HomeMy WebLinkAbout2016-01040 - advance plan review fee CITY OF ORONO * 2 0 1 6 - 0 1 0 4 0 *
2750 KELLEY PARKWAY DATE ISSUED: 08/29/2016
� ORONO, MN 55356-
: (952)249-4600 FAX: (952) 249-4616
ADDRESS : 565 FERNDALE RD N
PIN : 36-118-23-14-0004
LEGAL DESC : UNPLATTED 36 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
COi�ISTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 345,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 345,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT[S TIED TO:2016-01039
APPLICANT ADVANCED PLAN REVIEW 1,724.72
TOTAL 1,724.72
SHEP'S CONSTRUCTION Payment(s)
1620 MARSH AVE CHECK 1096 1,724.72
MAPLE PLAIN,MN 55359-
(763)479-4465
Minnesota State License#: BUIL-BC626612
OWNER
VEIT,TRAVIS
565 FERNDALE RD N
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 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 l80 days at any time after work has commenced.
The applicant is responsible for assuring a11 required inspections are
requested in c or c i the State Building Code.This permit may be ��p�
revoked at use. ��
��;� � � /�-V���C..� � ��-��' �
A p� e Signature Date Issued By Signatur Date
r-�,�-"
� City of Orono
.
• �ui[d�ng Permi� App(ic�tion
far New Structures or A►dditions
Mailing Address: ,
g„D�j PO Box 66 Perrnit number: ZD j �p"'OI(���
Q Crystal Bay, MN 55323-0066 Date received: �' ��.� /
l!i
Street Address:' Received b :
� �C' 2750 Kelley Parkw ''` � � _��
t,� ��,�� Orono, MN 5535 �� j0 '�� Q`�� Plan reviewfee: / ��� -�z,
kESH� Main: 952-249-4600 �
Fax: 952-249-4616 www.ci.orono.mn.us o a ee:
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: �� S r�F�,N �,�.�� � �r
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes f$� No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be
required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFOR ATI N:
Name: ��-� S ,�
State License# Ex,pJ�r�ation Date:
Phone: cell $'- office ' ,3 y`"/g ' (�
Mailing Address: (o � . . � �P.
Contact Person: !u ;}.{� ' �,, Applicant i • Contra /
Ernail and/or Fax: ne (Circle One)
PROPERTY OWNER WFORMATION:
Name: 1�-'� S �.. t
Phone (day): ► _ b
Address: �G � � . Cit : p N Z�p:
Email and/or Fax �,r � 0
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: Cit : Z�p:
Email and/or Fax:
PROJECT INFORMATION: Description of project: -f�� ' � �t-`��l 1� ��1
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8�
❑ New Construction ,�Single Family with ❑Accessory Bldg./Garage Water Supply
,�Addition attached garage ❑ Deck
❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer
❑ Relocation detached garage esidence
❑ Other:(specify) � �,Private Sewer
❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater ❑ Public Water
"'"'Any earth movement may require ❑ Commercial ❑ Storage
MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑ Other(speCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ 3��� QQv . g0
Packet Last Updated: August 2015
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