HomeMy WebLinkAbout2012-01043 - adv plan review CITY OF ORONO * 2012 - 01043 *
.. 2750 KELLEY PARKWAY DATE ISSUED: 10/17/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952)249-4616
ADDRESS 2643 THOROUGHBRED LA
PIN 04-117-23-12-0021
LEGAL DESC OLD CRYSTAL BAY ROAD 2ND ADDN
LOT 006 BLOCK 002
ORMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADVANCED PLAN REVIEW
VALUATION $ 34,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 34,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: DETACHED GARAGE
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-01042
APPLICANT ADVANCED PLAN REVIEW 331.34
SHORELINE BUILDERS TOTAL 331.34
2184 ISHADYWOOD RD
WAYZATA,MN 55391- PAID WITH CC# 4377
(763);506-0629
Minnesota State License#:20630814
OWNER
CHAMPLIN,3UDSON&ALEYA
2643 THROUGHBRED 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 bel 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
suspendled for a period of 180 days at any time after work has commenced.
The akae
risible for assuring all required inspections are
requence with the State Building Code.This permit may be
revokr due cause.
Ap c Pennitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Permit number:
0, PO Box 66
0 O Crystal Bay, MN 55323-0066 Date received: (` - —Q_
A ;, y, Street Address:' Received by7
*4 Gti� 2750 Kelley Parkw CG -3'1� Plan review fee: �{
�•gkHog� Orono, MN 55356 I r1 iz-
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 applications will be returned. (Please print)
GENERAL INFORMATION: r ga?v
Irl Site Address: (p
Will this be a Parade of Homes, Remodelers Showcase He e it other Display Home? ❑ Yesill No
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servai wbe
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
\
CONTRACTOR/APPLICANT INFORMATION: /
Name: 5 �W, "n r
State License# Expiration Date: /—
Phone: office cell
Mailing Address: D Cit ZIP.
Contact Person: G Applicant is* on ractor / Homeowner (Circle One)
Email and/or Fax: ✓r Pi- Mn.
PROPERTY OWNER INFORMATION: J
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3. Structure Type wage Disposal&
Water Supply
❑ New Construction ❑ Single Family with F71Residence
❑Addition attached garage Garage/Accesso Bldg. ❑ Public Sewer
Accessory Building ❑ Single Family with eck
❑ eiocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
"Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review&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.min nehahacreek.or
v J
Estimated Construction Valuation (excluding land) $ 3!y
Packet Last Updated: 03-06-2012
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