HomeMy WebLinkAbout2016-00877 - advance plan review fee .
� CITY OF ORONO * z 0 1 6 — 0 0 $ 7 7 *
2750 KELLEY PARKWAY DATE ISSUED: 07/26/2016
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 925 BROWN RD N
pIN : 27-118-23-34-0001
LEGAL DESC : LJNPLATTED 27 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 150,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 150,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00876
APPLICANT ADVANCED PLAN REVIEW 926.20
TOTAL 926.20
REITAN&SALLY NEUBAUER,GREGORY payment(s)
925 BROWN RD N CHECK 5214 926.20
LONG LAKE,MN 55356-
OWNER
REITAN&SALLY NEUBAUER, GREGORY
925 BROWN RD N
LONG LAKE,MN 55356-
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 goveming 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 responsible for assuring all required inspections are
requested conformance with the St e Building Code.This permit may be
revoked ny time for due cause. ' '
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fippli ermitee Signature Date Issued By Signature Date
- City af Orono
Buiiding �err�it Appiicatian
for (�ew Structures or Additions
�O A T MailiPO Bo�r66� Permit number. _�� . ...� Q
!VQ Crystal Bay, MN 55323-0066 Date received: 7 Z , ,
Street Address:' Received by: ��
� ,� 2750 Kelley Parkway � -
y�'� �� Orono, MN 55356 �� "'f� �P�����^'fee: , 2Q
'�xESHO� Main: 952-249-4600 otal 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: �'�5 �� ��� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No
/f yes, a special event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shutt/e bus service wil/be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: Gr� '��,`,!�„� �-, Bt,v H��--
State License# —' Expiration Date:
Phone: �cell) �/�_ $5� � 9�f � (office)
Mailing Address: .�,,� �� �t,r Cit :
Contact Person: Applicant is: Contractor / meowner
(Circle One)
Email and/or Fax: 1�'�. ,r�,`�a.,` �p�,.,,•/f�,`,f.y ,y e�c�..,��� ca,,..,.,
—�
PROPERTY OWNER INFORMATION:
Name: ��.�s�1 �
Phone(day):
Address: City: ZIP•
Email and/or Fax
ARCHITECT 1 ENGINEER INFORMATI,Q N:
Name: /�'j.c �`i� .4����r-Sa�--
Phone(day): �/�_ �l� �p
Address: Cit : ZIP:
Email and/or Fax: M /��,, ,�,,. Sa.� 73� �fraa�' . L'd�
ARCHITECT/ ENGI ER INFOR ATION:
Name: �� '�h � �,
Phone (day): �/� ,�y���
Address: Cit : ZIP:
Email and/or Fax: _ �d �" 103�/� av •��
PROJECT INFORMATION: Description of project: ��"���� �
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
❑ New Construction Water Supply
�Single Family with ❑Accessory Bldg./Garage
�Addition attached garage ❑ Deck �$(Public Sewer
❑Accessory Building ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage �'Residence ❑ Septic
❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wa►I(s) (Compliance certificate
❑ Public 4-feet or greater may be required)
""`Any earth movement may require ❑ Commercial ❑ Storage
MCWD review&permits. ❑ Industrial ❑Warehouse
❑ Public Water
Minnehaha Creek Watershed District(MCWD) � pthef:(SpeCify) ❑ Other(SpeCify)
15320 Minnetonka Blvd; Minnetonka, MN 55345 �Pfivate Well
Phone: 952-471-0590 / Fax: 952-471-0682
www.minnehahacreek.orq
Estimated Construction Valuation (excluding land) $ j�a �,
Packet Last Updated: January 2016
Paoe 21