HomeMy WebLinkAbout2015 - 01252 - adv plan review CITY OF ORONO I I* II I I1111 II1111 I I I II 121 151 z II*I
2750 KELLEY PARKWAY DATE ISSUED: 09/28/2015
ORONO,MN 55356-
, (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2160 WAYZATA BLVD W
PIN : 34-118-23-21-0002
LEGAL DESC : UNPLATTED 34 118 23
: LOT 000 BLOCK 000
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:$ 20,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-01251
APPLICANT ADVANCED PLAN REVIEW 231.57
TOTAL 231.57
Orono Station West Payment(s)
ERICKSON,BRAD&CHRISTY CHECK 5085 231.57
2486 BOBOLINK RD
LONG LAKE,MN 55356-
(612)490-2371
OWNER
Orono Station West
ERICKSON,BRAD&CHRISTY
2486 BOBOLINK 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 I/
revoked at any time for due cause. r 1
•pplicant Permitee Signature Date Issued By Signage Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
,' ..O� Mailing Address: Permit number: 20/ 5 - 01061
O PO Box 66
Crystal Bay, MN 55323-0066 Date received: �q-? S~-16
Street Address: Received by: 0 VI 1 V p
5* GZ2750 Kelley Parkwa 2_04 612 52 Plan review fee: 231 - 51 IA o t--
l-'kEs1-10 Orono, MN 55356
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: , k
Job Site Address: Gua42_0,,k 1 vot
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus s rvice will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
71 ra-
Name: E ti e_Ic' c,
State License # Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978 `�
Phone: (cell) /,Z C/•0 23 / (office) 7 1/7 3 3 7 29q
Mailing Address: 4 •� / al h City: ZIP: AU 55331
Contact Person: AD r Iv ' c //Applicant is: - 'n rac=' Homeowner (circle One)
Email and/or Fax: Q.r i on b ra-oe a/op_ e✓crr'l
PROPERTY OWNER INFORMATION:
Name: re4 7,- C4 / fSiLy Crickso
Phone (day): 6/, QO 3 7 l
Address: (Q 2-.3'.660/,,, f, 'J City:,Ian y/ 4 4 ZIP: /V/ 5753'5
Email and/or Fax: 'e ricb5-ay-)Ijre, _0 0 (//07) , e- y„„ J
PROJECT INFORMATION: Overall project description:
Type of Project: rf LelLI att, Any earth movement may also require
El Door(s) ►`iemodel El Fire Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage 15320 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration later Damage Minnetonka, MN 55345
111 Re-roof, other(specify) 1:1Siding )the :(specify) Phone: 952-471-0590
OL o Fax: 952-471-0682
CI Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ a
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 to
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 or
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 and
intended use of this information is to annually update our records and records of other governmental agencies required by law. If
ou refuse to su•.1 the informati.la,_,,;,0i '..•may not be issued.
Applicant's Signature: — Dater ZC� �S
_Js/ `/ /
Owner's Signature: � - _ a — Date: ��/ —
Last Updated:January 2015