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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions ,( <br /> Mailing Address: Permit number: a0/ —�.! (f/ <br /> t/ 0PO Box 66 <br /> \ Crystal Bay, MN 55323-0066 Date received: —4s—/ <br /> Received by 7 <br /> a. Street Address: <br /> 2750 Kelley Parkway d Plan review fee: 44 W4104 <br /> 9 <br /> Orono, MN 55356 <br /> D/ -O <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 Nww;,c;l,;_orono_;m'1,L1; � y L.D <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: y, <br /> Name: Masterpiece Homes, Inc ` Q/�, <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 Cana7l&. 55117 <br /> Contact Person: Howard Viaen Applicant is: Contract r / 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: 929 Portland Ave Shite #307 City: Min-neapolJg ZIP:F)c,anQ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Masterpiece Homes, Inc . <br /> Phone (day): 651-484-3244 <br /> Address: 127 East County Road C City: Little CanaciP: 55117 <br /> Email and/or Fax: Gt-P-\rPz 27Ca�ma�tPri er�hnmP�mn nnm <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction Single Family with [23 Residence <br /> ❑Addition 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 <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation (excluding land) $ 463 000 <br />