HomeMy WebLinkAbout2015-00156 - Advance Plan Review Fee � . , . CITY OF ORONO * 2 0 1 5 - 0 0 1 5 6 *
2750 KELLEY PARKWAY DATE ISSUED: 02/06/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 1432 SHOREL[NE DR
PIN : 11-117-23-22-0014
LEGAL DESC : UNPLATTED 11 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 150,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 150,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION RFMOUEL
PF,RMI"C#THIS PRE-PAYMENT IS TIED TO:2015-00155
APPLICANT ADVANCED PLAN REVIEW 925.98
TOTAL 925.98
GORDON JAMES CONSTRUCTION Payment(s)
5159 MAIN STREET E CHECK 5464 925.98
P.O. BOX 306
MAPLE PLAIN, MN 55359-
(763)479-3117
Minnesota State License#: BUIL-20531961
OWNER
BORN, LAUREN&JOYCE
1432 SHORELINE DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permi[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 Ihe work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laW�and ordinances governing this type of work
shall be compied with whetl�r or not specified herein."Chis permit will
expire and become null and void if construc[ion authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended f'or a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in confoimance with th tate Building Code.This permit may be
revoked at any time for due caus ���
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Applicant er e Signature at Issued By ignature Date
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�i�y oi urano
2750 Kelley par�Way
Orono MN 55356
Receipt No: 3.012763 952-249-4600
Feb 6, 2p15
Gordon James Const
Previous Balance:
Permits .00
2015-00156
101-34410 925.98
Plan Check/Site Exam Fees
Total: --------------
Check =_______925.98
Check No: 5464 Y
Payor: 925.9g
Gordon James Const
Total Applied:
Change Tendered: -------_925`98
_ .00
02/06/2015 09:53AM-====_--____
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CITY OF ORONO
BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
�O . `O MallingAddress: Permit number:
1�� PO Box 66
Crystal Bay,MN 55323-0066 Date received:
StreetAddress:' Received by;__ ,
__
y �` 2750 Keiley arkway
�, . ,jL 5 y Plan reviewfee: �j 7�- �� .y�
tq ��,L Orono,MN 55356 � � �c�__��S�__ _, '
KES H O _2�_.�_.----
- � - 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. (P/ease print)
GENERAL INFORMATION: t ,
Job Site Address: �� Z.. SytO�('�L{,v�.� � f'l�{.. �(1p
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No
If yes,a special event permlt!s required with Police Department and C(ty Councll approval 60 days prlor to the event. Shutfle bus service will be
required unless applicant demonstrates sufficient on-site parking(s ava11a61e. Non-permitted events wlll not be allowed.
CONTRACTOR/AP LICANT INF RMATION:
Name; �p ` ��,-{�
State License# G,. b Expiration Date: /
Phone: cell Z� office (
Mailing Address: Cit : n, ZIP: S"�'S'.3
Contact Person: �, IE„ Applicant is: ra / Homeowner (Circle One)
Email and/or Fax: (�(�( � qut �vn–"�,�,e�—('c�v�n
PROPERTY OWNER INFORMAT O
Name: �( 1 �,`t""r' �v r�
Phone (day): (rt 2. ?�1 `3 5`BO
Address: r r. Cit : (' ZIP: �,$3�y
Email and/or Fax �-������ � ,���
ARCHITECT/ENGINEER INFORMATION:
Name: Yri,i I��e. Q E }�r�2
Phone (day): G�Z qy�Tt,t �, 6 g�,
Address: Cit : ZIP:
Email and/or Fax: � ,�p .� � Tc� tvw ard aS�al1. CCJ��
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PROJECT INFORMATION: Descri tion of ro'ect:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
❑�New Construction �Single Family with �Residence
4ddition attached garage ❑Garage/Accessory Bldg. �Public Sewer
LJ Accessory Building ❑ Single Family with ❑Deck
❑Relocation detached garage ❑Office/Commercial ❑Private Sewer
❑Other: (specify) 0���` ❑Multiple Family/Condo ❑Warehouse
❑ Public ❑Storage �ublic Water
'''Any earth movement may also require ❑Commercial 0 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) $ _ �'' j �/��