HomeMy WebLinkAbout2012-01244 - adv plan review CITY OF ORONO * 2 B 1 2 — 0 1 2 4 4 *
, � - � ' 2750 KELLEY PARKWAY DATE ISSUED: 12/20/2012
' ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3805 NORTH SHORE DR
PIN : 17-117-23-21-0029
LEGAL DESC : SHERRI LAKEVIEW ESTATES
: LOT 002 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATIOl�1 : $ 325,000.00
NOTE: PLEASE FILL IN THE FOLLOWiNG: City af Orono
275�? K�11eY Pat^kway g�-249-45{�
Qrano 1�1 55356
VALUATION OF PERMIT:$ 325,000.00 Receipt No: 3.048139 �� �+ ��`
TYPE OF PERMIT THIS PAYMENT IS FOR: 2012-01245
Don Rachel
PERMIT#7'HIS PRE-PAYMENT IS TIED"I'0:NEW HOUSE ��t}
Rrevious Balance:
Persits i,�,4,3y
�p1�-01244 3805 North
Share l�r
101-34410
Plan Check/5ite Exam F��s---------------
Tatal: 1'�.��
�—=___
Check 1,564.39
Check Pb: 62�1
Payor:
Qon Rachel i}�4.39
T�tal Rpplied: �_________�_
r4_..__ T--�- -;
APPLICANT ADVANCED PLAN REVIEW 1,564.39
DEAN JOHNSON HOMES, INC. TOTAL 1,564.39
4700 CTY ROAD 19
MEDINA, MN 55357-
(763j 479-4820
Minnesota State License#: 20639439
OWNER
RACHEL, DON
3805 NORTH SHORE DR
MOUND, MN 55364-
AGREEMENT AND SWORN STATEMENT
T�he work for which this permit is issucd 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
pennits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specitied 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 180 days at any time afler work has commenced.
T'he applicant is responsible for assuring all required inspections arc
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. 7 �
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� Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� ,
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address:
�/'�0.� PO Box 66 Permit number: p�� —Q/
.v , \ Crystal Bay, MN 55323-0066 Date received:
� �Y,. e�
�� ' �����'=,.. ��, StreetAddress:' Received by:- --- __.__�_._
`� �lr:� �; ...._e_�_ . __
���;�,��,���,�,���� 2750 Kelley Parkw � , � Pfan review fee: C
'Y�sxo4`j Orono, MN 5535 r.f'��i(t�- i,��2 Z' •
� ---_' t�a�-Fe : — ! aZ� _-�'`'
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 returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: ��,L.r� ��,�.� ���� -�Y -�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
/f yes, a specia/event permit is required with Po/ice Department and City Council approva/60 days pnor to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: . � Y�� t— r � � v`c.�
State License# � . �� ° 3� Expiration Date: ��(�� � -'�
Phone: �� -,.7,_ � _�"- office '�. 3— ��4,. � � cell
Mailing Address: � � - • � � Cit � � ZIP:
Contact Person: L c�..� Applicant is: Contractor ` / Homeowner
(Circle One)
Email and/or Fax: �,,,1��„��y�C��.�4, . �.�hv�a,,-� +����^�,�.°� � �.-m-�->
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PROPERTY OWNER INFORMATION:
Name: lk.�',�v t��.�t���
Phone (day): ( �,�-z� c�� �_�-�-�—�
Address: �/�:"" :�.�E�rz ��� � i N� Citv.�i_�. t��N��c z ZIP �,«, -�c
Email andlor Fax �-7c,.�l y Z�( cS� �
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: Cit : ZIP:
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8�
New Construction Water Supply
�Single Family with Residence
Addition attached garage �Garage/Accessory Bldg. ❑ Public Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached ara e
❑ Other: (specify) 9 9 ❑ Office/Commercial ❑ Private Sewer
❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
""`Any earth movement may require ❑ Commercial ❑ Other(specify)
MCWD review&permits. ❑ Industrial
Minnehaha Creek Watershed District(MCWD) ❑ Private Well
18202 Minnetonka Blvd ❑ Othef: (speCify)
Deephaven, MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding land) $
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