HomeMy WebLinkAbout2017-00091 (Plan Review Fee) � � � CITY OF ORONO * z 0 1 7 — ro 0 0 9 1 *
2750 KELLEY PARKWAY DATE ISSUED: OU3U2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4705 AUGUSTA ST
PIN : 06-117-23-32-0006
LEGAL DESC : LAKEVIEW OF ORONO
: LOT 3 BLOCK 1
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 700,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERM[T:$ 700,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT IS T[ED TO:2017-00090
APPLICANT ADVANCED PLAN REVIEW 3,041.95
TOTAL 3,041.95
NORTON HOMES Payment(s)
18215 45TH AVE N, STE D 3,041.95
PLYMOUTH, MN 55446-
(763)559-2991
Minnesota State License#: BUIL-BC639221
OW1vER
Source Land Development Inc.
18215 45TH AVE N
STE D
PLYMOUTH,MN 55446-
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. Ail 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 Building Code.This permit may be
revoked at any i�e for ue cause. —
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Applicant Permitee Signature Date Issued By Signature Date
} Y' CITY OF ORONO
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BUtLDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
�O,� T Mailing Address: Permit�humber_ �l ;�
1��0 PO Box 66
Crystal Bay, MN 55323-0066 Date`received: ;� j';
y ,� Street Address:' / ` � ` '
t G� 2750 KelleyParkway Z�l � (,y( PI n:reviewfee � . ��:,.;.
.� �. Orono, MN 55356 �
k�SH°� Main: 952-249-4600
Tota l`Fee:
Fax: 952-249-4616 www.ci.orono.mn.us
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This application form must be comple�ed in full and all required information rnust be submi#ted`.
lncomplete applications will be_returned. (Please print)
GENERAL INFORMATION:
Job Site Address: ���,j �(/ US"� S�Y�f
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o
lfyes,a special event permif is required wifh Police Department and City Council approva160 days prior to the event. Shuttle bus service will be
required unless applicanf demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APP_L,ICANT INFORMATION:
Name: l»or�vr� �-o�-?�S, L � �
State License# BC (�3Sr�--I Expiration Date: 3-31 -/ 7
Phone: cell / }- 3Sf(o, � office �fo . S.S�-3. q/
Mailing Address: / $�a--! �- . Q Ci : r7yat/ ' SSy�-1
Contact Person: ri p� Applicant is: ontractor / omeowner (Circle One)
Email and/or Fax: � ,r%� n COM..
PROPERTY OWNER INFORMATIO
Name: „�OUr'C�_ �� �.W�{c�o�ne.z�"
Phone (day): _�fo3SSt.- D/dp
Address ��2/s y�T'� �,�z �/ Cit : •,rJ-[, ZIP:
Email and/or Fax ,,$'�/r�/�d;����
ARCHITECT l ENGINEER 1NFORMATION:
Name: , Br��e �G�cr�i-..�
Phone (day): �1�3.,'S,�.S'•.??Y�'__`—�
Address: . ��' (° cr i a. City: CI'LJc�I'�'i0 ZIP: 7�s���
Email and/or Fax: � Q,!-id p, ��y,,�, ' T �
PROJECT INFORMATION: Description of project:
1.Type o Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8�
Water Supply
� ew Construction ❑Single Family with ❑Accessory Bldg./Garage
❑Addition attached garage ❑Deck
❑Accessory Building ❑ Sin le Famil with ❑ Public Sewer
g y ❑ Office/Commercial
❑,Relocation detached garage ❑ Residence
❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer
p y ❑ Retaining Wall(s)
❑ Public 4 feet or greater • ❑ Public Water
'`*Any earth movement may also require ❑ Commercial ❑Storage
MCWD review&permits. ❑ Industrial ❑Warehouse
Minnehaha Creek Watershed District MCWD ❑ Private Well
( ) ❑ 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) $ �DD�p0
Last Updated: January 2016