HomeMy WebLinkAbout2011-00668 - adv plan review 1
" � CITY OF ORONO PERMIT NO.: 2011-00668
� 2750 KELLEY PARKWAY
� ORONO, MN 55356- DATE IssUEu: 07/18/2011
� ' 952 249-4600 FAX: 952 249-4616
AG jiiRESS : 679 MINNETONKA HGLD LA
PIN : 06-117-23-44-0008
LEGAL DESC : MINNETONKA HIGHLANDS ESTATES
: LOT 004 BLOCK 002 • -
PERMIT TYPE : ADVANCED PLAN REVIEW ��1E�
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PROPERTY TYPE : RESIDENTIAL `�� �� , ,-,,-,r� , ,�, -
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 10,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ $10,000.00 ��
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TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PF,RMIT i�ii,',
PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-00669 "1i" �`"��
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APPLICANT ADVANCED PLAN REVIEW 124.64
NELSON, ROBERT&VICKY TOTAL 124.64
679 MINNETONKA HGLD LA
LONG LAKE,MN 55356
OWNER
NELSON, ROBERT&VICKY
679 MINNETONKA HGLD LA
LONG LAKE,MN 55356
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 permi[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 nul]and void if construction authorized is not
commenced wi[hin 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.
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App ic] ant Permitee ignature Date ]ssued By nature� Date
SEPARATE PERMiTS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV .
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City of Orono �� �
"� Building Permit Appiication for nternal Work �c'q�
! , (windows, doors, siding, re-roof, etc.)
Mailing Address: permit number. o?O//-��d�O (o
� �g O�� Crystal Bay,MN 55323-0066 Date received: 7-�8� /�
a a SY�eet Addiess: Received by: �
�, Gti�' 2750 Kelley ParkwaY Plan review fee: Z�.
�o�.� Orono,MN 55356 pZ0/(—DD�o
Total Fee:
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.
tncomplete applications will be retumed. (P/ease print)
GENERAL INFORMATION:
Job Site Address: i n f�i � C� �. » 55��S
Will this be a Parade of Homes, Remodelers Showca e Home or other Display Home? Yes No
!f yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates suficient on-site parlvng is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: Qa�JC?r.'1'" /� E�sGi�l
State License# Expiration Date:
Lead Certificafion Number. Expira6on Date:
(for►Mork on homes that were constructed prlor!0 1978
Phone: �S 2—i-1 75'—(,`f 5 2 (office) (cell)
Mailing Address: �'y) ;,� � � n [., �� City: o ��V ZIP: �` 3
Contact Person: e Applicant is: Contractor / Homeowner �ci�cie o�e�
Email and/or Fax: {�� �K rn-I-1��, � A'1 G�1 c�• ��^
PROPERTY OWNER I FORMATION:
Name: o�e►�7� d'r�c� I�i'��C��r !��%3�a�
Phone(day): q`SZ-y 75�-(4 5 2
Address: �;�79 ,(?1,��r,��tdr,�E-crf�iw�h��hd�a��e ��ri�G`n��o,tm�►/ Z1P: 553�
Email and/or Fax � �/�m-�-1�� a vY1 G�i J'1".. C�r»
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCYYD review b permits:
❑Door(s) �Remodel ❑Water Damage Minnehaha Creek Wa�rshed District(MCWD)
❑Window(s) ❑Repair ❑Storm Damage 18202 Minnetonka Blvd
�Siding ❑Restoration �Other.(specify) DeePhaven,MN 55391
` Phone: 952-471-0590
❑Re-roof ❑Fire Damage �iO,�I� �a�"F Fax: 952-471-0682
�"�,�n r o�' www.minnehahacreek.orq
Overall Project Description: • b lE acs E �-'►o�I 4YI�l F r^ e.
Estimated Construction Valuation of Project(excluding land) $ jp,�p�j
APPLICANT ACKNOWLEDGEMENT:
. Agree.s to provide all information reyuir+ed or requested by the Building Deparhment;
• Certifies that the information supplied is true and corned to the best of hislher knowledge. The applicarrt recognizes tfiat they
are solety responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative
but to reject it urrtil it is complete;
• Some or all of the information that you are asked to provide on this application is classfied by State law as either private or
confidential. Priva�data is information which generally cannot be given to the public but can be given to the subject of the
data. Confiderrtial data is information which c,�:nerally cannot be given to either the public or the subject of the data. Our
purpose and irrtended use of this information is to annually update our records and records of other govemmental agencies
uired b law. If ou refuse to su the infom�ation the a lication ma not be issued.
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ApplicanYs Signature: ,�.Q,r�?`� 6L -��e,•�__ Date:
Last Updated: 03-01-2011