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City of Orono <br /> 7 Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: cO/O-CC/O0 <br /> 0 Cr Bax 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> A ‘-‘144,'";4- N Street Address: <br /> Received by: <br /> 1.4',44:),t j�,�,, G�ti 2750 Kelley Parkway Plan review fee: lam.57 <br /> �4 Orono, MN 55356c7.10 /O- cote/ <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: 40 Wear Lane <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# 1435 Expiration Date: 3/31/2010 <br /> Phone: 651-484-3244 (office) 612-363-3021 (cell) <br /> Mailing Address: 127 East County Road C City: L,jtt.le CanadaZlP: 55117 <br /> Contact Person: Steve Peters Applicant is: Cntractor ./ Homeowner (circle one) <br /> Email and/or Fax: stevep2/@masterpiecehomesmn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Hugh and Dianna Hoffman <br /> Phone(day): 612-325-6730 <br /> Address: 40 Wear Lane City: Orono ZIP: 55356 <br /> Email and/or Fax hugh.hoffman@)craig-hailum.com <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 /> `� <br /> New Construction )1 Single Family with Residence Water Supply <br /> OAddition attached garage 0 Garage/Accessory Bldg. 0 Public Sewer <br /> Accessory Building 0 Single Family with 0 Deck <br /> 0 Relocation detached garage 0 Office/Commercial Private Sewer <br /> 0 Other: (specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> "*Any earth movement may require 0 Commercial ❑Other(specify) <br /> MCWD review&permits. 0 Industrial 0 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 /> www.m i n nehaha creek.orq <br /> Estimated Construction Valuation(excluding land) $ 20,000 <br /> Last Updated: 9/29/2009 <br /> - 17- <br />