HomeMy WebLinkAbout2013-01075 - adv plan review CITY OF ORONO
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2750 KELLEY PARKWAY DATE ISSUED: 10/15/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1100 MILLSTON RD
PIN : 10-117-23-14-0015
LEGAL DESC : MILLSTON
: LOT 000 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 125,000.00
NO"I'E: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ 125000.00
"1'YPE OF PERMIT THIS PAYMENT IS FOR: BUILD[NG PERMI"I'
PERMIT#THIS PRE-PAYMENT IS TIED T0:2013-01076
APPLICANT ADVANCED PLAN REVIEW 784.39
TOM POTTER CONSTRUCTION INC. TOTAL 784.39
6531 DEVONSHIRE DR.
CHANHASSEN, MN 55317 PAID WITH CC# 2887
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Minnesota State License#: BCLi0144
OWNER
BURWELL, MR. & MRS. RODNEY P
1100 MILLSTON ROAD
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 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 ol'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 l80 days of the date of issuance,or if construction is
suspended for a period of I 80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conf ance with the State Building Code.This permit may be
revok y for due cause.
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A plicant Permitee Signature Date Issued y S' ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED A E.
DATA PRIVACY ADVISORY
In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen
waming", we would like to inform you that your request for a permit or license from the City of Orono or
any of its departments may require you to fumish ce�tain private or confidential information.
You are notified that -
1. The information you furnish will be used to determine your qual'fication for the permit or
license requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or
license.
3. The information may be shared with other local, state or federal agencies to the extent
necessary to process the permit or license.
4. If your requested permit or license requires Council action to approve, some information
may become public.
5. You have certain rights under Minnesota State Statute 13.04 (see following page) to
review private data on yourself.
6. Your full name is required to process this application or permit.
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First Middte tast
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I unders nd my rights as stated above.
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Signature
Packet Last Updated.� 04/19/2013
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