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� <br /> , <br /> � , ,�' ,�'� <br /> � �- '� �q.�9 <br /> City of Orono 1�� � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailin Address: <br /> ���' . PO Box 66 Permit number � �� `L�( <br /> (�'`, Crystal Bay, MN 55323-0066 Date received: � _ <br /> (� 1 Street Address:' —� �G.� � Received by: � �r�d�a�- <br /> � — 2750 Kelley Parkway � `��"�\ Plan review fee:�� �� �� � r � <br /> �, <br /> �`� �^ � � � � Orono, MN 55356 �� r��� � �� �'� � <br /> ... i u 4-..________-- <br /> �,,��.�sN`��ti,' Total Fee: _`_'�----- <br /> Main: 952-249-4600 <br /> -�—T Fax: 952-249-4616 www.ci.oronomn.us �U'� '�1,� � i��-r �'�-� <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: 10 Myrtlewood Rd <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 DepaRment and City Council approva160 days prior to the event. Shuttle bus seniice 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: Chamberlain Fine Custom Homes <br /> State License# Expiration Date: <br /> Phone: (cell) - - (office) <br /> Mailing Address: I 1578 Chamberlain Ct Cit : Eden Prairie ZIP: 55344 <br /> Contact Person: Paul Cameron Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: Paul a,Chamberlaincap.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Chamberlain Capital LLC <br /> Phone (day): 952-649-7653 <br /> Address: am er atn t City: Eden Prairie ZIP: 55344 <br /> Email andlor Fax Paul(c�Chamberlaincap.com <br /> ARCHITECT! ENGINEER INFORMATION: <br /> Name: Design Group C / Christine Charles <br /> Phone (day): - - <br /> Address: City: ZIP: <br /> Email and/or Fax: ccharles(adesign�;roupc.com <br /> 1 <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type�f Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �lew 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 /> 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 /> vvww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 1.4 million <br /> Packet Last Updated. August 2015 <br /> Page 21 <br />