HomeMy WebLinkAbout2015-00076 - adv plan review CITY OF ORONO *� _ 0 0 0 7 6 *
, 2750 KELLEY PARKWAY DATE ISSUED: OU23/2015
' ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 790 BROWN RD N
PIN : 34-118-23-11-0003
LEGAL DESC : REG. LAND SURVEY NO. 1275
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIY TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 370,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 370,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERM[T#THIS PRE-PAYMENT IS TIED TO: 2015-00077
APPLICA1vT ADVANCED PLAN REVIEW 1,826.88
GONYEA HOMES TOTAL 1,826.88
Payment(s)
6102 OLSON MEMORIAL HIGHWAY CHECK 15025 1,826.88
GOLDEN VALLEY,MN 55427-
(612)741-9069
Minnesota State License#: BUIL-2459
OWNER
STAVIG,JOHN& PHOEBE
780 BROWN RD N
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed acwrding 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 goveming[his 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 I80 days of the date of issuance,or if construction is
suspended for a period of l80 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. /C�)
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Ap�'icant Permite�gnature Date [ssued By Signature Date
' City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Z��s_(�(�.7
QA, PO Box 66 Permit number: �
� r vQ Crystal Bay, MN 55323-0066 Date received: � ` Z Z. :� �
Street Address:' Received by: ��l C
�y� ,� 2750 Kelley Parkw
�� Orono, MN 55356 �'�5��D60`7(� Plan review fee: p � , �
��'FFS H O��' Main: 952-259-4600
Total Fee:
� 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: 7�G7 f�j�--�',,�' ;,� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
If yes,a special event pe�mit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be
required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �onv�� ���v✓« S
State License # 02 l/S�� Expiration Date:
Phone: cell („ 1 -��(J-!Q office
Mailing Address: �,/l7 (soh ►'�'I� �v - Cit : (�--o �rn U,c � ZIP:
Contact Person: t f,�� � Applicant is:;�-= ntrac� / Homeowner (Circle One)
Email and/or Fax: e f y��,, qati�,,,r,� ,,K�s , Cc��'t
PROPERTY OWNER I�IFORMATION:
Name: C*��,;� �,,,,�� s
Phone (day):
Address: City: ZIP•
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: Z�p•
Email and/or Fax:
PROJECT INFORMATION: Description of project:
1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
ter Supply
ew Construction Single Family with ❑Accessory Bldg./Garage
❑Addition attached garage ❑ Deck Public Sewer
❑Accessory Building ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage ❑ Residence
❑ Other: (specify) ❑ Multi le Famil /Condo ❑ P � ate Sewer
P Y ❑ 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) ❑ Othe�: (Specify) ❑ Other(speCify)
15320 Minnetonka Blvd
Minnetonka, MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
l
Estimated Construction Valuation (excluding land) $ ,j 7C� l���
Packet Last Updated: January 2015
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