HomeMy WebLinkAbout2017-00199 - adv plan review CITY OF ORONO * z 0 1 7 — 0 0 1 9 9 *
2750 KELLEY PARKWAY DATE ISSUEn: 03/03/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRES� : 1480 SIXTH AVE N
Pln : 26-118-23-32-0008
LEGAL DESC : DOUGLAS ESTATES
: LOT 001 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 5,000.00
NOTE: PLEASE FILL IN THE FOLLOW[NG:
VALUAT[ON OF PERMIT:$ 5,000.00
1'YPE OF PERMIT THIS PAYMENT IS FOR: SHED
PFRMIT#TH[S PRE-PAYMENT IS T[ED TO:2017-00198
APPLICANT ADVANCED PLAN REVIEW 80.52
GULBRANDSON, DAN &ERICKA TOTAL 80.52
Payment(s)
1480 SIXTH AVE N CHECK 8176 80.52
LONG LAKE, MN 55356-
OWNER
GULBRANDSON, DAN&ERICKA
1480 SIXTH AVE N
LONG LAKE, MN 55356-
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 separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit wiil
expire and become null and void if construction 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 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
�
revoked at any time for due cause. )
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Applicant ermitee Signature Date Issued By Signature Date
CITY OF ORONO
„ BUILDING PERMIT APPLICATION
�" FOR NEW STRUCTURES OR ADDITIONS
�O A, Mailing Address: Permit number: c�(�� �`� � O
`VO PO Box 66
Crystal Bay, MN 55323-0066 Date received:
,R,eceived by:
�, ,, Streef Address:' �-----�� ��
S'�. : 2750 Kelley Parkway ��� � P an review fee: , �� �
`qkESH���G Orono, MN 55356 �- ---�- ' ��- �
Main: 952-249�600 --
Total Fee:
Fax: 952-249�616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete appllcations will be retumed. (Please print)
GENERAL INFORMATION:
Job Site Address: 1�}go G R l� O«,a,e S�5 3 S�o
Vllill this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ❑ No
If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CQNTRACTOR/APPLICANT INFORMATION:
N�me: N Ar 5�m� w5 a�-r�c�—
State License# Expiration Date:
Ploone: (cell) (office)
M�iling Address: City: ZIP�
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: Eri{sw G-ul6rwr�Sav�+
PMone(day): lp1'1 �3 09 • o I I�}
Address: I�•f�0 GN-. lo City: p�..,�e Zlp: 5�53$��
Email and/or Fax ��A y Ib�•a�r,dsa►� C� q M►+w��. Go�
ARCHITECT/ENGINEER INFORMATION:
Name: N A.
Phone(day):
Address: City. Z�p•
Email and/or Fax:
PROJECT INFORMATION: Descri tion of ro�ect: ,�/�' I��/
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewa e Dis
9 Posal&
Water Supply
❑ New Construction ❑Single Family with ❑Accessory Bldg./Garage
❑Addition attached garage ❑Deck ❑Public Sewer
,�Accessory Building ❑ Single Family with ❑Office/Commercial
❑ Relocation detached garage ❑ Residence
❑Other:(specify) ❑Multi le Famil /Condo ❑Private Sewer
p y ❑ Retaining Wall(s)
❑Public feet or greater ❑Public Water
**Any earth movement may also require ❑Commercial �torage
MCWD review&permits. ❑Industrial ❑Warehouse �Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:{specify) ❑Other(speCify)
15320 Minnetonka Blvd
Mi�netonka,MN 55345
Phone: 952�71-0590
Fax: 952-471-0682
www.mi nnehahacreek.or
Estimated Construction Valuation (excluding land) $ -r,,'�OOp
Last Updated: January 2016