HomeMy WebLinkAbout2012-00569 - deck replacement CITY OF ORONO * Z 0 1 2 - 0 0 5 6 9 *
2750 KELLEY PARKWAY DATE ISSUED: 06/25/2012
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 455 SUSSEX LA
PIN : 04-117-23-32-0011
LEGAL DESC : FOX BEND
: LOT 005 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 20,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 20000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: DECK REPLACEMENT
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-005'70
APPLICANT ADVANCED PLAN REVIEW 220.51
ROBERT WILLIS CONSTRUCTION LLC TOTAL 220.51
11401 COUNTY RD 3
HOPKINS,MN 55343-
(612)323-5036
Minnesota State License#:20576ll 1
OWNER
CRAWFORD,BRUCE&CAROL
455 SUSSEX LA
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 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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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City of Orono ���,� ����.r...
Building Permit Application -
for New Structures or Additions
Mailing Address: Permit number: p��l� -�Q�'��
�0,�. PO Box 66
0 � � Crystal Bay, MN 55323-0066 Date received: �' �—'
� ��,�/
a -j�. �, StreetAddress:' Received b : j�c.
�'.F, �`�� Gti�' 2750 Kelley Parkway an review fee: O�a���
�kESH��`'� Orono, MN 55356 . �
Tota e .
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � 3 �-f � _ z.S
This application form must be completed in full and all required information must be submitted. ��r.�� �/�j�Z.
Incomplete applications will be returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: 5 �� � �
Will this be a Parade of Homes, emodelers Showcase Home or ot er isp ay Home? ❑ Yes No
If yes,a special event permif is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is availab/e. No/��Permitted events will not be allowed.
CONTRACTOR/APP ANT INFORM TION:
Name: G�
State License# Expiration Date: � jJ �E"
Phone: � office cell
Mailing Address: Ci : ZIP:
Contact Person: Applicant is: Con ractor / Homeowne (Cirele �e>
Email and/or Fax:
PROPERTY OWNER I FORMATION:
Name: �
Phone(day): ,�
Address: 4�r--- ��, LL/`+ �/ �,s�,,,,b,Dk Ciry: /�p�h�j� ZIP:�� ��",�
Email and/or Fax
ARCHITECT/ENGINE R INF4RMATI N:
Name: ��� 11J���/,f�l�
Phone (day): _ --
Address: � � Cit : ZIP: �
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8
Water Supply
❑ New Construction ❑ Single Family with ❑ Residence
❑Addition Q���r attached garage ge ccessory Bldg. ❑ Public Sewer
❑Accessory Building ��ji H`�G ❑ Single Family with eck
Relocation �j(,�7�.�1j detached garage e/Commercial ❑ Private Sewer
Other. (specify) tl�iln ❑ Multiple Family/Condo Warehouse _.
❑ Public ❑Storage ❑ Public Water
**Any earth movement may require ❑Commercial ❑Other(specify)
MCWD review 8�permits. �Industrial ❑ Private Well
Minnehaha Creek Watershed District MCWD
( ) Ot er: (specify)
18202 Minnetonka Blvd ��} Qf/�v'_�i�
Deephaven,MN 55391 'rJ(
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ � �?�
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Packet Last Updated: 03-06-2012
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