HomeMy WebLinkAbout2015-01412 - Advance Plan Review CITY OF ORONO * z 0 1 5 - 0 1 4 1 2 *
. . 2750 KELLEY PARKWAY DATE ISSUED: 1 UO3/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 4375 BAYSIDE RD
PIN : 06-117-23-12-0008
LEGAL DESC : UNPLATTED 06 117 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
TYPE OF PERM[T THIS PAYMENT 1S FOR: SCREENED PORCH
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-01413
APPLICANT ADVANCED PLAN REVIEW 231.57
TOTAL 231.57
PAT FAITH Payment(s)
4011 GLENDALE DRIVE CREDIT CARD 5019 231.57
EXCELSIOR,MN 55331-
(612)7G0-0628
Minnesota State License#: BUIL-BC637448
OWNER
WHITE, STEVEN& PATR[CIA
4375 BAYSIDE RD
MAPLE PLAIN,MN 55359-
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 onty the work described and does
not grant permission for additional or related work which requires separate
permiu. 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 l SO 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.
:-�"�
_ . - -- .
`�o �e i" �� � � � �--3 � I�
Applicant Permitee Signature Date Issued B Signature Date
� ��
� Crty of Qrono � �(p �
Building Permit Application
for New Structures or Additions
� Mailing Address: permit number: �UL.S^ O/�
PO Box 66
� �Q Crystal Bay, MN 55323-0066 Date received: �,/-3 '/
Street Address:� n •� / Received by: /yf 7�
'' ,� 2750 Kelley Parkway I �� � 1�
y�' �` Orono, MN 55356 v ��'� Plan review fee: 3�. S
�'�kesMo��' Main: 952-249-4600 Total Fee:�� a �� s f� �
Fax: 952-249-4616 www.ci.orono.mn.us �
This apptication#om�r must be com�tet�d ir�fufl arrd aft required irrfarmation must be subm ed. �K
Incomplete applications wiN be returned. (Please print)
GENERAL INFORMATION• ,
Job Site Address: 3 7 q �
Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑Yes No
li yes,a specia!event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutile bus service wi be
required unless applicanf demonsirates s�cient on-site parking is ava1la61e. Non-permitted events wil/not be allowed.
CONTRACTOR/APP�A�T,�FOR�.M�ATION:
Name: {-��,�
State License# Expiration Date: '3�3l'
Phone: cell - office b[(2-
Mailing Address: Q� ry�? Cit :
Contact Person: � � ZIP� $
Applicant is: ontractor Homeowner (Clrcle One)
Email and/or Fax:
PROPERTY OWNER INF1O�RMATIQ�
Name: �-ItIIP � t`�.��► ������
Phone (day): u -
Address: 1�. �']� �,�P � City: �q� ���f� ZIP: �-�j �
Email and/or Fax
ARCHITECT I ENGINEER I OR ATION:
Name:
Phone(day): -
Address: C� : p Z�p: 5' L�l�
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 �ingle Family with ❑Accessory Bldg./Garage
�Addition attached garage ,�'Deck ❑ Public Sewer
Accessory Building ❑ Single Family with ❑Office/Commercial
❑ Relocation detached garage ❑ Residence �rivate 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 8 permits. ❑ Industrial ❑Warehouse �Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) �Other(specify
15320 Minnetonka BNd Si2 tezv� ��G�
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ °���0�'
Packet Last Updafed.' August 2015
Page 21