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HomeMy WebLinkAbout2016-01099 - adv plan review 1111111111114111111 IN CITY OF ORONO * 2 0 1 6 — 0 1 0 9 9 2750 KELLEY PARKWAY DATE ISSUED: 09/0812016 ORONO,MN 55356- (952)249-4600 FAX: 952 2494616 ADDRESS 200 TRUFFULA TR PIN 33-118-23-44-0039 LEGAL DESC MEADOW WOOD POND LOT 005 BLOCK 001 PERMIT TYPE ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW ACTIVITY : 434-RESIDENTIAL VALUATION : $ 10,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 10,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: BASEMENT BATRHROOM/WET BAR PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-01100 APPLICANT ADVANCED PLAN REVIEW 130.86 LECY BROS HOMES TOTAL 130.86 Payments) 15012 HWY 7 CREDIT CARD 5637 130.86 MINNETONKA,MN 55345- (952)944-9499 Minnesota State License#:BUIL-20325555 OWNER ADAMS,DONALD&SHEILA 200 TRUFFULA TR 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 City of Orono Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) r �Ol VO Mailing Address: Permit number: — d/ PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: Received b : 2750 Kelley Parkway QE Plan review fee: j .e � L Orono, MN 55356 I, OC!, �KESH� 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. ���© I Incomplete applications will be returned. (Please print) J GENERAL INFORMATION: Job Site Address: aloo rti ,1`v,, • l_ 0,(`w.c, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? D 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 INFORMATION: Name: 1 � R.,1`4A--o -s State License# g_')9,s.j 5_� Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed nor to 1978 Phone: (cell)A 1 - j-�- (office) Mailing Address: "'U(a City: ZIP: " Contact Person: a Applicant is' d tractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Overall project descripti n: Type of Project: &VJV1QA c} Awv\ t kk+tar Any earth movement may also require ❑ Door(s) NRemodel Fir/Damage MCWD review&permits: El Re-roof,asphalt ElRepair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.org Estimated Construction Valuation of Project(excluding land) $ OC 0 r 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 alternative but tc 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 of 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 anc intended use of this information is to annually update our records and records of other governmental agencies required by law. I you refuse to supDly4h%information,the application may not be issued. q Applicant's Signature: Date: I e /1(7) Owner's Signature: Date: Last Updated:January 2016