HomeMy WebLinkAbout2016-01073 - adv plan review CITY OF ORONO * 2 0 1 6 — 0 1 ld 7 3 *
2750 KELLEY PARKWAY DATE ISSUED: 08/3ll2016
� ORONO, MN 55356-
" (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1849 FAGERNESS POINT RD
PIN : 17-117-23-23-0021
LEGAL DESC : MAPLEGATE INLET
: LOT 004 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 12,000.00
NOTE: PLEASE FILL IN'I'HE FOLLOWING:
VALUATION OF PERMIT:$ 12,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: REBUILDING EXISTING DECK
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-01072
APPLICANT ADVANCED PLAN REVIEW 151.00
TOTAL 151.00
VANTAGE CONSTRUCT[ON SERVICES,LLC Payment(s)
14355 24TH ST CHECK 6216 151.00
WATERTOWN, MN 55388-
(612)272-2828
Minnesota State License#: BUIL-BC647228
OWNER
SHUMAN, THOMAS&STACY
1849 FAGERNESS PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry 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 responsible for assuring all required inspections are
requested in conformance with the State[3uilding Code.This permit may be
revoked at any time for due cause. �'�+'�
` a �- ���� ��-� g' �3 / � /�
Applicant Permitee Sign tur Date Issued By Signature Date
�ity of �ror�Q
�c��[e�i�� �err�it Applicati�r�
� � far �e�nr ����ct�res or �ddit�o�s
Mailing Address:
Q�T PO Box 66 Permit number: � — � (`��
� j YQ Crystai Bay, MN 55323-0066 Date received: � ?�� �(�
Street Address:' cEjv�d by_ /�
y � 2750 Kelley Pa ay 4 - t '� �`L� p�an review fee: I �'�
�' � Orono, MN 5535 Z d�10 -Q((� � /�� -
t'�k�sxo�`` Main: 952-249-4600 otal Fee:
Fax: 952-249-4616 vw✓w.ci.orono.mn.us
Tt�is.app�ication fiorm must be completed in full and aPf rec�uired information must be submitted.
Incomplete appllcations wiN be returned. (P/ease print)
GENERAL tNFORNfATION:
Job Site Address: ���-{ ' _ �; Z��Q
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 Depa�finent and City Council approva160 days prior to the evenf. Shuttle bus service will be
required unless applicant demonstrafes sufficient on-sHe parking is available. Non permitfed events wil/not be allowed.
CONTRACTOR/APPLIC NT INFO MATION:
Name: b/c.ar,� � �c- �'� . ��v ��s L'!._
State License # �'3G U,r�-� ���, Expiration Date: ; • Zp�c�,
Phone: cell �,,�a- � _ office
Mailing Address: '+-�. `'� Z�� ' Cit : ,� ZIP: �53Q,��
Contact Person: � � - Applicant is: o tracto / Homeowner (Circle One)
Email and/or Fax: o,sc� �;��,�,.� �, ��cl'�� ,,�m
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PROPERTY OWNER INFORMATION:
Name: �.,-;:�,�� c�r,� ��r3r� .> ��r�i s��r�
Phone (day): _ � p�
Address: !P�JI�i ��-�,_, �� �� City. . ;�-�-���� ZIP `j`�� I
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City:
Email and/or Fax: Z�P
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone(day):
Address: Ci ;
Email and/or Fax: Z�P
PROJECT INFORMATIO�I: Description of pro'ect: �ii ��1�� C� `��5 �.J.-� �
1.Type of Project 2.Proposed Use 3. Structure Type 4. Sewage Disposal&
❑ New Construction �+,Sin le Famil with Water&upply
1� 9 y ❑ Accessory Bldg./Garage
❑Addition attached garage � Deck
❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer
�Relocation detached garage ❑ Residence ❑ Septic
Other.(specify) p.E=�xrrQ (�3r� � Multiple Family 1 Condo ❑ Retaining Wall(s) (Compliance certificate
❑ Public 4-feet or greater may be required)
*'Any earth movement may require ❑ Commercial ❑ Storage
MCVIID review 8� permits. ❑ Industrial ❑Warehouse ❑ Public Water
Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Othe�(SpeCify)
15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well
Phone: 952-471-0590 / Fax: 952-471-0682
www.m innehahacreek.oen
Estimated Construction Valuation (excluding land) $ �2 �
Packet Last Updated: January 2016
Paae 21