HomeMy WebLinkAbout2015-00453 (adv. plan. review for int. remod.) CITY OF ORONO * Z 0 1 5 - 0 0 4 5 3 *
2750 KELLEY PARKWAY DATE ISSUED: 04/22/2015
, ORONO, MN 55356-
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 2696 CAROLINE AVE
PIN : 20-117-23-24-0034
LEGAL DESC : WESSELS SUBD OF SPRING PARK LO
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 75,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$75,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: [NTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00454
APPLICANT ADVANCED PLAN REVIEW 593.35
TOTAL 593.35
REVISION LLC Payment(s)
153 E LAKE STREET CHECK 10779 593.35
WAYZATA,MN 55391-
(952)540-7150 � �
Minnesota State License#: BUIL-BC639027 '
kr-.ceipt No: 3.013237 Apr ?_2. 2U15
OWNER
MILLER,CHARLES&JILL Revision LLC
2696 CAROLINE AVE
WAYZATA, MN 55391- Previous Baiance: .���.%
Permits
2015-00453 269ti f.'aroline 593.35
Ave
AGREEMENT AND SWORN STATEMEIVT 101-34410
The work for which this permit is issued shall be performed according to Plan CheCk/S1 te Exdm Fees __
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does Total: 593.35
not grant permission for additional or related work which requires separate -__________---
permits. All provisions of laws and ordinances goveming this type of work CheCk
shall be compied with whether or not specified herein.This permit will Cherk N�: 1U779 593.35
expire and become null and void if construction au[horized is not payor:
commenced within 180 days of the date of issuance,or if construction is ;
suspended for a period of 180 days at any time afrer 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.
` V� �' '�- �/ �L'/ f` �-? (
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Applicant Permitee Signature Date Issued By Signature Date
� CITY OF ORONO
' BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
�O�O Mailing Address: Permit number: q��/,j�
PO Box 66 //
Crystal Bay, MN 55323-0066 Date received: �7-o� "' ,5
Street Address:� eceived by: __!�
� � 2750 Kelley Parkway .� �G� Plan review fee: 9�. � �
.
`�l,�k ��,� Orono, MN 55356 �i ��� ���5 �
fSH�
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: G�
Job Site Address: �? I �* J`�,
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes , No
lf yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service ill be
required unless applicant demonstrates sufficient on-site paricing is availab/e. Non-permitted events will not 6e allowed.
CONTRACTOR/APPLIC�NT INFORMATION:
Name: �C v� ��r� LL C
State License# ���. � Expiration Date:
Phone: cell 1 office
Mailing Address: ( F. a.Y.,e, Cit : Z - ZIP: �i5 3�1 I
Contact Person: (�� vt< �. Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax: �' i �pn -ON� �-'�"�
PROPERTY OWNER INFORMATION: �/�
Name: � I�1Gf �i2 (.�1/�} .J 1 �1 I' 11`�
Phone (day):
Address: City: ZIP:
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Descri tion of ro�ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
❑ New Construction �Single Family with �Residence
❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ,,,��-���e(' ❑ Single Family with ❑ Deck
Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
, Other: (specify) ��1'�Q��-�1'n�'1 ❑ Multiple Family/Condo ❑Warehouse
� ❑ Public ❑ Storage ❑ Public Water
*"Any earth movement may also 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
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ � � � ���