HomeMy WebLinkAbout2017-00024 - adv plan review '` '` CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 7 — 0 0 0 2 4 *
DATE ISSUED: OUl?J2017
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 485 STUBBS BAY RD N
PIN : 32-118-23-24-0003
LEGAL DESC : LJNPLATTED 32 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 18,500.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 18,500.00
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2017-00025
APPLICANT ADVANCED PLAN REVIEW 221.47
TOTAL 221.47
JEFF MCCALL CONSTRUCTION Payment(s)
3920 HILLCREST WAY CHECK 12904 221.47
WAYZATA,MN 55391-
(612)71&4345
Minnesota State License#:BUIL-5858
OWI�IER
WILL,JOHN&JOCLYN
485 STUBBS BAY RD 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. 1'his 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 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 Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
A, Mailing Address:
��`VO PO Box 66 - � Permit number: �(�/ '7-dvo a
Crystal Bay, MN 55323-0066�� Date received: /-/ �-/
�, � Sfreet Address: �� ���� _Received b : 2 P � �'Yl
S'�,` G� 2750 Kelley Parkway(/' �� ��p0 p,�j n review fee• -
�kFSHo��. Orono, MN 55356 �C��L�,
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: � �� �Q�
/� lJ
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: �15 5 �►'vfy�p5 12D .H.
Will this be a Parade of Homes, Remodelers Sho e Home or other Display Home? Yes No
If yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service wip be
required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events will not be al/owed.
CONTRACTOR/APPLICANT I ORMATIO
Name: ��� �l� �N����d+� �. 'SNC .
State License# 5�5� Expiration Date: 3� 31 . ��g
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) ��Z.��� , �.3,,�5 (office)
Mailing Address: 3 ��� �i�,,,� �.E�.rs��s, Cit : ��r�p, ZIP: �53
Contact Person: Applicant i ontractor Homeowner (Circle One)
Email and/or Fax: w�NL p�y�•�SN •C�v„�
PROPERTY OWNER INFORMATION:
Name: ��,,� �. ���� ���
Phone(day): �,-y , � �yy �
Address: �ggc, A � • �j , CitY� ��a o ZIP: t�t;,3 z�(�
� Email and/or Fax:
PROJECT INFORMATION: Overall pro'ect descri tion:
Type of Project: Any earth movement may also require
❑ Door(s) �] Remodel ❑ Fire Damage MCWD review 8 permits:
❑ Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,cedar ❑ Restoration 15320 Minnetonka Blvd
❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590
❑Window(s) Fax: 952-471-0682
www.minnehahacreek ora
Estimated Construction Valuation of Project(excluding land) $ l Sd,5 vo •
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are
solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to
reject it until it is complete;
• Some or all of the information that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data.
Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and
intended use of this information is to annually update our records and records of other governmental agencies required by law. If
ou refuse to su I the info at' ,the 'cation ma not be issued.
ApplicanYs Signature: Date: _ � � i z - Zv �-�
Owner's Signature: � Date:
Last Updated:January 2016