HomeMy WebLinkAbout2010-00335 - adv plan review CITY OF ORONO PERMIT NO.: 2010.00335
� 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 05/12/2010
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 2172 SHADYWOOD RD
PIN : 17-117-23-42-0010
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 000 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 755,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$755,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT FOR NEW STRUCTURE
PERMIT#THIS PRE-PAYMENT IS TIED TO:2010-00336
APPLICANT ADVANCED PLAN REVIEW 3,075.64
TRUE NORTH HOMES INC TOTAL 3,075.64
410 LAKEVIEW AVENUE
TONKA BAY,MN 55331-
(612)281-2540
Minnesota State License#:20636839
C�i�:y of Orono
OWNER 2750 Kelley Paria+ay
DORE,STEVEN ��0 � �'�' �-2���
8351 WEST 109TH STREET Receipt No: 3.002557 May 12, 2010
BLOOMINGTON,MN 55438- 5teve Dore
AGREEMENT AND SWORN STATEMENT Per�it5
2010-40335 2172 �adyNood 3,075.64
The work for which this permit is issued shall be performed according to �
the approved plans and specifications,applicable City approvals,and the iQi—�¢1Q
State Building Code. This permit is for only the work described and does Plan Check/5ite Exas Fees
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work TOtdl: 3���J.�F
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not �F1ECk
commenced within 180 days of the date of issuance,or if construction is �1ECk �0� 11� 3t��J.�
suspended for a period of 180 days at any time after work has commenced. ����e
The applicant is responsible for assuring all required inspections are Total Appl ied7 �0�`J.�!
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.
�
4
� City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Permit number: dld-lJL3
Og,�,�0 PO Box 66
Crystal Bay, MN 55323-0066 Date received: /D
.� ,�` �, StreetAddress:' Received by:
�'�� � � ����' 2750 Kelley Parkway �� ��/Z��� Plan review fee: ��� � �
`��'Esxo4`' Orono, MN 55356
c�0 C'j- 0 D3�J`
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: Zl 7Z Slt��y�ooc� /���G�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No
If yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to fhe event. Shuttle bus service will be
required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: Z�� y��o�� �s i�,c
State License# 2a 6 3� g zg Expiration Date: /V��r� zor�
Phone: _2g�-Z q o office cell
Mailing Address: � • e;,� 64�,� Cit : o � ZIP: �533
Contact Person: a�,4ce Ue��.r Applicant is: ontractor / Homeowner (Clrcle One)
Email and/or Fax: -,c w�d�i,,eas�Oul I r2 (� av�,co�
PROPERTY OWNER INFORMATION:
Name: STev� �ov��
Phone (day): 95�- 92 S- 5 0 7.S
Address: 2� » S�Qo��u,av�, City: Deo�O ZIP: 5.53�7 f
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name: ,�OS 1�v�C1�:�ec-�-S
Phone (day): 6l Z- 81 �' - `?6=��
Address.: Cit : � n�o�fl� ZIP:
Email an`d/or Fax: IrS i�I� ;rw C'sw� C�s�, ,v�'�
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
Water Supply
($� New Construction � Single Family with � Residence
❑Addition attached garage ❑ Garage/Accessory Bldg. � Public Sewer
❑ Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ 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
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ �S 5 �oo, c�o
Last Updated: 9/29/2009
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