HomeMy WebLinkAbout2016-01016 - adv plan review CITY OF ORONO * 2 0 1 6 - PJ 1 0 1 6 *
� , 2750 KELLEY PARKWAY DATE ISSUED: 08/23/2016
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1122 LOMA LINDA AVE
PIN : 08-117-23-23-0026
LEGAL DESC : LOMA LINDA
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CO1vSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 600,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 600,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-01015
APPLICANT ADVANCED PLAN REVIEW 2,700.70
TOTAL 2,700J0
DOVETAIL RENOVATIONS INC. Payment(s)
3503 HENNEPIN AVE. S. CHECK 20559 2,700.70
MINNEAPOLIS,MN 55408-
(612)377-3071
Minnesota State License#: BUIL-20099046
OWNER
G&G Holding Co. Ltd.
ARONSON, MARTHA
2021 HUMBOLDT AVE S
MINNEAPOLIS,MN 55405-
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
permits. All provisions of laws and ordinances governing 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 no[
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time afrer 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 � �,I^
revoked at any time for due cause. ���V�
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Applicant Permitee Signature Date Issued By Signature \_ Date
�i�� �� C�rar��
. ' ����c�i�c� ���-r�it �4p����c�t�a�
far {���r ��ructures ar �c�dit���s
Mailing Address:
�Q� PO Box 66 Permit number: ��,� --���
� Crystal Bay, MN 55323-0066 Date received: ���,j
Streef Address:' Received b :
y ,�• 2750 Kelley Parkway i( .. v �
`� �� Orono, MN 55356 �Y� lan review fee:
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Main: 952-249-4600 —��----- !- -_------�_
Fax: 952-249-4616 www.ci.o ono.mn.us Total Fee;
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: �1�:a�-l��n,r�. '�.,,i �v�� �:�,���
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 Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitfed evenfs will nof be allowed.
CONTRACTOR/APPLI ANT INFORMATIQN:
Name: h� 1 G����'-�--'��r � � �
State License# `� ; �^�;f��y�, Expiration Date: . "��3� ��.
Phone: cell '��_ ���,.p p � office � ��-`3=f-� -'���,.
Mailing Address: _3� �c,���� ; ;� � vcL �. Cit : � ZIP: �� •
Contact Person: � ' � �k�,�*l�, Applicant is: Contractor / Homeowner
Email andbr Fax: �, , , �,� � (Circle One)
PROPERTY OWNER INFORMATI N:
Name: � �� �� �ti'nr � �._,��ti
Phone (day): � �q 1 _ �^���
Address: b, �,�,�-r �!e�, �,,,,� Cit : (Y1 � ZIP: �j .,�`� �7�
Email and/or Fax � � ��,��L; ��
ARCHITECT/ ENGIN�R�I�NFOR ATION:
Name: � ,�. � .�
Phone (day): +� -�` 4 -�
Address: � "'��, '�,,,�, ¢ ���,
c�t : (�'� 1 ziP: ���ii0
Email and/or Fax: �,\ � ; � ��� ��
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: Cit : Z�p:
Email and/or Fax:
PROJECT INFORMATION: Description of project: 'v�U.�
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
ew Construction Water Supply
�-Single Family with ❑ Accessory Bldg./Garage
❑Addition attached garage ❑ Deck
❑Accessory Building ❑ Single Family with ❑ Office/Commercial ��ublic Sewer
❑ Relocation detached ara e
9 9 �-Residence
❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retainin Wall s � Septic
9 ( ) (Compliance certificat
❑ Public 4-feet or greater may be required)
*"Any earth movement may require ❑ Commercial ❑ Storage
MCWD review 8�permits. ❑ Industrial ❑Warehouse
Minnehaha Creek Watershed District(MCWD) ❑ PubliC Water
❑ Other: (specify) ❑ Other(specify)
15320 Minnetonka Blvd;Minnetonka,MN 55345
Phone: 952-471-0590 / Fax: 952-471-0682 rivate Well
www.m innehahacreek.orq
Estimated Construction Valuation (excluding land) $