HomeMy WebLinkAbout2016-01131 - adv plan review CITY OF ORONO * 2 0 1 6 - 0 1 1 3 1 *
. 2750 KELLEY PARKWAY DATE ISSUED: 09/16/2016
'' ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 140 LEAF ST
PIN : 04-117-23-22-0006
LEGAL DESC : REG.LAND SURVEY NO.0744
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 13,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 13,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: REBUILDING ATTACHED DECK&EXPANSION
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-01130
APPLICANT ADVANCED PLAN REVIEW i61.06
TOTAL 161.06
KATCHMARK,GREGG&REBECCA Payment(s)
140 LEAF ST CHECK 10545 161.06
LONG LAKE,MN 55356-
OWNER
KATCHMARK,GREGG&REBECCA
140 LEAF ST
LONG LAKE,MN 55356-
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
permiu. All provisions of Iaws 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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
City of Qrono
. ` Building Permit Application
far New Structures or Additions
Mailing Address: Permit number: d� — (�
QA, PO Box 66
� l v� Crystal Bay, MN 55323-0066 Date received: `/ —
Street Address:� � Received by: C�
y� ,� 2750 Kelley Parkway ��� �/�� Plan review fee: � d ��
�` Orono, MN 55356 �, �
�'�k�sHo�``` 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: � �O L�p,-r ,�'(-
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
/f yes, a special event permit is required with Police Department and City Council approva/60 days prior fo the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is availab/e. Non�ermitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �Q�C-..G. F•p�t��-41M1°t(r-1,�
State License# Expiration Date:
Phone: (cell) (0l2 - 2�5— �,�CO (office)
Mailing Address: _ � Cit : Ov'e��o S��
Contact Person: �ft.F� �<.q--2��/Z� Applicant is: Contractor / omeowner �c��ae o�e�
Email and/or Fax: ��r ✓� � Gy�y�,� , � csm
PROPERTY OWNER INFORMATION•
Name: �re�a� ka�vn��/k
Phone (day): U,�2.-Zb�'-�g��
Address: �u LEP,-� ST CitY: (S�rca ZIP: ���ZF
Email and/or Fax ci Kct-1�rr,c:r1� (�j qrv�c�.� � � tv,,.-�
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: Z�p;
Email and/or Fax:
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: Z�p;
Email and/or Fax:
PROJECT INFORMATION: Description of project:
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8�
Water Supply
❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage
❑Addition attached garage Deck ❑ Public Sewer
❑Accessory Bui►ding ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage ❑ Residence ❑ Septic
'�Other: (specify) � ���� ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate
❑ Pubtic 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.orq
Estimated Construction Valuation (excluding land) $ D
Packet Last Updated: January 2016
Paae 91