HomeMy WebLinkAbout2016-00567 - adv plan review CITY OF ORONO * 2 0 1 6 - 0 0 5 6 7 *
2750 KELLEY PARKWAY DATE ISSUED: 05/23/2016
ORONO,MN 55356-
" (952)249-4600 FAX: (952)249-4616
ADDRESS : 2024 SHADYWOOD RD
PIN : 17-117-23-31-0011
LEGAL DESC : GUST S JOHNSONS ADDN
: LOT 004 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 13,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 13,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BOATHOUSE&STEPS
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00566
APPLICANT ADVANCED PLAN REVIEW 161.06
KIEFFER,JOHN&BENJAMIN TOTAL 161.06
2024 SHADYWOOD RD Payment(s)
WAYZATA,MN 55391- CHECK 5263 161.06
OWNER
KIEFFER,JOHN&BENJAMIN
2024 SHADYWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed 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
permiu. All provisions of laws and ordinances governing 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 1 SO 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 are
requested in conformance with the State Building Code.This permit may be
revoke an ime for due cause. ��/J/}
�(/'/
� i�� �(o
Applic ee Signature Date Issued By Si ature Date
, Cityr af Qrono
�uilding Permit Application
' - for �New Structure� or Additions
' Mailing Address: Permit number: • () j
�Q� PO Box 66 ' C �
Q Crystal Bay, MN 55323-0066 Date received:
Street Address:' R
' ,� 2750 Kelley Parkw '�
y�' �~ Orono, MN 55356 �� ��'���r Plan�e�iew- e: ��(
t9xfSH0�� Main: 952-249-4600 Total Fe�e.�� -- -
Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information rnust be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: 2oLq- �,�, o� o( ��,�,p �/vi .J ,S�3q �
Will this be a Parade of Homes, Remode ers Showcase Home or other Display Home? ❑ Yes �N�o
If yes,a special event permit is required with Police Department and Ciry Council approva/60 days prior to the event. Shutt/e bus service lwll be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPUCANT INFORMATION:
Name: 3 -�,�. -� �u l�h �c1�c�
State License# Expiration Date:
Phone: (cell) (i 670 ,fD 4- (office)
Mailing Address: ?.ot4 Sln.�� � Cit : 8r�wo � 5�39/
Contact Person: C1,a-� Applicant is: Contractor / own
(Circle One)
Email and/or Fax: Q�.,(�_c,.„,�o��� v,,,-�n• ,�,,•.,u--, F �,w..
PROPERTY OWNER INFORMATION:
Name:
Phone (day):
Address: City: ZI P�
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name: G-c.�^c.. �e�uk.P/� - ��J.Sa CA.n,(�I���S I �c-•
Phone(day): �SZ_ �4 4- -j� 3 7
Address: 7oz9 Cow�a���•c �� � City: ��.;�� ZIP� �r �39
Email and/or Fax: ('_ �sso�a (a �,,,�,,,,�. �-�,.�
�
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP�
Email and/or Fax:
PROJECT INFORMATION: Description of project: Q�o�� a,nJ R�.�o)a� o�} 1�w�� and J�PJ
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
❑ New Construction Water Supply
❑ Single Family with ❑ Accessory Bldg./Garage
❑Addition attached garage ❑ Deck
�4ccessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer
❑ Relocation detached garage ❑ Residence ❑ Septic
❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate
❑ Public 4-feet or greater may be required)
'�`Any earth movement may require ❑ Commercial � Storage
MCWD review 8�permits. ❑ Industrial Warehouse
Minnehaha Creek Watershed District(MCWD) Q Other: s eCi ❑ PubllC Water
( p fy) ❑ Other(specify)
15320 Minnetonka Blvd;Minnetonka,MN 55345 _ S�e ❑ Private Well
Phone: 952-471-0590 / Fax: 952-471-0682
www.minnehahacreek.orq
Estimated Construction Valuation (excluding land) $ ( � �6 d
—�--�
Packet Last Updated: January 2016
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