HomeMy WebLinkAbout2017-00474 - addition/remodel � CITY OF ORONO * z 0 1 7 — 0 0 4 7 4 *
2750 KELLEY PARKWAY DATE ISSUED: OS/10/2017
` ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 825 FOREST ARMS LA
PIN : 07-117-23-12-0011
LEGAL DESC : FOREST ARMS
: LOT 003 BLOCK 002
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 120,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUAT[ON OF PERMIT:$ 120,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERM[T#THIS PRE-PAYMENT IS TIED TO:2017-00473
APPLICANT ADVANCED PLAN REVIEW 803.35
TOTAL 803.35
NIEMELA CONSTRUCTION INC. Payment(s)
5765 QUAM AVE NE CHECK 1010 803.35
OTSEGO, MN 55330-
(612)532-7956
Minnesota State License#: BUIL-BC602194
OWNER
BRANDENBURG,NATHAN& BETH
825 FOREST ARMS LA
MOUND, MN 55364-
AGREEMENT A1vD 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. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if consvuction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of L 80 days at any time after work has commenced.
The applicant is onsible for assuring all required inspections are
requested in c f mance with the State Building Code.This permit may be
revoked at y ti e for due cause. I .
, �� � � ������,
S a � �CJ �-�'�1? �—e�-J`�� J � ��J l �
pplicant ermitee Si ur ate Issued By Sign ture Date
� -
� City of Orono
Building Permit Application
for New Structures or Additions
Marling Address:
i��� PO Box 66 Permit number: b��._�L�7
/ (� � Crystal Bay, MN 55323-0066 Date received: —f�'—(`�
/ ,
( � Street Address:' iverl�,T � �,�
� � � 2750 Kelley Parkway j� —� PI n review fee: �(J��
�` v�� Orono, MN 55356 � �
�qk�'s'�i�4�".f Main: 952-249-4600 Total Fee:
Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be compaeted in full and ali required information mus#be submitted.
Incomplete apptications will be returned. (Please print)
GENERAL INFORMATION: P�S � �
JobSiteAddress: p ar,�s� rrns Lan�� Drohd� � lJ 553� �/
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 approval 60 days prior to the event. Shuttle bus service will be
required unless applrcant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATI N:
Name: iQm-e�1 �cns��vc�on InC•
State License# �c6 o a� �y Expiration Date: 3 3/ �a/
Phone: (cell) 7C�;. a ►3 . S8 9 S office 7GT,. ya-$. yysry
Mailing Address: S 7LS va ++� �-� Cit : S . %���+�/ ZIP: S' 37
Contact Person: /3 e N�"Q rn�P/� Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax: b c ��Y � co h 5 vc �ch, f a w�
PROPERTY OWNER INFORMATION:
Name:
Phone (day):
Address: City: ZIP
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone(day):
Address: City: ZIP�
Email and/or Fax:
PROJECT INFORMATION: Descri tion of pro ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
❑ New Construction � Single Family with ❑Accessory Bldg. I Garage
�Addition attached garage ❑ Deck � Public Sewer
❑Accessory Building ❑ Single Family with ❑ Office/Commercial
❑ Relocation detached garage � Residence
❑ Other: (specify) ❑ Private Sewer
❑ Multiple Family!Condo ❑ Retaining Wall(s)
❑ Fublic 4-feet or greater � Public Water
""Any earth movement may 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
wwvd.minnehahacreek.or
Estimated Construction Valuation (excluding land) $ ��� Q�V
Packet Last Updated: August 2015
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