HomeMy WebLinkAbout2011-00776 - adv plan review ,� CITY OF ORONO PERMIT NO.: 2011-00776
� � 2750 KELLEY PARKWAY
-�` ORONO, MN 55356- DATE �SSVEn: 08/02/20ll
952 249-4600 FAX: 952 249-4616
ADDRESS : 1205 DICKENSON ST
PIN : 02-117-23-31-0040
LEGAL DESC : MINNETONKA BLUFFS
: LOT 000 BLOCK 016
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 105,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERM[T: $ 105,000.00
TYPE OF PERMIT TFIIS PAYMENT IS FOR: BUILDING
PERMIT#7'1 IIS PRE-PAYMENT IS TIED TO:201 1-00777
APPLICANT ADVANCED PLAN REVIEW 706.39
VAN HEEL CONSTRUCT[ON, INC. TOTAL 706.39
2375 ORKLA DR.
GOLDEN VALLEY, MN 55427 PAID WITH CC# 1270
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Minnesota State License#: 1592
OWNER
WOT[PKA, LINDA A& LEE A
9908 N W 20TH ST
PEMBROKE PINES,FL 33024-
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 related work which requires separate
permits. 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 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 responsiblc for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked a[any �me for due caus
� _� ;� �i / � 1
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Applic�nt Perrnit e Signat� re Date
_ � Issued By S'g ature Date
� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
City of Oron�`��i��/ � �3�, a5
' � Buildin Permit Application � :__v_.
9
for New Structures or Additions
Mailing Address: � Permit number. o?Dl�—� �7��
� g'� C�sBtal Bay, MN 55323-0066 I Date received: '" z ��
� ���r� �
� Received by: J�S
!I Street Address:� ��6.3�
�, ,��,�� �,�'� ;;�`' ti� 2 7 5 0 K e l l e y P a r k w a y P l a n reviewfee: �/
�``'l�'�����r�� Orono, MN 55356 ao/l 0 0 77G
ESK� Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us I
This application form must be completed in full and atl required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: �2-� ����'^�� ��'
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 be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR 1 AP�UC—��O— � 4 �-,C�'Z�+'�
Name: ��'� p � � �,���
State License# �°� _ Expiration Date. 70��
2- � office cell
Phone: ' �
Mailing Address: Cit : ' -�-tt, ZIP: �-�7
Applicant is: Contractor I Ho owner (Circle One)
Contact Person: w�. �
Email andlor Fax: ` �'
PROPERTY OiNNER INFORMATION:
� � �
Name: �
Phone (day): � C�3� —2
Address: a„ Cit : �— ZIP:
Email and/or Fax
�%"�'� ARCHITECT! ENGINEER INFORMATION:
Name:
Phone (day): Cit : ZIP:
Address:
Email and/or Fax:
! PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8�
Water Supply
Sin le Famil with Residence
❑ ew Construction � 9 Y
,�Addition attached garage ❑ Garage I Accessory Bldg. ❑ Public Sewer
❑ Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
**Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review 8�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.m innehahacreek.or
Estimated Construction Valuation (excluding land) $ �o�
Last Updated: 4/26/2011
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