plan Review Fee ❑ ❑ Other: APPLICANT/OWNER 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 infoRnation 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, porary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as uilt urve an ite improvements. ApplicanYs Signature: ` Date: �� Owner's Signature: Date: " � � Packet Last Updated: 1 Page 23 of 23