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City of Orono 7, <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Q y Crystal Bay, MN 55323-0066 Date received: <br /> Received by: <br /> Street Address:' <br /> \ s�, 2750 Kelley Parkway Plan review fee: 99 <br /> \L�AES 10 Orono,MN 55356 _ vv <br /> -' Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 125 Turnham Road <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special 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: Masterpiece Homes, Inc <br /> State License# BC 0 014 3 5 Expiration Date: 3/31/2014 <br /> Phone: 651-484-3244 (office) 612-363-3022 (cell) <br /> Mailing Address: 127 East County Road C City: Little Cana7119: 55117 <br /> Contact Person: Howard Vigen Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: 651-484-7723 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Anthony and Surya Rochel <br /> Phone (day): 612-812-8252 <br /> Address: q7q Pnrtl and Ave Suite #3n7 City: MinnPapnlig ZIP:c r,4n4 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ElNew Construction ElSingle Family with Residence <br /> [2Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd Screen Porch <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 Fireplace Chase <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> $ GG <br /> Estimated Construction Valuation (excluding land) J4, 00 0 <br />