HomeMy WebLinkAbout2010-00510 - adv plan review �
` ' CITY OF ORONO PERMIT NO.: 2oiaoosio
2750 KELLEY PARKWAY
ORONO, MN 5535(- DATE ISSUED: 06/22/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1978 SHADYWOOD RD
PIN : 17-117-23-24-0026
LEGAL DESC : SHADY-WOOD
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 2,981.79
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 2981.79
TYPE OF PERMIT THIS PAYMENT IS FOR: DECK PERMIT
PERMIT#THIS PRE-PAYMENT IS TIED TO: 20 1 0-005 1 1
APPLICANT ADVANCED PLAN REVIEW 57.53
PETERS,BRIAN TOTAL 57.53
1978 SHADYWOOD ROAD
WAYZATA,MN 55391-
OWNER
PETERS,BRIAN
1978 SHADYWOOD ROAD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfortned according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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�f� �a
City of Orono ,,�� 90 ��
Building Permit Application
for New Structures or Additions
Mailing Address: Permit number: O��/O-�,S/l
'gi►�.� PO Box 66
� � Crystal Bay,MN 55323-0066 Date received: �v aL�d
a a StreetAddress:' Received by: �'Jr
�'� " ���' 2750 Kelley Pa�lcway Plan review fee: �,;! '.J'�.�
t'9$�SHp4�' Orono,MN 55356 � ��,..
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: />7,Q S�j��ia Do� � Gc����'Z���- t'��'� ✓��3�/
Will this be a Parade of Homes, Remodele Showcase Hom or oth r Display Home? ❑ Yes ❑ No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. ShutUe bus service will be
required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: ��/'i�tr� '�f���"S
State License# Expiration Date:
Phone: — — �/ 2 o�ce �j ,�— � —��c,� cell
Mailing Address: / 7 S �,��,, Cit : � � ZIP: .5'S
Contact Person: ._Sn,�-,�_ Applicant is: Contracto / omeowner �cir�ieo�e>
Email andlor Fax:
PROPERTY OWNE�FORMATION:
Name: ���i��� �r�t�"�
Phone(day): G/� .�yd�-i�lL;{
Address: ,.5'a�>>t �S � �✓- City ZIp•
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone(day):
Address: City ZIP•
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
❑New Constructi n Water Supply
y� ❑Single Family with ❑Residence
�Addition — ,c(/1�,� attached garage ❑Gara e/Accesso Bld
❑Accesso Buildin 9 rY 9• ❑Public Sewer
�Y g ❑ Single Family with �7(Deck—rc�%kCiri y^l�
❑Relocation detached garage ❑Office/Commerci� ❑Private Sewer
�}Other:(specify) �`cD/r�CiR� r.,��rfh� ❑Multiple Family/Condo ❑Warehouse
� "�tt�L ❑Public ❑Storage ❑Public Water
*"Any earth movement may require ❑Commercial ❑Other(specify)
MCWD review&permits. ❑ Industrial ❑Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:(SpeCify)
18202 Minnetonka Blvd
Oeephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.o
Estimated Construction Valuation (excluding land) � d���. ��
Last Updated: 9/29/2009
- 17-