HomeMy WebLinkAbout2016-01243 - adv plan review CITY OF ORONO * Z 0 1 6 - 0 1 2 4 3 *
2750 KELLEY PARKWAY DATE ISSUED: 09/30/2016
� ORONO, MN 55356-
� (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1225 DICKENSON ST
PIN : 02-117-23-31-0048
LEGAL DESC : M[NNETONKA BLUFFS
: LOT 000 BLOCK 016
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 30,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 30,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BOULDER RETAINING WALL>4'
PF,RMIT#THIS PRE-PAYMENT IS TIED TO:2016-01 183
APPLICANT ADVANCED PLAN REVIEW 318.58
TOTAL 318.58
BOULDER IMAGES Payment(s)
1225 DICKENSON CREDIT CARD 0764 318.58
WAYZATA, MN 55391-
(651)322-7499
OWNER
GIEL,TOM&SARAH
1225 DICKENSON STREET
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 rclated 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 I80 days at any time afrer work has 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. ��`�' �
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�, licant Permitee Signature Date [ssued By Signature Date
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CITY OF ORONO �d ����� �c'�
- BUILDING PERMIT APPLICA I N
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, FOR NEW STRUCTURES OR ADDITIONS
�O�O Mailing Address: Permit number. ��(�l�p �l`�
PO Box 66
Crystal Bay, MN 55323-0066 Date received: �
�, �, Street Address:� `�
Received by: /��
y�, G` 2750 Kelley Park y ���� —bl.�7 lan review fee: � ,
�qk�'SH��� Orono, MN 55356 � � } _ ____�---
Main: 952-249-4600 Tota1 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.
lncomplete applications wili be returned. (Please print)
GENERAL INFORMATION:
�ob Site Address: 1225 DICKENSON STREET ORONO MN 55356
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/APPLICANT INFORMATION:
Name: BOULDER IMAGES INCORPORATED
State License# NA Expiration Date:
Phone: (cell) 651-260-2337 (office) 651-322-7499
Mailing Address: 14555 S ROBERT TRAIL SUITE #11 City: ROSEMOUNT ZIP: 55068
Contact Person: TODD MONTREUIL Applicant is: Contractor / Homeowner (CircleOne)
Email and/or Fax: todd@boulderimages.com
NaOe ERTY OWNER �N TOM GIEL' �- St�lrah Ca121 �Q�L ' 1�j' " �7� 3
Phone (day): ��Q N� 55356
Address: 1225 DICKENSON STREET Cit : ZIP:
Email and/or Fax �r0�j���,(��
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of pro�ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal &
Water Supply
❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage
❑Addition attached garage ❑ Deck ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage ❑ Residence ❑ Private Sewer
� Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s)
Boulder re ainin� wal! ❑ Public 4-feetorgreater ❑ PublicWater
"*Any earth movement may als 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) � ����v�
Last Updated: January 2016