HomeMy WebLinkAbout2011-00990 - adv plan review � � CITY OF ORONO PERMIT NO.: 20ll-00990
2750 KELLEY PARKWAY
' ORONO, MN 55356- �ATE ISSUED: 09/OU2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1635 BOHNS POINT RD
PIN : 17-117-23-11-0006
LEGAL DESC : REG. LAND SURVEY NO. 0565
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REV[EW
VALUATION : $ 250,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ 250,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR RGMODEL&CHANGE ROOF PITCH
PERMIT#THIS PRE-PAYMENT IS TIED TO: 20 1 1-0099 1
APPLICANT ADVANCED PLAN REVIEW 1,271.89
TIMBERLAND BUILDERS
17641 CASCADE DR 1,271.89
._ �. ."r�' -'n�'
EDEN PRAIRIE, MN 55347 ;;no 'MFI �5S3.5f
(612)909-0663
Minnesota State License#:20135484
OWNER
KOZLAK, STNICK&JODEE "�j�'r�`• ��n';��'
1635 BOHNS PT RD �'���
:5..
WAYZATA,MN 55391- 4 Ru
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AGREEMENT AND SWORN STATEMENT .tdl:
The work for which this permit is issued shall be performed according to '+� bdi3YrL8: y c i.t,:.
the approved plans and specifications,applicable City approvals,and the , ��" �"
State Building Code. This permit is for only the work described and does �.-� Nq; 15b29 lr c'��
not grant permission for additional or rclated work which requires separate -��,�
permits. All provisions of laws and ordinances governing this type ofwork ;;�rland Aui lder'Sw I1it.
shall be compied with whether or not specified herein.This permit will {��pi�o�j; 1a�j;.,'.
expire and become null and void if construction authorized is not ---------------
commenced within 180 days of the date of issuance,or if construction is ���j; ,��
suspended for a period of 180 days at any time after work has commenced. --.-
The applicant is responsible for assuring all required inspections are � O1/;-'_l1;i ���:�n�'
requested in conformance with the State Building Code.This permit may be
revoked at any time for due ause. , •� ��IJi
k f/� ��L "l1L� C"�-/L�/ ��r CC ���'Y1C i�1 � � //. //
Applicant Permitee 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: ;��(l— ��,,,. �
j�.,0,�. PO Box 66 Permit number: �-�t�
� Crystal Bay, MN 55323-0066 Qate received: -/ `�� '
� O y9, O ... . .,
�I ��,�'" � � Received by: l2� -� l��C �f-��a/�i!� �ylYlC
1,a "'�{� ` �,� Street Address:� ? �
�\,
i' � �,,'y,� Gti� 2750 Kelley Parkway ���C������ �P an�review fee: I< o� f •
5� «'�g� Orono, MN 55356
�`?jtESHo
" --- 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 applic tions will e returned. (Please print)
GENERAL INFORMATION:
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
!f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the evenf. Shuttle bus service will be
required unless applicant demonstrates suffrcient on-site parking is ailable. Non-permitted events will not be allowed.
CONTRACTOR/APPLICA I FO M ION �)
Name:
.� I �
State License# Expiration Date:
Phone: � office cell
Mailing Address: � City: ' ZIP:
Contact Person: Appficant is: ontrac o / omeowner (Circle One)
Email andbr Fax: (�
`
PROPERTY OWNER INF , ATION:
Name:
Phone(ciay): ..
Address: Cit : ZIP:
Email and/or Fax
ARCHITECT/ ENGIN ER FORMATION:
Name: �
Phone(day): _
Address: Cit : ZIP: f I
Email and/or Fax: '
PROJECT INFORMATION;
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
, � Water Supply
Q New Construction �ingle Family with �esidence
�' Addition �T ��� '��m�'�(� � � attached garage ❑ Garage/Accessory Bldg. ❑ Pubfic Sewer
Accessory Building 1 ❑ Single Family with ❑ Deck
❑ Relocation ��,(^f r� detached garage ❑ Office/Commercial ❑ Pnvate Sewer
❑ Other. (specify) �I. i �(� ❑ Muitiple Family/Condo ❑Warehouse
� � � � ❑ Pubfic ❑ 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 �� t �6
Fax: 952-471-0682
www.minnehahacreek.or ,
Estimated Construction Valuation (excluding land) $
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