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HomeMy WebLinkAbout2015-00033 - adv plan review CITY OF ORONO * Z 0 1 5 — 0 0 0 3 3 * � 2750 KELLEY PARKWAY DATE ISSUED: OUl2/2015 ORONO, MN 55356- � 952 249-4600 FAX: 952 249-4616 ADDRESS : 2617 CASCO POINT RD PIN : 20-117-23-24-0035 LEGAL DESC : WINSHIPS SUBD LOT 1 SPRING PK : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTIOiY TYPE : ADVANCED PLAN REVIEW VALUATION : $ 200,000.00 NOTE: PLEASF,FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 200,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION TO HOMG PF.RMI'I'#THIS PRE-PAYMENT IS TIED TO:2015-00034 APPLICAIVT ADVANCED PLAN REVIEW 1,130.73 TOTAL 1,130.73 AMEK CUSTOM BUILDERS Payment(s) 9340 JAMES AVE S CREDIT CARD 0430 1,130.73 BLOOMINGTON,MN 55431- (952)888-1200 Minnesota State License#: BUIL-20164402 OWNER MARQUARDT,GARY&JOAN 2617 CASCO PT 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 specitications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or rela[ed work which requires separate permits. All provisions of laws and ordinances goveming 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[he Sta[e Building Code.This permit may be revoked at any ime for du ause. � ����J r z �' ��.� L-yy1_C,c� � � �� � / 1 App i a ermitee Signature ate Issued By Signature Date . �' City of Orono Building Permit Application for New Structures or Additions Mailing Address: ����J 3 QA,. PO Box 66 Permit number: � `v0 Crystal Bay, MN 55323-0066 Date received: � " �z �� StreetAddress:' Received b : 1 "'"{,1 � 2750 Kelley Parkwa ��' L` Orono, MN 55356 ��� �5`�� �✓'3 Plan review fee: � �.3 tq'�E S HO4� Main: 952-259-4600 T o t a l F e e: 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: Job Site Address: 2�p `j CC CO �O�- ��- Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will b required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT I�ORlVIVA�TION��. l� Name: us�u ui/ rS State License # G J� �/O Z Expiration Date: 3-$�- J$' Phone: cell -g/Q�fSZ� office 2�$$�-�va Mailing Address: � p awus . � Cit : ZIP: � Contact Person: < < Applicant is: Contractor / omeowner (Circle One) Email and/or Fax: a wS c ' C • C6 w� PROPERTY OWNER INFORMATION: Name: �v4 1�' J 4� IMQY'�Ua✓� Phone (day): Address: 2Got� C4'Co �,p�v�-� �� City: ��� o ZIP: Email and/or Fax ARCHITECT/ ENGINEER INFORM�4TION: r Name: �-tc Nc�tL� '�412 Lt i�C)s �C Phone (day): �Z - G - �o/s' Address: /`j�a �q ��yvqG� City: ��p�S • ZI P: Sj'r'L{I!� Email and/or Fax: PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8 Water Supply ❑ New Construction �Single Family with ❑Accessory Bldg./Garage (�Addition attached garage ❑ 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: (SpeCify) ❑ Other(SpeCify) 15320 Minnetonka Blvd Minnetonka, MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ 2��� l�C� � Packet Last Updated: January 2015 Page 20