HomeMy WebLinkAbout2015-01521 - adv plan review CITY OF ORONO * 2 0 1 5 - 0 1' S 2 1 *
• 2750 KELLEY PARKWAY DATE [SSUED: 12/03/2015
' ORONO, MN 55356-
(952 249-4600 FAX: 952) 249-4616
ADDRESS : 3438 LYRIC AVE
PIN : 17-117-23-43-0077
LEGAL DESC : NAVARRE HEIGHTS
: LOT 023 BLOCK 005
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 165,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUAT[ON OF PERMIT:$ 165,000.00
TYPE OF PERMIT TH1S PAYMENT IS FOR: NEW HOME
PERMIT#THIS PRE-PAYMENT IS TIED TO:20 1 5-01 520
APPLICANT ADVANCED PLAN REVIEW 987.62
TOTAL 987.62
FIELDSTONE FAMILY HOMES Payment(s)
801 CLIFF RD E CHECK 6242 987.62
SUITE 135
BURNSVILLE,MN 55337-
(952)469-8800
Minnesota State License#: BUIL-BC631164
OWNER
Fieldstone Family Homes
801 CLIFF RD E
SU[TE 135
BURNSVILLE, MN 55337-
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 onty the 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.
The 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. � / I`
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- _ =-�. i 2�`3�� ���' ��,��_� ����.�� ������ ,���- �, ��-_-_
Applicant Permitee Signatare Date Issued By Signature " Date
.
• City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: permit number: Z(�� ,S� d
QA, PO Box 66
� �`v� Crystal Bay, MN 55323-0066 Date received: 2 — 3-1
Street Address:' Received by: �
y ,� 2750 Kelley Parkway ��C�� 5ao plan reviewfee: , (a Z. � C
�' o� Orono, MN 55356
1'�kFstto�`�' 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: L ,�r/
Will this be a Parade of Homes, Remodeler Showcase Home or other Display Home? Yes No
!f yes,a specia/event permit is required with Po/ice Department and City Council apprnval 60 days prior to the event. Shuttle bus service will
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events wil/not be al/owed.
CONTRACTOR/APP ICf� INFORMATION:
Name: d"�cl�S�olA.2- �pwt��CY ���i
State License# _�(�3 J/L�! �— Expiration Date:
Phone: cell � . -7 o�ce �`i -
Mailing Address: L 1' �D ' 1 Ci : rw y� � d'�IZIP:
Contact Person: p q,,� Wq) Applicant is:��ra r I O Circle One)
Email and/or Fax: � f� f-� ,"1 .Ga,.n
PROPERTY OWNER I FORMA ON:
Name: ��4vy-G
Phone(day): '
Address: City: ZIP:
Email and/or Fax
ARCHITECT/ENGINEf R INF ATION:
Name: /�Se�t vvt,��
Phone (day): �
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATtON: Descri tion of ro ect:
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 �f Public Sewer
❑Accessory Building ❑ Single Family with Office/Commercial
❑ Relocation detached garage �Residence ❑ Private Sewer
❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater �ublic Water
""Any earth movement may require ❑Commercial ❑Storage
MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑Private Well
Minnehaha Creek Watershed District(MCWD) ❑Othe�: (SpeCify) ❑Other(SpeCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minneh hacreek.o
Estimated Construction Valuation (excluding land) $ ��J/�
Packet Last Updated: August 2015
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