HomeMy WebLinkAbout2013-01256 - adv plan review ' CITY OF ORONO * 2 0 1 3 — PJ 1 z 5 6 *
` 2750 KELLEY PARKWAY pATE IssuE�: 12/03/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4325 CHIPPEWA LA
PIN : 31-118-23-42-0009
LEGAL DESC : CHIPPEWA
: LOT 001 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 2,800.00
NO"I'G: PLEASE FILL IN THE FO[.L.OWING:
VALUA��ION OF PGRMIT: $ 2,800.00
I'YPk;OF PERM[T TH1S PAYMEN"I IS FOR: S"I�OIZAGE SHI?D
PERMI"f#"I�1IIS PRL-PnYMI�:N"I-IS"[�IP,D TO: 2013-012�7
APPLICANT ADVANCED PLAN REVIEW 57.53
PETRUSA, JOSEPH & JANELLE TOTAL 57.53
4325 CHIPPEWA LA
ORONO, MN 55356-
OWNER
PETRUSA, JOSEPH &JANELLE
4325 CHIPPEWA LA
ORONO, MN 55356-
AGREEMENT AND SWORN STATEMENT
fhe 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 1br additional or related work which requires separate
pennits. 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 Ihe date ot�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 ti�me for due cause. � ��-!� ��� � �
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_ �-�_�.c..c ��� �Z i 3 i j � ��" _/�� �� > > i i �
Applicant Permitee Signature Date Issued By Signat re Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
' .
City of Orono
Building Permit Appiication
for New Structures or Additions
Mailing Address: .; . ; �:_ : ' "=:,�""'?
.�Q A TO PO Box 66 Permit number: � , � .� �
`V Crystal Bay, MN 55323-0066 Date received: �_'/ '1, ! `
Received b �-�-,<' ��/�r�`
Street Address:' - � Y� _—
a �- 2750 Kelley Parkwa #, . , '� ! �l "• "' �
- Plan review fee: ` � -� " -'f'i�'� ��-�`��� =
y� �, ti:��✓y l':(� �G 1� � ., _ � _ _r ,''
c,` Orono, MN 55356 � '
l�kfSHOQ'� Main: 952-259-4600 Total Fee:
Fax: 952-249-4616 www.ci.orono.mn.us
This appiication form must be completed in full and ail required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: �
Job Site Address: � � l�� "� �.,G� e r�� �?t`��'1G ►`��`� �`� ��`�
Will this be a Parade of Homes, Rem elers Showcase Home or other Dispiay 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 ill be
required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name:
State License# Expiration Date:
Phone: (cell) (office)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INF RMATION: � { j_- L
Name: ` :.�I'7 ��. '�` `J IL� �."�Y1���--'
Phone (day): �'_ .' - %3 �-'
Address: " > �r;:. � �• Cit : ��1�1� ZIP: ��.��J��
Emaii and/or Fax ' � � � � c�j . ��,-t���
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP: _ _
Email and/or Fax:
PROJECT INFORMATION: Description of project:
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
[y�'Accessory Building ❑ Single Family with ❑ Deck •
❑ Relocation detached garage ❑ Office/Commercial �Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑ Warehouse j�
❑ Public �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
Fax: 952-471-0682
www.minnehahacreek.or
/ (I'�•J
Estimated Construction Valuation (excluding land) �.��� .
Packet Last Updated. 04/19/2013
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