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� <br /> t RECEIVED <br /> ' ' CITY OF ORONO <br /> BUILDING PERMIT APPLICATION MAY � � 7_Otfi <br /> FOR NEW STRUCTURES OR ADDITION��N OF ORONO <br /> �O� �� Mailing Address: Permit number: pZd � —�,S <br /> O PO Box 66 _ <br /> Cl��` �� Crystal Bay, MN 55323-0066 Date received: � "-1 7 C�' ll� <br /> �g - ���� <br /> � Street Address:' �'�����P Receiv�by: �� �1 � }���. <br /> y�, � � 2750 Kelley Parkway Plan review fee: vv„S <br /> �qk�SHO�F,G Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: �f Q� G /_ <br /> Fax: 952-249-4616 www.ci.orono.mn.us / U D �P <br /> This application form must be completed in fuil and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: z445 snaayWooa Road <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes X❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: The Bainev Group Inc. <br /> State License# Expiration Date: <br /> Ph011e: (C@II) 612-968-2733 (OffIC@) 763-231-8182 <br /> Mailing Address: 14�00 28th Ave N. , Suite 30 Clty: Plymouth ZIP: 55447 <br /> Contact Person: Jeff xeiskari Applicant is: on rac / Homeowner (CircleOne) <br /> Email and/or Fax: ,7effh@bainev.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Rri d�ewatPr Rank _- <br /> Phone (day): 9S�-��-�--���� <br /> Address: 380o American Blvd West Suite 100 City: Bloominqton ZIP: 55431 <br /> Email and/or Fax 952-893-6850 <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> N8m2: Momentum Desiqn Group <br /> PhOfl@ (d8y�: 952-583-9788 <br /> Addr@SS: 765 North Hampden Ave Suite 180 Clty: St Paul ZIP: 55114 <br /> Email and/or Fax: Jeff@mdqarchitects.com <br /> PROJECT INFORMATION: Descri tion of pro'ect: Interior remodel - exterior refacin <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck � Public Sewer <br /> ❑Accessory Building ❑ Single Family with X� Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> � Other: (specify) Interior Remodel ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater [�Public Water <br /> "Any earth movement may also require � Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Othe�(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> w�nnv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 6so, o00.o0 <br /> Last Updated: January 2016 <br />