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* ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: o+70/0—00/00 <br /> 0 , Cr Bax 66 <br /> / Crystal Bay,MN 55323-0066 Date received: <br /> aa Street Address:' Received by: <br /> l G~ 2750 Kelley Parkway Plan review fee: Nee•5/ / 1 <br /> 4111 * Orono, MN 55356 /0- 00/4/ • p1 <br /> Total Fee: `���f • <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us _L y/ <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 E] 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: Little CanadaZIP: 55117 <br /> Contact Person: Steve Peters Applicant is: c_c_ontracto / Homeowner (circle One) <br /> Email and/or Fax: stevep2 atmasterpiecehomesmn.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 /> �{ Water Supply <br /> New Construction .sI Single Family with )AResidence <br /> Addition attached garage Garage/Accessory Bldg. ❑Public Sewer <br /> ❑❑Accessory Building 0 Single Family with 0 Deck <br /> ❑ Relocation detached garage ❑Office/Commercial Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Warehouse <br /> 0 Public ❑Storage 0 Public Water <br /> "*Any earth movement may require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial 0 Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> _www.minnehahacreek.oro <br /> Estimated Construction Valuation(excluding land) $ 20,000 <br /> Last Updated: 9/29/2009 <br /> - 17- <br />