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Home My WebLink About2015-00081 - adv plan review • CITY OF ORONO * z 0 1 5 — 0 0 0 s 1 * _ 2750 KELLEY PARKWAY DATE ISSUED: OU23/2015 ORONO, MN 55356— 952) 249-4600 FAX: 952 249-4616 ADDRESS : 100 CREEK RIDGE PASS PIN : 03-117-23-12-0016 LEGAL DESC : CREEKSIDE IN ORONO : LOT 005 BLOCK 001 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 1,400,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 1,400,000.00 TYPE OF PERM[T THIS PAYMENT IS FOR: NEW HOME PERM['C#THIS PRE-PAYMENT IS TIED TO:2015-00080 APPLICANT ADVANCED PLAN REVIEW 5,157.48 TOTAL 5,157.48 BESIKOF,JUSTIN&MEIRA Payment(s) 16103 CROSBY COVE CHECK 1022 5,157.48 WAYZATA, MN 55391- OWNER City ot Orur�u 2750 Kelley_Parkw�y �52_�49-460i1 Or�no MN 55356 BESIKOF,JUSTIN& MEIRA 16103 CROSBY COVE Rer,�ipt Nn: 3.U12653 Jan 23, 2015 WAYZATA, MN 55391- Just.n & Meira Besikuf Previous Balance: •�� Permits 5,15j.4� AGREEMENT AND SWORN STATEMENT 21�-U0081 l0U Creek Ridge Pass The work for which this permit is issued shall be performed according to 101-34410 the approved plans and specifications,applicable City approvals,and the Plan Cher.k/Slte Exam Fees S[ate Building Code. This permit is for only the work described and does 5,157.48 not grant permission for additional or related work which requires separate �Uta1: ________ _____ permits. All provisions of laws and ordinances governing this type of work [;r1ECk shall be compied with whether or not specified herein.This permit will Check No: 1072 ',�5�.44 expire and become null and void if construction authorized is not �'aY':�r ; commenced within 180 days of the date of issuance,or if construction is . , „ ,, ,__:�.�.c 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. � ��,}/ -- � ��;'� �� j `�_� 1�(f (, �� 'd� �C�_� i � �� ( �, — Applicant ermit e Signature Date Issued By Signature Date �-----a City of Orono Building Permit Application for New Structures or Additions Mailing Address: r �,�T PO Box 66 Permit number: '�b�5-��) � �vQ Crystal Bay, MN 55323-0066 Date received: j"Z� �� . St�etAddress:' _-_-- __---__ eG�ived�:�� _��_. y ,� 2750 Kelley Par y, � � �. � � � 5.-� ,4� _ Z �'t �� Orono, MN 55356 �'�5 _�'�'� Plan review fee: i � qk�sxo��' Main: 952-259-4600 Total Fee: Fax: 952-249-4616 www.ci. ron .mn. This application form must be completed in fu�l and all required information must be submitted. Incomplete applications will be returned. (Please print) G�ENERAL INFORMATION: Job Site Address: � �r�-� �Will this be a Parade of Homes, Remodel Showcase Home or other Display Home? Yes No If yes,a special event permit is required with Police�epartment and City Council approval 60 days prior to the event Shuttle bus service will be required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events will not be al/owed. CONTRACTOR/APPLICANT INFO T N: Name: `� State License# Expiration Date: Phone: cell fp 2>3 -'73� office Mailing Address: ((pr03 � Cit : ZIP: � Contact Person: Applicant is: Contract r / Homeowner Circle One) Email and/or Fax: .� PROPERTY OWNE INF RMATION• . Name: � '►�, ��p�- Phone (day): �3 �,- 2 Address: 0 tr Cit : ZIP:� 1 Email and/or Fax ,�p ARCHITECT/ENGI I.��R� INF RM�4?ON• Name: ��j� YC-t1 . � Phone (day): - Address: `"� I Cit : ZIP: � Email and/or Fax: r PROJECT INFORMATION: Descri tion of pro�ect: 1.Type of Project 2. Proposed Use 3.Structure T ype 4.Sewage Disposal� 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 8�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.minn h h k. r Estimated Construction Valuation (excluding land) $ ��'�, � . Packet Last Updated: January 2015 Page 20