HomeMy WebLinkAbout2012-00955 - adv plan review CITY OF ORONO * Z 0 1 2 — 0 B 9 5 5 *
" 2750 KELLEY PARKWAY DATE ISSUED: 09/25/2012
. ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3520 NORTH SHORE DR
PIN : 08-117-23-43-0009
LEGAL DESC : BALDUR PARK
: LOT 003 BLOCK 002
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 243,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 243,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-00956
APPLICANT ADVANCED PLAN REVIEW 1,244.59
ROBERTS RESIDENTIAL REMOD INC.
2999 W CTY RD.42-#100 TOTAL 1,244.59
BURNSVILLE,MN 55306- Cit of Orono
(952)224-3680 ����ey p�Y y��49�
Minnesota State License#:BC006885
Reeeipt No: 3.007fi79 5ep 25, P012
OWNER
PETERS ET AL,ANN L Roberts ttesidential R�odeling
3520 NORTH SHORE DR Previous Balar�e: .40
,MN 55391- Pereit5
201�-00955 3520 North 1,244.59
Share Dr
141-34410
AGREEMENT AND SWORN STATEMENT Plan Check/Site Exa� Fees
The work for which this permit is issued shall be performed according to Tatal S 1�244.`J9
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does (��k
not grant permission for additional or related work which requires sepazate (�12Ck �; i� 1�2�.S9
permits. All provisions of laws and ordinances governing this type of work payppp
shall be compied with whether or not specified herein.This permit will Roberts Resident ial Re�odel ing
expire and become null and void if construction authorized is not Tatal Applied: I�244.59
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. aldfl� TBTId21"2d C .I�
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be �����12 ���
o e at any time for du ause. /(f!/
/�? � c-�n� � i �i �S -/
Applican ermitee Signatur Date Issued By Sig ture Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� City of Orono
Building Permit Appiication
for New Structures or Additions
O MailiPO Box 66• Permit number: o�Ol a���S(o
O� �vO Crystal Bay,MN 55323-0066 Date received: � �b�` Z
� a St�et Address:' Received by:
Gti�' 2750 Kelley Pa aY�.��� ��' Plan review fee: �g
�.�o�,� Orono,MN 553
Totai Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be compteted in fuli and afl required information must be submitted.
Incomplete applications will be returned. (PJease print)
GENERAL INFORMATION:
Job Site Address: 11�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
If yes,a special ev�ent permit is required with Polioe Depa►tment and City Counal approva160 days prior b the e�rent. Shu bus senrice will be
required unless applicant demonstretes sufficient on-site paricing is available. Non pe►mitted events wiH not be albinred.
CONTRACTOR/A PUCANT INFO ATfON: �
Name: ` � f ���i
State License# �"/�d/� ,W�'� Expiration Date:
Phone: �Z-1 '?�"�a�-��.�C� (office) �,5�—.Z�.2' L,�3�7� (cell)
Mailing Address: � d2 '� p t� Ci : r� fi / ZIP:
Contact Person: J�' �� Applicant is: n � / Homeowner �cir�ie ooe�
Email and/or Fax: _,`��}(-���J 312 � f�� r CD YY1 / g.s� -�i2�%-3!��`�
PROPERTY OWNER INFORMATION:
Name: r17�1n �! SA'VtMa �C-�/1 S
Phone(day): �,�t _��'�- S G l�
Address: ��07 t� N D V'�-f� �1'1.b Y2 A 3' 1 V °� City: �j/�Oy, �, ZIP: 5�3 t f
Email and/or Fax ��/i�-, ��o f �`S� @q�r,ai/, c e��
ARCHITECT/ENGINEER INFORMAT N: , .
Name: ��'� 2 / "h� �C' /� �l�C
Phone(day): . — — '
Address: � ,� '�;.� c '< � � � i�r Ci : ' ��,i , ZIP:
Email and/or Fax: ��}�-(��C.-�f".� �� �. f�'Z'�L- : Ct�y�
PROJECT INFORMATION:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8
Water Supply
❑ �Vew Construction ;�Single Family wfth ' ence
ddition attached garage ' arag /Accessory Bldg. �..Public Sewer
❑Accessory Building ❑ Single Family with
� Relocation detached garage Office/Commercial ❑ Private Sewer
Other. (specify) ��'I'�Cl�k ❑ Multiple Family!Condo ❑Warehouse
❑ Public ❑ Storage �Public Water
"kAny earth movement may require ❑Commercial ❑ Other(specify)
IIACWD review 8 permits. ❑ Industrial ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify)
18202 Minnetonka BNd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-�82
www m'n eh
Estimated Construction Valuation (excluding land) � ��-�j GO f.�
Padcet Last Updated: 03-06-2012
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