HomeMy WebLinkAbout2009-00232 - adv plan review CITY OF ORONO PERM[T NO.: 2009-00232
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUE�: OS/15/2009
� ' 952 249-4600 FAX: 952 249-4616
AUDRESS : 1981 FAGERNESS POINT RD
PIN : 18-117-23-14-0005
LEGAL DESC : FAGERNESS
: LOT 004 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REV[EW
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ 440000
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME PERMIT ADVANCE PLAN REVIEW
PERMI"C#"I'HIS PRE-PAYMENT IS TIED TO: 2009-00233
APPLICANT ADVANCED PLAN REVIEW 2,012.89
MICHAEL GALLUS CONSTRUCTION INC. TOTAL 2,012.89
6306 EHLER AVE.
DELANO,MN 55328
(612)709-9796
Minnesota State License#: 20061956
OWNER
WHITTINGTON-GGROENKE, MICHEAL&JULIE �''' ``�``"' � �'� `� � � � -
:�rn'� �'�d r.'��>`i.: _--
1981 FAGERNESS PT RD -
WAYZATA, MN 55391- .+��E�i ��=: �;,{�;"`
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according[o
the approved plans and specifications,applicable City approvals,and the .- � „
State Building Code. This permit is for only the work described and does �,�y�"r�F�;�r?yj;p �;��r;!
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing[his type of work ., "
shall be compied with whether or not specitied 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 I 80 days at any[ime atter work hu 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.
/ / � �
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
.
� ' City of Orono
Building Permit Application
for New Structures or Additions
�� Mailing Address: Permit number: aQ -DD�33
,%�v�,��. PO Box 66
\ Crystal Bay, MN 55323-0066 Date received: J�' s
`\
i0 � O ,
���R�.
� �, Received by: �T
\.� �A�. s.J Street Address:�
�'� ' °°' � ��% 2750 Kelley Parkway � Plan review fee: a D I oZ . � ! <�
�`�kEsxoti`%� Orono, MN 55356 �
aoo9-o�s� 34 �
Total Fee: /�QR
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us "� b"
This appfication form must be completed in full and all required information must be submitted.
Incompiete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: �y�/ �ay;�,.,Qs Pa;-,,. }� �vE:.� �
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 prror to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs wil/not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: ✓vt��ltia-e�� Cz� (�u 5 ��s� �T c
State License# a�o�,j 5 5-� Expiration Date: � �i-a,�.�
Phone: 7.� 7-- �7 z-z i 3 i (office) ��2 - 7c 9 -- 9�y E (cell)
Maifing Address: � 3 0� �i� ,¢. Cit : �4 ZIP: s s� 3 i�
Contact Person: '��.,, C-� (1� s Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax: d- -�a (l� s �y-,��r; _ �o�-.-�
PROPERTY OWNER INFORMATION:
Name: i^�1,�< rt- �.���� c�.> k--,:-� � �
Phone(day): 9 S z - 2�o - a 3 z,S
Address: /4 Y! ��,�.,r..� s �z,r �. �2,�,�- � City: U°�-�<� � ZIP:
Email and/or Fax '
ARCHITECT/ENGINEER INFORMATION:
Name: � c„ s���,� t-�s �� k S
Phone(day): �� 3 � a-a y - "3 �S g
Address: � a a �c,,2e f�. s �r.�,�....� Clty: f.�.,)c«.-en �.� ZIP: S-S .3") G
Email and/or Fax:
PROJECT INFORMATtON:
1. Type of Project 2. Proposed Use ' 3. Structure Type I 4. Sewage disposal &
i
Water Supply
�'New Construction j �Single Family with �Residence ',
❑ Addition �I attached garage I ❑ Garage/Accessory Bldg. i � Public Sewer �
❑ Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation � detached garage ❑ Office/Commercial I ❑ Private Sewer
❑ Other. (specify) � ❑ Multiple Family/Condo ❑Warehouse
❑ Public � ❑ Storage [�Pubfic 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.minnehahacreek.or
Estimated Construction Valuation (excfuding land) � ��U;D 6 �
- i£ -