HomeMy WebLinkAbout2011-00004 - adv plan review CITY OF ORONO PERMIT NO.: 2011-00004
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUEn: OU04/2011
' 952 249-4600 FAX: 952 249-4616
AL`�:JRESS : 3095 NORTH SHORE DR
PIN : 09-117-23-32-0014
LEGAL DESC : REG.LAND SURVEY NO.0670
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 870,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 870,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME PERMIT
PERMIT#THIS PRE-PAYMENT IS TIED TO: BUILDING PERMIT 2011-00005
APPLICANT ADVANCED PLAN REVIEW 3,44939
ROBERT CRAIG HOMES INC. TOTAL 3,449.39
464 2ND ST.#101
EXCELSIOR, MN 55331 PAID WITH CC# 4679
(952)470-6639
Minnesota State License#: 8846
OWNER
SIME,MICHAEL&PAMELA
1592 MEDINA RD
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 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 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 an e for due cause.
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Applicant Permitee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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City of Orono
Building Permit Application ,�
for New Structures or Additions -�;7�� 7�
Mailing Address: permit number: p'�//-f C°J� ✓'�
O�D,�.O PO Box 66
Crystal Bay, MN 55323-0066 Date received: � oz0/�
,� �, StreetAddress:' Received by:
's'�c,t . Gti�' 2750 Kelley Parkway Plan review#ee: 3 • 3%
�EsH�4'� Orono, MN 55356 a ���a��
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.
Incomplete applications will be retumed. (Please print)
GENERAL INFORMATION:
Job Site Address: 3��'S 11����' Sfi�r✓� 1�l"•
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No
If yes,a specra/event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will e
required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION: �
Name: �, P� lo t1z�m�� +a-
State License# {2y�c�� Expiration Date: ?��I 2�'i
Phone: �j52-i�'1 D�le�i��.i� (office) G;12.-F�d0 � �17� (cell)
Mailing Address: �,� -; Dt Cit :,� �s Iv� ZIP: SS�_�`
Contact Person: �,ri Applicant is: E ac o / Homeowner (CircleOne)
Email and/or Fax: ��, :.y c�Q;��, ���� � �cs d ���v+
PROPERTY OWNER INFORMATION: .
Name: �Ui k� pft � 5 i/n�=
Phone (day): (,<��..— 7�g �- �S �S
Address: i 5��'Z vr+�Ai�+G� �i� City: LC7r. �S �--'�E ZIP: ��s�C�
Email and/or Fax ���P S i m t: 4= /FvL ����"
ARCHITECT/ENGINEER INFORMATION:
Name: �I'1�!'it7R�'T �E�sl�;n�
Phone(day): �I Si.~ �-4"7 C5 � �''"1_S�
Address: q:�c�- Z :�• s'i. ��1- 1 C 0 City:��;,,5 jcs � ZIP: j����
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8�
Water Supply
�New Construction �Single Family with ��Residence
❑Addition attached garage Garage/Accessory Bldg. �Public Sewer
❑Accessory Building �Single Family with ❑ Deck
❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer
❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
**Any earth movement may require ❑Commercial ❑Other(specify)
MCWD re�iew&permits. ❑ Industrial �Private Well
Minnehaha Creek Watershed District(MCWD) ❑Othe�: (specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.or
Estimated Construction Valuation (excluding land) $ yL�, p��s
Last Updated: 12/21/2010
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