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CITY OF ORONO * 2016 - 00537 *
2750 KELLEY PARKWAY DATE ISSUED: 05/17/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS 660 TONKAWA RD
PIN 05-117-23-33-0016
LEGAL DESC PARTENS POINT 1 ST DIV
LOT 003 BLOCK 000
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 1,055,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 1,055,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00536
APPLICANT ADVANCED PLAN REVIEW 4,215.85
TOTAL 4,215.85
PILLAR HOMES Payment(s)
1700 NIAGARA LANE N CREDIT CARD 0934 4,215.85
PLYMOUTH,MN 55447
(763)475-1700
OWNER
LADD&CAROL STAINBROOK,MICHEAL
660 TONKAWA RD
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 Petmitee Signature Date Issued By ggnature Date
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address:
PO Box 66 Permit number: 2— 01 -
V Crystal Bay, MN 55323-0066 Date received: 5 - 1 -]-�
Street Address:' by:
a ' 2750 Kelley Par a h
sF y y �(p -(�bvc Plan review fee: G �J
c` Orono,MN 5535
ESHo�� Main: 952-249-4600 Total Fee:
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: 2, jcc�_A
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If 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 sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INF MATION:
Name: r` rrp L
State License# Expiration Date: ZO
Phone: cell (Q office 3• "75 Ob
Mailing Address: a r Cit : ZIP:
Contact Person: Applicant is: Contra / Homeowner (Circle One)
Email and/or Fax: 6l ; • C
PROPERTY OWNER INFORMATION: , l I
Name: 1- r0 t7�, rc)t7
Phone(day): GO I
Address: City: ZIP:
Email and/or Fax t"1�,4_ C4
ARCHITECT/ENGINEER INFORMATION:
Name: y f Q nyq SW t, A~1
Phone(day):
Address: tL CS1 0 K City: �0-kyl.Q ZIP: 5511
Email and/or Fax: ih��'� ��7plZ ,Ac„ag n /tail-
PROJECT INFORMATION: Descri tion of project: NUJ ,,
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
New Construction Single Family with [IAccessory Bldg./Garage
Addition attached garage ❑ Deck ❑Public Sewer
❑Accessory Building ❑ Single Family with ❑Office/Commercial
❑ Relocation detached garage ❑ Residence ❑ Private Sewer
❑ Other:(specify) ❑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) ❑Other:(specify) ❑Other(specify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
00
Estimated Construction Valuation(excluding land) $ d 000 "'-
Packet Last Updated: August 2015
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