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City of Orono <br /> � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Marling Address: <br /> ��Q A.� PO Box 66 Permit number: � ��`�j�( <br /> / �VQ�� Crystal Bay, MN 55323-0066 Date received: �t � �f� � <br /> / � StreetAddress:' Received by: �� <br /> �y� G'-� 2750 Kelley Park y 2b���'d U �)f y plan review fee: � � �� . �� <br /> \� Orono, MN 55356 ���- � / <br /> �kFSHot` Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orona.mn.us <br /> This application fo�m must be completed in full and ali required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 134t) Fox Street <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> !f yes.a specia/event permit is required with Police Deparfinent and City Council approval 60 days prior fo the event. Shuttle bus service will be <br /> requrred unless applrcant demonstrates sufficrent on-srte parking is avaitable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Chamberlain Fine Custom Homes <br /> State License# BC661410 Expiration Date: 3/16 <br /> Phone: (cell) 952-(49-7653 (office) <br /> Mailing Address: 11578 Chamberlain Ct City:Eden Prairie ZIP: 55344 <br /> Contact Person: Paul Cameron Applicant is: ontrac / Homeowner (Circle One) <br /> Er�ail andlor Fax: Paul(a?Chamberlainca�.coin <br /> PROPERTY OWNER INFORMATION: <br /> Name: Chamberlain Capital LLC <br /> Phone(day): 952-649-7C53 <br /> Address: 11578 Chamberl�in Ct City: Eden Prairie ZIP:»344 <br /> Email andlor Fax Paul(a��Chamberlaincap.com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Teardown and new residential <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> �New Construction �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck (�Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse � Private Well <br /> ti1innehaha Creek Watershed District(MCWD) ❑Other. (specify) ❑ Other(specify) <br /> 15320 h1innetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> �Nvw.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ������� <br /> Packet Last Updafed: January 2015 <br /> Page 20 <br />