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Home My WebLink About2011-00731 - adv plan review � CITY OF ORONO PERMIT NO.: 2011-00731 . 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 07/26/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4195 HIGHWOOD RD PIN : 07-117-23-44-0022 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW � PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 255,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 255,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-00732 APPLICANT ADVANCED PLAN REVIEW 1,291.39 PAQUETTE CONSTRUCTION TOTAL 1,291.39 3730 SHADY OAK RD MINNETONKA,MN 55305- PAID WITH CC# 5784 �) Minnesota State License#: 3225 OWNER SMITH,DOUGLAS&ROBAN 4195 HIGHWOOD RD. MOLJND,MN 55364 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 in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. - City of Orono Building Perr�it Application for New Structures or Additions � Mailing Address: �pErm�t�umber, �f ��,„� �,0 j�. PO Box 66 �, , f,: r Q 4 0 Crystal Bay, I�N 55323-0066 Date receiued '''7' `�� -+�.,�•. _ -� ,,a °;. a, Street Address:' Re�1Y8��-� � � '� � �, �ti�' 2750 Kelley Parkway Paan arevie�rfee. � �•� 4 �•7 e':. r \'�g�Ho4� Orono, MN 55356 ` `_—� �,: 4�1.��''�'-�-�.�,�`a�. Tfltak�ee: - Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � t,. '- �` 'E ° - ;„; , : . , 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: � Will this be a Parade of Homes, Remode s Showcase Home or other Display Home? ❑ Yes �No If yes,a special event permit is required with Police Department and City Councif approval 60 days prior to the event. Shuttle bus service will e required unless applicant demonstrates sufficient on-site parking is avaifable. Non permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMAI�'iION: , Name: e T�'U c State License# _ 3��5 Expiration Date: - ° Phone: 5 ^- 33 ^ 30 o ice �^ ,3�-,� cell Mailing Address: 3 Cit : c� - ZIP: Contact Person: ` i`�" App(icant is: ontraetor / Homeowner (Circle One) Email andlor Fax: ' c � 3 -3a�� PROPERTY OWNER INFORMATION: r \ I - Name: ��:��Q.S -� `��t�.,/�_ ��n l 1'h. Phone(day): .� -� �jl �f Address: � ^ Cit : ZIP: ��y Email and/or Fax 'yl G ,�-� ARCHITECT/ENGINEER INFORMATION: ,�,��`yG��n � �.�5'(3c <,. /��, Name: �Uo� �l AAL�IA � ' �T � , Phone(day): — p�� '� Address: j^ Cit : � ZIP:�� 3 Email and/or Fax: �x 7�3 7��5� PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & Water Supply ❑ New Construction ❑ Single Family with '��esidence �ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer LJ Accessory Building ,� Single Family with ❑ Deck ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer ❑Other:(specify) ❑ Muftiple Family/Condo ❑Warehouse � Pubfic ❑Storage ❑ Public Water ""Any earth movement may require ❑ Commercial ❑Other(specify) MCWD review�permits. ❑ Industrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.m inneha hacreek.or Estimated Construction Valuation (excluding land) $ �J�, �j�, v N � � � � .-- CV w � N tiy., cy � . � T �"-� �� SQ � y,o p �—~ _ 3 fv�j �ti � Z� o�� s .� c...a � �� . L � O L � � � � � ? O J W r.�� l-+�l p�, Q ��Q � U � � Y� 0 �/I r.J L p CW.? �� 'A = E � N J �� V y ¢ � � � V ~? 10 � !'�� w�� 4 . ^� L � �--I �y O � L � �� `"'� a� Q �C E � � � � Sx �� LO � � S. }O �.,� � •e' �� $ ('� �� ,e��,fy� � � �'A � � Gi.l[V� 4L 44 � "{� �5 � � � � . r�i� � �y � � � �i� .� o � _ � :� � �, � �, � � A "' .w = W �i w �� A �� . �'�ri � N �� Y � � � � .Y. � � y O. ��i � �� A�y �Myp�� ~ ^p+��" ++ '«' 0.1�+$ �� ^:W ..�Ta T�'' � OY a '�j ...•.�.-. 1 C � 7d6�' ip ..�r�� •� a •�C1.NCC�O' p"'� � ~ � .