HomeMy WebLinkAbout2015-00877 - adv plan review WKNEEEMEM
CITY OFO120N0 * 2015 - 00877 *
2750 KELLEY.PARKWAY DATE ISSUED: 07/15/2015
ORONO,MN 55356-
952 249-4600 FAX: 952 2494616
ADDRESS : 220 WAKEFIELD RD
PIN : 36-118-23-31-0010
LEGAL DESC : WAKEFIELD FARMS 2ND ADDN
: LOT 001 BLOCK 001 -
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 35,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 35,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: DETACHED PORCH OR GAZEBO
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00876
APPLICANT ADVANCED PLAN REVIEW 355.26
TOTAL 355.26
LECY BROS HOMES Payment(s)
15012 HWY 7 CHECK 42306 355.26
MINNETONKA,MN 55345-
(952)944-9499
Minnesota State License#: BUIL-20325555
OWNER
DAVIS,RICHARD&BETH
220 WAKEFIELD RD
WAYZATA,MN 55391-
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
rev ok d at any time for due cause. I �
ROW .�C.A��! Sj
Applicant Permitee Signature Date Issued By Signa ure Date
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address:
PO Box 66 Permit number: — ��
0
Crystal Bay, MN 55323-0066 Date received: !s /.S
Street Address:' Received by:
y 2750 Kelley Pa
Orono,MN 5535 p��=()U $'�� Plan review fee: S • Z
0SHo�� Main: 952-249-4600 d C Z
Fax: 952-249-4616 www.ci.orono.mn.us
Thisapplication form mustU caff,rlplet6d"* fup grid all required'(nf ion Must, subtalft
GENERAL INFORMATION: Incomplete�apptications virlll Ilia retpmed.. (Please print)
Job Site Address: 2Za i?r*oZz g P419
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes YNo
ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �G
State License# Ex iration Date:
Phone: cell -7. office Z—
Mailing Address: Cit / ZIP:
Contact Person: &I 4,re�- Applicant is: ontracto / Homeowner (circle one)
Email and/or Fax: �� z�r,��q. J��_ � q - —c:t
PROPERTY OWNER INFORMATION:
Name:
Phone (day):
Address: 2.7.0 61c.�e fir tj /PB,¢,0 City do-eoma-✓p ZIP SS'3�? [
Email and/or Fax ��"f-8 T 1�1� ,�e4 Ce�i
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of project:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
Z New ConstructionWater Supply
❑ Single Family with Accessory Bldg./Garage
❑Addition attached garage LJ 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: (speci C9 Other(specify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ S 0
Packet Last Updated: January 2015
Page 20