HomeMy WebLinkAbout2011-01279 - adv plan review CITY OF ORONO PERMIT NO.: 2011-01279
� 2750 KELLEY PARKWAY
� . ORONO, MN 55356- DATE ISSUED: 10/20/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2550 SIXTH AVE N
PIN : 28-118-23-41-0005
LEGAL DESC : WILLOW RUN
: LOT 004 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 30,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 30000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT-PORCH ADDITION
PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-01280
APPLICANT ADVANCED PLAN REVIEW 303.39
PINEWSKI BUILDERS TOTAL 303.39
13750 CROSSTOWN DR- SUITE 203
ANDOVER,MN 55304 PAID WITH CC# 7971
(763)753-5095
Minnesota State License#: 6859
OWNER
RICE,EDWARD&TERESA
2550 SIXTH AVE N
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfortned 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 sepazate
permiu. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if consWction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at after work has commenced.
The applicant is responsible for all required inspections aze
requested in confo ce w' ate Building Code.This pertni[may be
revoked at an for e. �
/Di Zo i zol� i i
pplicant Permitee Signature Date Issued By ' ature e
SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED ABOV .
� City of Orono
Building Permit Application
for New Structures or Additions
— _ Mailing Address: Permit number: D( ���2� /
.g,�,�.\ PO Box 66
O � O� Crystal Bay, MN 55323-0066 Date received: �O-Z0-��
���� Received by: ��S
`1a t� ,, StreetAddress:'
\'�, . � G�F/ 2750 Kelley Parkway :Plan review fee: o? D<<-'O l 2.,'j q
\�. , �j Orono, MN 55356 � GG•
���o. 3o3•3�i b6l
_=-- Totaf 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: ��s� " 6 L-
Will 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 approval 60 days prior to the evenk Shuttle bus service will be
required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATIO
Name: �ir�rwa+��f .a �'S
State License# Expiration Date: 3 3/- ZO/Z
Phone: �0 9�` office �/ - Z o -//y cell
Mailing Address: S �s ��`v�c Cit : rr ZIP: ,$� D
Contact Person: v i i Applicant is: ontractor Homeowner (Circle One)
Email andbr Fax: Sfw„� Q �n r�ws�i �t� /vrrr5 � co n►-� 763-y�>- v3�2.-
PROPERTY OWNER INFORM 4�TION:
Name: ,/tS5 ���
Phone(day): � �- �
Address: � O�6 ..J�+^G City: ��� ZIP: ,5 5.���
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone(day):
Address: City: ZIP:
Email and/or Fax:
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 eck
❑ 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 8�pertnits. ❑ Industrial �-Private Well
Minnehaha Creek Watershed Distnct(MCWD) ❑Other. (specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952�71-0590
Fax: 952-471-0682
www.minnehahacreek.o
Estimated Construction Valuation (excluding land) $ �Q pQ�
r