HomeMy WebLinkAbout2013-00482 - adv plan review CITY OF ORONO * 2 0 1 3 - 0 0 4 B 2 *
2750 KELLEY PARKWAY DATE ISSUED: 06/18/2013
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3515 SIXTH AVE N
PIN : 29-118-23-43-0002
LEGAL DESC : UNPLATTED 29 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 80,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ $80000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT
PERMIT#THIS PR�PAYMENT IS TIED TO:2013-00483
APPLICANT ADVANCED PLAN REVIEW 589.39
MITTELSTAEDT INC TOTAL 58939
P O BOX 454
WATERTOWN,MN 55388- PAID WITH CC# 1074
(612)716-9595
Minnesota State License#:20012394
OWNER
WOJCIESZAK,JOY
3515 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 sepazate
permits. 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 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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / �Pll� lI
Applicant Permitee Signature Date ' Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� . � ,,� �_
� CITY OF ORONO � ����
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• BUILDING PERMIT APPLICATION � �'�C�
FOR NEW STRUCTURES OR ADDITtONS
�O • _O Mailing Address: Permit number: 3=D 0 3
1�l PO Box 66
Crystal Bay, MN 55323-0066 Date received: ( � �
StieetAddress:' Received by: C�j�
y�, ti� 2750 Kelley Parkway Plan review fee: 3
� Orono,MN 55356
�'�kFSHo�`�' TotalFee: oZb�3'OO�gy
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in fult and all required information must be submitted.
Incomplete applications will be returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: � / l,
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o
If yes,a special event pem►it is requi►ed with Police Department and City Council approva160 days prior to the evenk Shuttle bus se ' 'll be
required unless applicant demonstrates sutficient on-site parlcing is available. Non permitted events will not be allowed.
CONTRACTOR/APPLI ANT INFORMATION:
Name: � „� , '
State License# ��;q y B<O�.�3�rY Expiration Date: � — /
Phone: cell � — / G g y 5' office fo!.�— 7!G ��-�'ys—
Mailing Address: 1 O r.� mc Ci • A zc.r m.•-H ZIP:
Contact Person: �G� Applicant is: Contrac�or— Homeowner �ci�cie o�e�
Email and/or Fax: �� �,,� ; ,7.�,�I s.F..Q�,�-F, 5i L
PROPERTY OWNER INFORMATION:
Name: /)� /c d-���.,.c Pc�-c�sov�
Phone(day): ��-- S
Address: � �r Ci : ZIP: 6
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name: �C,. �. �,r�k�-rcc-rK r �
Phone(day):
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 Disposal�
Waber Supply
❑ New Construction �,Single Family with �Residence
�Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commeraal � Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
""Any earth movement may also require ❑Commercial ❑Other(specify)
MCWD review 8 permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other: (specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952�71-0590
Fax: 952-471-0682
www.minn hahacreek.or
Estimated Construction Valuation (excluding land) $ �� �(�� �
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