HomeMy WebLinkAbout2016-01568 - adv plan review CITY OF ORONO * Z 0 1 6 — 0 1 5 6 8 *
2750 KELLEY PARKWAY DATE ISSUED: 12/27/2016
ORONO, MN 55356-
� (952) 249-4600 FAX: (952) 249-4616
ADQitESS : 3295 CRYSTAL BAY RD
PIN : 17-117-23-41-0013
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 002 BLOCK 002
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 815,425.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 815,425.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT[S TIED TO:2016-01567
PAID WITH CHECK#37391 WHICH[NCLUDED THE ESCROW FEE
APPLICANT ADVANCED PLAN REVIEW 3,437.80
TOTAL 3,437.80
PILLAR HOMES Payment(s)
1700 NIAGARA LANE N CHECK 37391 3,437.80
PLYMOUTH, MN 55447
(763)475-1700
OWNER
GREG BLASKO&WHITNEY WINDMILLER
3295 CRYSTAL BAY RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEME1vT
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 � �j
reuoked any time for due cause.
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Applicant Pe ite ignature ate Issued By Signature Date
City of Orono
Builcling Permit Application
� for IVew Structures or Additions
, Mailing Address:
PO Box 66 Pe�it number. ��,-�(�`
��O Crystal Bay,MN 55323-0066 Date received:
StreetAddress:' Received by:
y 2750 Kelley Pa ` � J
�' ��� Orono,MN 55356 Z� ^ P�an review fee: �� � 7 ��
�kFsxo�`�` Main: 952-249-4600 �~� 1 -----
Fax; 952-249-4616 www.ci.orono.mn.us Total Fee:
Thls ap�ication#orm must be c�arr�pteted in futf artd'a!��uired in#ormation must be su6mitted.
InCompfete appli�tions w#il he r�um+�cf. (P/ease prinf)
GENERAL INFORMATION:
Job Site Address: �
Will this be a Parade of omes, Remodele howcase Hom or other Display Home? Yes No
K yes,a specla/event permit fs risqufred w/th Police Deparfinent and C/ty Cound/appmval 60 days prior to the event. Shutt/e bus service will be
requ/red unless appHcanf demonsbafes sul�cfent on�lte parking/s avallab/e. Non pem►itted events wdl not be albwed.
CONTRACTOR/AP � ANT INFORMATION:
Name: ��1 S Zr�L -
State License# Expiration Date: . 3 � r�
Phone: cell . ( o�� 3 , `
Mailing Address: 1 p p ' �c � � C' : Z�p:
Contact Person: Applicant is: n a / Homeowner (Circle One)
Email and/or Fax: • �
PROPERTY OWNER 1 FO MATION:
Name: �,-� 0.�
Phane(day): - �-- 1.� s t
Address: o o.. C� : �S ZiP: ���2�
Email and/or Fax � , �
ARCHITECT/ENGIN ER INFO ATIO •
Name: ' � '
Phone(day): -a O - � . �
Address: ` C' ZIP: )
Email and/or Fax: � `� � �p
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone(day):
Address: C� : Z�P
Email and/or Fax:
PROJECT INFORIVIATION: Descri tion of ro ect: � �' � �-(c;>l'�^�Z..
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8
�New Construction 1Nater Supply
Addition �Single Family with ❑Agcessory Bldg./Garage
attached garage ❑ Deck
❑Accessory Building � ❑ Single Family with ❑ Office/Commercial �0 Public Sewer
❑Relocation detached garage ❑ Residence
❑Other.(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Cosmpiiance csrtificate
❑ Public 4-feet or greater may be required)
*"Any earth movement may require ❑Commercial ❑ Storage
MCWD review�permits. ❑ Industrial ❑Warehouse ❑pubiic Water
Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) ❑ Other(specify)
15320 Minnetonka Bivd;Minnetonka,MN 55345
Phone: 952-471-0590 / Fax: 952-471-0682 ❑ Private Well
www.mirmehahacxeek.ora
Estimated Construction Valuation(excluding land) $ �
Packet Last Updated: January 2016
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