HomeMy WebLinkAbout2016-01228 - adv plan review CITY OF ORONO * z a 1 6 - 0 1 z z 8 *
2750 KELLEY PARKWAY DATE ISSUED: 09/29/2016
�, ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
AD�IRESS : 1285 FRENCH CREEK DR
PIN : 10-117-23-32-0007
LEGAL DESC : FRENCH CREEK
: LOT 008 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTTON TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 25,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERM[T:$ 25,000.00
TYPE OF PERMIT TH[S PAYMENT IS FOR: REPLACE DECK WITH SCREEN ENCLOSURE UNDER
PERM[T#THIS PRE-PAYMENT[S TIED TO:2016-01227
APPLICANT ADVANCED PLAN REVIEW 281.89
TOTAL 281.89
PLEKKENPOL BUILDERS Payment(s)
470 W 78TH ST CREDIT CARD 6675 281•89
BLOOMINGTON, MN 55420-
(952)888-2225
Minnesota State License#: BUIL-BCD01797
OW1vER
O'CONNELL&LYNNE RASUMSSEN, BEZ[AN
1285 FRENCH CREEK DR
WAYZATA, MN 55391-
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
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shali 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 I ��
requested in conformance with the State Building Code.This permit may be
revoked at any time for due c se.
�`_ �✓ ��� �� ���% �1 � � � i 2`�i �k=
Appli t Permitee Si a re Date [ssued By Signature Date
� City of Orono
Building Permit Application
` for New Structures or Additions
Mailing Address: Permit number: � U� — v"Z
� � PO Box 66
� �� Crystal Bay, MN 55323-0066 Date received:
Sfreet Address:' f� eceived by: _
� 2750 Kelley Parkway � a
9 �' �n�� ,P an review fee:
�'t c.` Orono, MN 55356 (�+� . �,.�
qkfSH��� Main: 952-249-4600 Total 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: �a�.� �(��/i/(,�- C�;�� �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 Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applrcant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: 'PL�"K kr�vpoL
State License# COo t 7�l 7 Ex iration Date:
Phone: cell 6'f -3a ~ office ��2--�
Mailing Address: - � l� Cit : 7aru ZIP: �'
Contact Person: �}N2c� -1,,/ � Applicant is: Contrac / Homeowner (Circle One)
Email and/or Fax: Z�b a ken,�ui � CdN�t
PROPERTY OWNER INFORMATION:
Name: � QCO NC:7,L N L 11/NC � 1�}S/LI(,��5�.71/
Phone (day): �- -
Address: S �C C K Cit : ZIP:
Email and/or Fax ,�nt a�,,�, vv�/� Cp
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of project: ��L/'�"� ��CK �7N $C/I�� ��'�,huiC� Gret,���
1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8�
Water Supply
❑ New Construction �Single Fa[nily 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 Wall(s) ( ompliance 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) ❑ Other: (Specify) ❑ Other(SpeCify)
15320 Minnetonka Blvd;Minnetonka,MN 55345 �Private Well
Phone: 952-471-0590 / Fax: 952-471-0682
www.minnehahacreek.org
Estimated Construction Valuation (excluding land) $ o`��DOC�
Packet Last Updated: January 2016
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