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� � City of Orono Building Permit Application for New Structures or Additions �--� Mailing Address: ; O Permit number: O�d�(o— U�/ �j � A, PO Box 66 % � `v(�� C stal Ba , MN 55323-0066 ; rY Y Date received: d —/� —/ � �� Street Address:' Received by: �\, �� 2750 Kelley Parkway *',�� c,� Orono, MN 55356 Plan review fee: �..��j.�`. D ��kfsHo�� Main: 952-249-4600 Total Fee: d� ��" ��'3Z Fax: 952-249-4616 www ci orono mn us t ��y. ✓ This application form must be completed in full and all required information must b submitted. , Incomplete applications will be returned. (P/ease print) � �5,O IJ� �� GENERAL INFORMATION: � Job Site Address: 1220 Bracketts Point Road, Orono, MN 55391 L'�'"s`� `��g�� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Welch Forsman Associates Incorpora.ted State License# BC005890 Expiration Date: 03/2018 PhOn2: _�Cell) 612-221-0841(Peter Welch);612-221-0842(Don Forsman) (OffIC2) 612-827-4455 Mailing Address: 6026 Pillsbury Avenue South Cit : Minneapolis ZIP: MN 55419 Contact Person: Peter Welch/Don Forsman Applicant is: ontractor / Homeowner (CircleOne) Email and/or Fax: Pete@WelchForsman.com ; Don@WelchForsman.com PROPERTY OWNER INFORMATION: Name: Elizabeth and Jule Hannaford Phone (day): 612-759-8011 Address: 1220 Bracketts Point Road City: Orono ZIP: MN 55391 Email and/or Fax Bhanna1891@aol.com ; Jhannaford@khblaw.com ARCHITECT/ENGINEER INFORMATION: Name: Kar-Keat Chong - Snow Kreilich Architects Phone (day): 612-752-0270 Address: 219 North 2nd Street Suite 120 Cit :Minneapolis ZIP: MN 55401 Email and/or Fax: ar- ea snow rei ic .com PROJECT INFORMATION: Description of pro�ect: 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� Water Supply �New Construction �Single Family with ❑Accessory Bldg. /Garage ❑Addition attached garage ❑ Deck �Public Sewer ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Relocation detached garage �Residence ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ❑ Public 4-feet or greater ❑ Public Water "'Any earth movement may require ❑ Commercial ❑ Storage MCWD review 8�permits. ❑ Industrial ❑Warehouse � Private Well Minnehaha Creek Watershed District(MCWD) � Othe�: (SpeCify) ❑ Other(SpeCify) 15320 Minnetonka Blvd Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ 3,000,000.00 RECEIVED FEB � 0 2016 Packet Last Updated: August 2015 Page 21 (^,,m(OF ORONO