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� Chamberlain Capital LLC <br /> Previous Balance: <br /> .00 <br /> Permits 5,157.48 <br /> 2015-01199 <br /> 101-34410 <br /> Plan Check/Site Exam Fees <br /> --------------- <br /> _V-_- 5_157j48 City of Orono <br /> Total: ______ <br /> Check 5,157.48 iing Permit Application <br /> Check No: 933 <br /> Payor: V Structures or Additions <br /> Chamberlain Capital LLC <br /> Total Applied: 5,157.48 Address: <br /> _____ Box 66 Permit number: ' � �b l( <br /> 00_ 'stal Bay,MN 55323-0066 Date received: � <br /> Change Tendered: _ " <br /> ===---"`- ddress:' <br /> - -- <br /> - _ . � Received by: <br /> 09/17/2015 02:41PM 0 Keiley Parkw /���' <br /> �o, MN 55356 �,�,�� Plan review fee:� � , �g � <br /> i2-249-4600 o af�ee: � 3 <br /> '-249-4616 www.ci.orono.mn.us <br /> �mpleted in full and all required information must be submitted. <br /> pplications will be retumed. (P/ease print) <br /> ,�ood Rd <br /> �rs Showcase Home or other Display Home? Yes No <br /> -�� ��� . - ...••...�y�„aa wrtn�olice Deparfinent and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> �Cyuued unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Chamberlain Fine Custom Homes <br /> State License# Expiration Date: <br /> Phone: cell - - (office) <br /> Mailing Address: 11578 Chamberla�n Ct Ci . Eden Praine ZIP: 55344 <br /> Contact Person: Pau ameron Applicant is: ontracto / Homeowner <br /> Email and/or Fax: Pau ,C am er a�ncap.com cci►�ieo�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: _Chamberlain Capital LLC <br /> Phone(day): y52 649 7653 <br /> Address: am er am t Ci : Eden Prairie Z�p. 55344 <br /> Email and/or Fax Paul ,Chamberlaincap com <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Design Group C/Christine Charles <br /> Phone(day): - - <br /> Address: C� : ZIP. <br /> Email and/or Fax: ccharles(u�designQroupc.com <br /> PROJECT INFORMATION: Descri tion of ro'ect: � <br /> 1.Type�f Project 2.Proposed Use 3.Structure T <br /> YPe 4.Sewage Disposal 8 <br /> �lew Construction Water Supply <br /> �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial �Public Sewer <br /> ❑Relocation detached ara e <br /> 9 9 �Residence <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Retaining Wall(s) �Private Sewer <br /> ❑Public 4-feet or greater �Public Water <br /> '"My earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8�permits. ❑Industrial ❑Warehouse <br /> Minnehaha Creek Watershed District(MCWD) ❑Pfivate Well <br /> �5320 Minnetonka Blvd ❑Other: (specify) ❑Other(specify) <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 i <br /> www.minnehahacreek.o ; <br /> 4 <br /> Estimated Construction Valuation (excluding land) $ 1.4 million <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />