HomeMy WebLinkAbout2016-00516 - adv plan review CITY OF ORONO * Z 0 1 6 - PJ P1 5 1 6 *
2750 KELLEY PARKWAY DATE ISSUED: OS/12/2016
�� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2264 SHADYWOOD RD
PIN : 17-117-23-43-0124
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 005 BLOCK 001
PERM[T TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 75,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 75,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: DETACHED GARAGE
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00515
APPLICANT ADVANCED PLAN REVIEW 593.40
S J REUS CONSTRUCTION INC TOTAL 593.40
Payment(s)
3955 MERINO AVE CHECK 5623 593.40
WATERTOWN,MN 55388-
(952)446-1572
Minnesota State License#: BUIL-1513
OWNER
WIPSON, DAVID& LISA
4870 MINNESOTA LANE N
PLYMOUTH, MN 55446-
AGREEME1vT 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 separate
permits. 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 conshuction 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 afrer 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
,
revok t a time for due cause. t
� � — � ! �
� ��� _ r�.�� �� �, ��, l�
Applicant Permitee Signature Date Issued By Signature � Date
CITY OF ORONO
_' BUILDING PERMIT APPLICATION
'� FOR NEW STRUCTURES OR ADDITIONS
�O A,. Mailing Address: Permit number: � �
1 VO P�B�X 66
Crystal Bay, MN 55323-0066 Date received:
y �, Street Address:' �r d ,�L c�� Z� Received by: :S �. �
�, G� 2750 Kelley Parkwa C� �P�n review fee: � . '�/O
�'�kESHO��' Orono,MN 55356 ��b
Main: 952-249-4600 Total Fee:
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: - Z .s-" � �� 6rjr�o� l�f�, p� �J.
Wiil this be a Parade of Homes, R modelers Sh wcase Home or other Display Home? Yes No
If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service ii!be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: ,S' R S Gv�.� '^Rdci ioN ,LN'�,
State License# /S`/ 3 Expiration Date: � 2 0-�
Phone: �cell) G/Z� y/ � (; 7�Z (office)q1"L ^y y6 ^ /3'?Z
Mailing Address: �'y s` '�n �/2 i,tJo GL Cit : G�/�." j �� IP: �"y'S p�
Contact Person: 5' /� lz /t v� Applicant is: Contracto / Homeowner �ci��ie o�e�
Email and/or Fax: t��! �/lviv ��c L /Z%, /1/
PROPERTY OWNER INFORMATION: �
Name: �/�r/�2 GcJ��'J s 4 N
Phone(day): (>l L - '3 S G � �' �/�/Z�-
Address: �2 y .s�j�jPJywval,�/ZJJ City: �/POi✓O ZIP: �.� � �'/
Email and/or Fax
ARCHITECT/ NGINEE INFORMATION:
Name: �j�d!y! !E�O ►�- /.1.�,gOG/Al� 1�vc .
Phone(daY)� / - 3�1 - 3�G y � .rfi yZ-
Address: City: ZIp:
Email and/or Fax:
PROJECT INFORMATION: Descri tion of ro'ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Dtsposal 8
Water Supply
�New Construction ❑ Single Family with �Accessory Bldg./Garage
❑Addi6on attached garage Deck ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage ❑ Residence ❑ Private Sewer
❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4feet or greater ❑ Public Water
""Any earth movement may also require ❑ Commercial ❑Storage
MCWD review 8�permits. ❑ Industrial ❑Warehouse
Minnehaha Creek Watershed District MCWD ❑ P�vate Well
( ) ❑ Other:(specify) p Other(specify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Constructiorr Valuation(excluding land) $ � f^�� �
Last Updated: January 2015 '