HomeMy WebLinkAbout2017-00068 - advance plan review fee CITY OF ORONO * 2 0 1 7 - a 0 0 6 8 *
2750 KELLEY PARKWAY DATE [SSUED: OU24/2017
ORONO, MN 55356-
� (952) 249-4600 FAX: (952) 249-4616
ADDRFSS : 2995 DEER RUN TR
PIN : 04-117-23-23-0030
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 500,000.00
NOTE: PLEASE FILL[N THE FOLLOWING:
VALUATION OF PERM[T:$ 500,000.00
TYPE OF PERMIT THIS PAYMENT[S FOR: GREAT ROOM ADDITION
PERMIT#THIS PRE-PAYMENT IS TIED TO:2017-00067
APPL[CANT ADVANCED PLAN REVIEW 2,359.45
TOTAL 2,359.45
NOR-SON INC Payment(s)
700 LAKE STREET E CRED[T CARD 2737 2,359.45
WAYZATA, MN 55391-
(952)767-7949
Minnesota State License#: BUIL-BC001969
OWNER
LEISCHOW, KELLY
2995 DEER RUN TR
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according ro
the approved plans and specifications,applicable Ciry approvals,and the
State E3uilding 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 rype 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.
Thc 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. ��/
�
;�>
� /�Z�� � / �C���.. ) `�-�--� Z- 1 � � f
� �
A�pplicant ermit e Sign re Date Issued By Signature � Date
.
City of Orono
� Building Permit Application
for New Structures or Additions
Mailing Address: permit number: ZQ �� —� ��
�Q A> PO Box 66
{VQ Crystal Bay,MN 55323-0066 Date received: 1 Z ��j
StreetAddress:' ceived b : �/
y ,� 2750 Kelley Parkway , -1 ��o -Plan evie fee: 2 � 5�_ -t�] �
F L Orono, MN 55356 � �
`qkESHOQ'� Main: 952-249-4600 Tota 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: Z�j�j - �N L - O ZoNO
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 Po/ice Department and City Council approva/60 days prior to the event. Shutt/e bus service will be
required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events wil/not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: 0�2- �'iN lN�..
State License# C�P Expiration Date: - / - j
Phone: (cell) r:�/2 . S�a . f�� (office) Gj f 2 �(�� . �}�1
Mailing Address: � • � - ��Z Ci : Z� Z�p� �0, S-S- _
Contact Person: " Applicant is: ntrac o / Homeowner (Circle One)
Email and/or Fax: � � - �
PROPERTY OWNER INFORMATION:
Name: - p
Phone(day):
Address: �"i L Cit : bZeY�'O ZIP:,$�
Email and/or Fax ►��..L�� 1 F�SCl�'�� < ���'�
ARCHITECT/ENGINEER INFORMATION:
Name: �SK-J�N� 1��.`5l���
Phone (day): (Qt2 - ��- >��
Address: 7,�� L�'(1�� Si E S�/'7b Zf� City: �/�pL/�} ZIP: d's1JJ 5��/
Email and/or Fax: �-��'}-'iZ_ �=5�L �?�..N� �l�Z - o�J _�U•.,�
PROJECT INFORMATION: Descri tion of pro'ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8
❑ New Construction Water Supply
❑ 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 �tesidence �(Private Sewer
❑Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater ❑Public Water
"'My earth movement may require ❑Commercial ❑Storage
MCWD review&permits. ❑ Industrial ❑Warehouse � Private Well
Minnehaha Creek Watershed District MCWD ( p fy) ❑Othe�(speCify)
( ) Other: s eci
15320 Minnetonka Blvd L7�`t1`7•L��"'� �j"�I���
Minnetonka,MN 55345
Phone: 952-471-0590 ��f n��
Fax: 952-471-0682
www.m innehahacreek.or
� f1 �c�C_r�'_ ��
Estimated Construction Valuation (excluding land) �f,
Packet Last Updated: August 2015
Page 21