HomeMy WebLinkAbout2012-00782 - adv plan review r
� CITY OF ORONO * z 0 1 z — 0 0 7 8 z *
� . 2750 KELLEY PARKWAY
DATE ISSUED: 08/13/2012
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2850 LITTLE ORCHARD WAY
P[N : 09-117-23-21-0007
LEGAL DESC : LITTLE ORCHARD
: LOT 001 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW ,.
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PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 15,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
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VALUATION OF PERMIT:$ $15,000.00 rniE:'
TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERM[T ''�''-'
PERM[T#THIS PRE-PAYMENT IS TIED TO:2012-00783 '��r''
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APPLICANT ADVANCED PLAN REVIEW 172.58
SWENSON,JAY TOTAL 172.58
2850 LITTLE ORCHARD WAY
WAYZATA, MN 55391-
OWNER
SWENSON,JAY
2850 LITTLE ORCHARD WAY
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only Ihe work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
"Che applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
oke t any time f ue cause.
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Ap �cant ermitee Signature Date Issued By 'i nature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED AB
C i ty of O ro n o ��.,i �,��
Buildin Permit A lication for Maintenan'ce/ Renova i �
9 Pp t aZ3�o
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' (windows, doors, siding, re-roof, etc.) �`
Mailing Address: Permit number: �� - ('�
04.,O,�O PO Box 66
Crystal Bay, MN 55323-0066 Date received: �'1� '�i
a s, Street Address: Received by:
�� � ���' 2750 Kelley Parkway Plan review tee: D l a� - OD 7�SL
t9'kE3H�4� Orono, MN 55356 �
Total Fee: ��2'.5$
Main: 952-249-4600 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 prinf)
GENERAL INFORMATIONZ �� G "� �_ I^
Job Site Address: w
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Ho e? ❑ Yes No
If yes,a special event permif is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be al/owed.
CONTRACTOR/APPL CANT INFORMATION:
Name: �� SC,c�P�, S'c7 �'7-•
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior fo 1978
Phone: � S Z ^ �3_ �� � � (office) (cell)
Mailing Address �, l Q� wc City: a • , : �3
Contact Person: r,�,c�z., -,_., Applic nt is: Contractor / omeowner (Circle One)
Email and/or Fax: J�� . S'w e h S o i, � � M�i � - C.�,,�
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PROPERTY OWNER INFORMATION:
• Name: �A s'1��, S' �
Phone (day): �� - '7 Z 3 . / 2-7
Address: 2 ��U C,.�lr ' f (�,•�� City: (�lJ��, ZIP• �53�j/
Email and/or Fax ,"�y Sp -� � , �d,,,�
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) �Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof,asphalt ❑ Re air Minnehaha Creek Watershed District(MCWD)
p ❑ Storm Damage 18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof,other(specify) ❑ Sidin Phone: 952-471-0590
9 ❑ Other: (specify) Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
Overall Project Description: �. �,� P
Estimated Construction Valuation of Project(excluding land) S �S� O D�
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APPLICANT ACKNOWLEDGEMENT: �
• Agrees to provide all information required or requested by the Building Department;
• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they
are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative
but to reject it until it is complete;
• Some or all of the information that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the
data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our
purpose and intended use of this information is to annually update our records and records of other governmental agencies
re uired b law. If ou refuse to su I the information,the a lication ma not be issued.
ApplicanYs Signature: Date: �^� � �' Z d�2
Last Updated: 08-09-2011