HomeMy WebLinkAbout2011-00579 - adv plan review � � CITY OF ORONO PERMIT NO.: 2011-00579
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE Iss[7ED: 07/05/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2850 SOMERSET LA
PIN : 04-117-23-21-0013
LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN
: LOT 006 BLOCK 003
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE . ��L�i��}1��
CONSTRUCTIOIv TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 18,000.00
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APPLICANT ADVANCED PLAN REVIEW 201.34
ROBEY CONSTRUCTION LLC
3806 WESTON AVE TOTAL 201.34
WOODBURY,MN 55125- PAID WITH CC# 8410
(6l2)275-4441
Minnesota State License#:20635859
OWNER
TRANGSRUD,JON&TERESA
2850 SOMERSET LA
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for�vhich this pennit 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 consVuc[ion is
suspended for a period of 180 days at any time af'ter 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.
/ / / /
Applicant Permitee Signature Date Issued By Signature Datc
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
. . �
City of Orono
Building Permit Application �
for New �tru-ctures or Additions
�O� MailiPO Boxr66• �Q 3��t number: �{�� � ��
� Q Crystal Bay, MN 55323-0066 <t�ate received " , � _
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:f�eceived by , `r �. � ���, '�'�£
.� o. Street Address:' �nF r �
�' tii5' 2750 Kelle Parkwa a0f1 U� J�� � � , r : ,,
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�a,kEsxog'w Orono, MN 55356 ��,��� S , � � � rt
�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 appfications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: g�� ,Sd w��e�"S�e �/\.
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If yes,a specia!event permit is required with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service wil/be
required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be al/owed.
CONTRACTOR/APP ICANT INFORMATION: �� L��
Name: � e Ca�i S F►�✓c..
State License# Expiration Date: '3^ 3 1 -
Phone: �'L- � � "�J office sa.�� cell
Mailing Address: g' es�--'� Cit : �r,, e��- ZIP: SS/Z�'
Contact Person: /�;,�( �b.e c� Applicant is: ontracto �/ omeowner (Circle One)
Email and/or Fax: �p t�e:� Cc� S r v��I-1b�t� ��f����
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PROPERTY OWNER INFORMATION:
Name: � � �
Phone (day): 61 Z^ �I`�f''- � .��
Address: �gs� �,������ City: �rorl0 ZIP: S,��i�
Email and/or Fax
ARCHITECT/ENGINEER INFO ATION: �1
Name: �v S C.�e!� 4 .iT S.S�C r�'�2�5
Phone (day): G n� �S - �'�
Address: �7�" yv��_r iC� S' , s�i`�-e SO� City: �/�.� ZIP: S,S y�
Email and/or Fax: �(2- 3 Sy' 3� %
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8�
Water Supply
❑ New Construction ❑Single Family with ;�tesidence
❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
�.Other.(specify) rk �f'� ❑ Multiple Family/Condo ❑Warehouse
-l-+a �t1 ��y�-,vur� ' ❑ Public ❑Storage ❑ Public Water
"'Any earth movement rrl y requ re ❑ Commercial ❑ Other(specify)
MCWD review 8�permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:(specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.or
Estimated Construction Valuation (exduding land) $ ,o(,�� r
Last Updated: 4/26/2011 �
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