HomeMy WebLinkAbout2015-00755 - adv plan review CITY OF ORONO * Z 0 1 5 - 0 0 7 5 5 *
,, 2750 KELLEY PARKWAY DATE ISSUE�: 06/1U2015
E ORONO, MN 55356-
952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2760 SHADYWOOD RD
PIN : 21-117-23-24-0040
LEGAL DESC : REG. LAND SURVEY NO. 1196
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUAT[ON : $ 110,000.00
NOTE: PLEASE FILL IN THE FOLLOW[NG:
VALUATION OF PERM[T:$ 110,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ATTACHED GARAGE
PERMIT#THIS PRE-PAYMENT[S TIED TO:2015-00754
APPLICANT ADVANCED PLAN REVIEW 762.18
CREATIVE BUILDERS [NC. TOTAL 76218
5958 FENNING AVE SE Payment(s)
DELANO,MN 55328- CHECK 7032 762.18
(952)955-3062
Minnesota State License#: BUIL-BC037260
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OWNER 21u�� Kellry Parkway
Ornno MN 55;�56 952-249-�460U
ENGLER,JEFF Receipt No: �.013610 .ii.�n 1 I, �016
3330 MARTHA LANE
MINNETONKA, MN 55345- Creatide Builders Inc
f�revious Balance: ���
Permits
AGREEMENT AND SWORN STATEMENT ZR��-�0755 276U Shadywood 70�.�g
The work for which this permit is issued shall be performed according to 101-34410
the approved plans and specifications,applicable City approvals,and the Plan Cherk/Si te EXam Fees
State Building Code. This permit is for only the work described and does TUtc�l: �
not gran[permission for additional or related work which requires sepazate 76L,1 i?
permi[s. All provisions of laws and ordinances governing this type of work ('f'ie�k `
shall be compied with whether or not specified herein.This permit will ChecK N0: 7032 762.���
expire and become null and void if construction authorized is not Payor:
commenced within l80 days ofthe date of issuance,or ifconstruction is _ Greative Bui lders If1C
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 `
cevoked at any time for due cause. �
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Applicant Pe ignature Date Issued By Signature Date
� CITY OF ORONO
; BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
�O�O Mailing Address: Permit number: � —�d� 'rJ
PO Box 66
Crystal Bay, MN 55323-0066 Date received: � ( � S
�, ,, Street Address:'
Received by:
y G` 2750 Kelley Parkway �r fV1 Plan review fee: �
��'�kESH��� Orono, MN 55356 Tlw
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 wiil be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: ���� �h�-� ��� ���
Will this be a Parade of Homes, Ftemodelers S owcase Home or other Display Home? ❑ Yes No
lf yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLlCA,NT� INFORMATION:
Name: G����7'-�� ��S
State License# O 31a.6o Expiration Date: 3 3 —�
Phone: cell 6�L—?60-2��Z office
Mailing Address: �9 � �en K�.� �- S� Cit : d ZIP: � Z
Contact Person: :;� �,� z Applicant is: Contractor / Homeowner �c���ie o�e�
Email and/or Fax: �f��-�='.t��,.�-l�J.«Sl3 �,/,�koo ��e,�-7
PROPERTY OWNER INFO ATION:
Name: �� � (-�
Phone (day): T6o - �lo - �o
Address: d-16� l� �o Cit : C�/6K� ZIP: S��/
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name: T���-��! L«+
Phone (day): �.<>3- y6y - � 'y r
Address: I z�� �.� U=cs,� � .�t� _ Cit : ,sc��.� ZIP: �l� }
Email and/or Fax:
PROJECT INFORMATION: Description of project: ��Z�-�G ���
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8�
Water Supply
❑ New Constructio� �] Single Family with ❑Accessory Bldg./Garage
�Addition "��-'�-�-�— 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 4-feet or greater �,Public Water
**Any earth movement may also require ❑ Commercial ❑Storage
MCWD review&permits. ❑ fndustrial ❑Warehouse ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify)
15320 Minnetonka Blvd
Minnetonka, MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
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Estimated Construction Valuation (excluding land) $ �1�, (`i�3C�
Last Updated: January 2015