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p, / <br /> (��7 <br /> ��' / RECEIVED <br /> . City of Orono aUG 2 � �016 <br /> Building Permit Application <br /> for New Structures or Additions CITYOFORONO <br /> —_, Mailing Address: Permit number. oC O��'��� � <br /> j"� A,\ PO Box 66 � Q ` � <br /> / O`�� ` Crystal Bay, MN 55323-0 �` ,�� Date received: a '.�-T� � <br /> � ' <br /> � ` ,� Street Address:' 1! �; . I/� ived by: � <br /> �,�� 1 ` ; 2750 Kelley Parkway �' �G ��� Plan review fee: � S. � <br /> , .. . Orono, MN 55356 � <br /> �' ��kEsri������ Main: 952-249-4600 Total ��� 4'"O /O/ � <br /> �`"'�`� Fax: 952-249-4616 �������. , �,,c� ; �r�:� u�. -' <br /> This application form must be completed in full and all required information must be sub itted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2480 Casco Point Road,Wayzata,MN 55391 <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 wilf be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �N B��n,��c <br /> State License# Bcssaaiz Expiration Date: o�-s�-2o�a <br /> Phone: (cell) s�2-zso-s2os (office) 952-473-0781 <br /> Mailing Address: 801 Twelve Oaks Center Drive Suite 812 Clt : Wa zata ZIP: 55391 <br /> CoIltaCt PePSOrI: rzaino Nieme�a Applicant is: Contractor / Homeowner (Circle One) <br /> E(7181� 8tld/Of FBX: raino@jnbuilt.com <br /> PROPERTY OWNER INFORMATION: <br /> Na�pg: Stephen J.Rudolph <br /> Phone(day): �sa-asa-aos� <br /> Addf6SS: 2480 Casco Point Road City:Wayzata ZIP: 55391 <br /> Email and/or Fax steve.rudolph@yahoo.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Nafpg: Murphy&Co.Design <br /> Phone (day): siz-a�o-ssi� <br /> AddfESS: 811 Glenwood Avenue,Suite 250 CI�/: Minneapolis ZIP:55405 <br /> E17181I 811d/Of FBX: TJ@murphycodesign.com orjeff@murphycodesign.com <br /> PROJECT INFORMATION: Descri tion of ('O @Ct:Addition and Remodel <br /> 1,Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction 0■ Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck � Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Refocation detached garage � Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4feet or greater 0 Public Water <br /> *"Any earth movement may require ❑Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �,000,000.00 <br /> Packet Last Updated: August 2015 <br /> Page 2f <br />