HomeMy WebLinkAbout2015-01176 - Plan review fee CITY OF ORONO * 2 0 1 5 — 0 1 1 7 6 *
"" 2750 KELLEY PARKWAY DATE ISSUED: 09/15/2015
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1825 CONCORDIA ST
p�� : 17-117-23-22-0015
LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK
: LOT 008 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIY TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 142,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 142,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODGL
PGRMIT#THIS PRE-PAYMENT IS TIED TO:20 1 5-0 1 1 75
APPLICANT ADVANCED PLAN REVIEW 893.22
TOTAL 893.22
LECY BROS HOMES Payment(s)
15012 HWY 7 CREDIT CARD 3171 893.22
MINNETONKA, MN 55345-
(952)944-9499
Minnesota State License#: BUIL-20325555
OWNER
WING,JOHN
1825 CONCORD[A ST
WAYZATA, MN 55391-
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 only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this rype of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construc[ion 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 the State Building Code.This permit may be
revoked at any time for due cause.
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' C�/ ��� "� � �-�s:_-( `� �< <�,� �S� i
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Applicant Permitee Signature Date Issued By Signature Date
� City of Orono
Building Permit Application
for New Structures or Additions
MailingAddress: Permit number: �-D���� /f �
� PO Box 66
� �� Crystal Bay, MN 55323-0066 Date received: q - �5—t �
StreetAddress:' Received b :
�' ,�- 2750 Kelley Parkway � �Z
y�' �` Orono, MN 55356 �� � Plan review fee:
t'�KFSHo�`�" Main: 952-249-4600 Total Fee: �1
Fax: 952-249-4616 www.ci.orono.mn.us
'Ti�is apa�n fc�m must be completed in full and al(required inform��i�t�►c�st be ' _; „
Mcomplete apptications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: �f3��" �o.�.c.���;.� ��r,•�.s..�'�"
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be
riequired un/ess app/icant demonstrates su�cient on-site parking is availab/e. Non-permitted events wil/not be allowed.
CONTRACTOR/APPLICANT INFORMATION: `�
Name: l�c.-t L�.�*�,
State License# � n g Z �SSS Expiration Date: 3 � � Z o r �,.
Phone: (cell) L ��- 70 3 - Z't 53 (office) 4 3'Z.- R�- 9�a-T 9
Mailing Address: i �'� ��., L�L; !,�c..+ Ci : wc-rt�.,�. ZIP: S'S'.t�S"
Contact Person: ..y Applicant is: ontract / Homeowner
(Circle One)
Email and/or Fax: �-r-Z� ,j ot�,�,.5 •.r� �o l..�c,-t t�.,o�� �„�.,.�,
PROPERTY OWNER INFORMATION:
Name: .J u�..�. �/: v�S
Phone (day):
Address: ZS �w • 1: o.. 'S'f' City: W.-.Y�e— ZIP:
Email and/or Fax
ARCHITECT/ENGINEER INFO�MATION:
Name: L� �a.s
Phone (day): �ri'S'2.� 9 ��+ • "�� t''
Address: /.Sca i L !-��o l�.,_,cy,, "� City: �''�"C+E.� ZIP: SS3 �-�
Email and/or Fax:
PROJECT INFORMATION: Descri tion of ro�ect: -�-�� . % :� /�� � � �� - �-toCC=� ,
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
❑ New Construction ❑Single Family with ❑Accessory Bldg./Garage
[�PCddition 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) [v]�(�ther: (speCify) ❑Other(SpeCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345 r � ��
Phone: 952�71-0590 �'^��
Fax: 952�71-0682 V,acuc, .a.,"� {�
www.minnehahacreek.or � �` �" ���s0�'°E
Estimated Construction Valuation (excluding land) $ P'�f�.L,pvo
Packet Last Updated: August 2015
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