HomeMy WebLinkAbout2016-00023 - adv plan review CITY OF ORONO * Z 0 1 6 - 0 0 0 2 3 *
2750 KELLEY PARKWAY DATE ISSUED: 01107l2016
E • ORONO, MN 55356-
(952) 249-4600 FAX: 952) 249-4616
ADDRESS : 60 SMITH AVE
PIN : 02-117-23-21-0003
LEGAL DESC : ORONO ORCHARDS
: LOT 041 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
COIYSTRUCT[ON TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 550,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$550,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR:ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00022
APPLICANT ADVANCED PLAN REVIEW 2,530.07
TOTAL 2,530.07
REPLACEMENT HOUSING SERVICES Payment(s)
5200 WILSON RD#150 CHECK 3575 2,530.07
EDINA, MN 55424-
(952)836-2665
Minnesota State License#: BUIL-BC643121
OWNER
MILLER,ROBERT
60 SMITH AVE
WAYZATA,MN 55391-
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 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
cequested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Sig ature Date Issued By Sigriature Date
� ' City of Orono
Building Permit Application
for New Structures or Additions
MailiPgO Bd�d 6s6s: Permit number: Z���' -Z
�O�Q Crystal Bay, MN 55323-0066 Date received: � � "—�tp
Street Address:� Received by: � ��
y � 2750 Kelley Parkw � �d� •
�' c> Orono,MN 55356 C� - .-� Plan review fee: _��
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�kfSHOQ'�` Main: 952-249-4600 Total ee:
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: ��p ���� /���
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. 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 INFORMATION: ,
Name: R.��I.,.��..��,,.� I.�_„ � 5�„.,► e �
State License# 5�,����� ��
(�(,.,(d4-3a�_� Expiration bate: �/3t��-�
Phone: (cell) c�12-�, S--r��g (office) �yS -���- � _
Mailing Address: � Ci : ZIP: -
Contact Person: �„o,.., ���,,rQ,Y,-��Q � Applicant is: Contract / Homeowner (Circle One)
Email and/or Fax: ��.,�„ ��������„`�,,�,o�,��`�� .� �N„
PROPERTY OWNER INFORMATION:
Name: Ro1�„-}- IM;11 w
Phone (day): �g��� �S_ ����
Address: �� SM:�^ �� City: d���� ZIP:�J� � ►
Email and/or Fax ,�ol�.a-;,��,F,;��p ��e f,t,.4..��,��i L��
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ARCHITECT/ENGINEER INFORMATION:
Name: g� /��� 4,: k�� < j��. �- 5}.oY 1.�.-��
Phone (day): ���, g,�p_c��a�
Address: Ci :N ZIP: 5
Email and/or Fax: r����.r�\s s�^L��-,
PROJECT INFORMATION: Descri tion of pro�ect:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8
Water Supply
❑ New Construction �Single Family with ❑Accessory Bldg./Garage
�Addition attached garage ❑ Deck
❑Accesso Buildin � Public Sewer
ry g ❑ Single Family with ❑Office/Commercial
❑ Relocation , detached garage � Residence ❑ Private Sewer
�Other.(specify) �h...��� ❑Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater ❑ Public Water
"*Any earth movement may require ❑Commercial ❑Storage
MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well
Minnehaha Creek Watershed District(MCWD) ❑Othef:(specify) ❑Other(speCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952�71-0590
Fax: 952-471-0682
www.minnehahacreek.o
Estimated Construction Valuation (excluding land) $ -rjrjQ.pc�
Packet Last Updated: August 2015
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