HomeMy WebLinkAbout2016-00122 - adv plan review �
CITY OF ORONO * 2 0 1 6 - 0 PJ 1 2 2 *
• " 2750 KELLEY PARKWAY DATE ISSUED: 02/OS/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3683 NORTH SHORE DR
PIN : 08-117-23-34-0053
LEGAL DESC : CRYSTAL BEACH
: LOT 005 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 210,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 210,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00121
APPLICANT ADVANCED PLAN REVIEW 1,171.90
TOTAL 1,171.90
HOMES BY LEGACY Payment(s)
34 WATERSTREET CHECK 5393 1,171.90
SUITE A
EXCELSIOR,MN 55331-
(612)270-6214
Minnesota State License#: BUIL-BC667652
OWNER
RESSLER,JON
3683 NORTH SHORE DR
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. AII 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 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 res onsible for as ed inspections are
requested in c orm nce wit e State Building de.This permit may be
revoked at y time for due c se.
� � 2 � �� � � � � �
Appli t Pe D e Issued By Signature �— Date
, - CITY OF ORONO
BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
�O A, Mailing Address: Permit number. Zj� (p — ��� �
i VO PO Box 66
Crystal Bay, MN 55323-0066 Date received: � � '
� Street Address:' Received by:
y�. G� 2750 Kelley Parkway ���-�b i� lan reviewfee: � ,
t�kESH��� Orono, MN 55356 e-tc. 5�9�
Main: 952-249-4600 Total Fee:
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: (p -x,� �� S , (�L 1�(�--
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �Alo
liyes,a special event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shutt/e bus service will be
required un/ess applicant demonstrates sufficient on-site parking is available. Non permitted events wil!not be allowed.
CONTRACTOR/APP�ICANT INFORMATION:
Name: �m�S 13� L��Cr�`{
State License# L- Z, Expiration Date:
Phone: (cell) (p�2-- Z'"!p � l��-1 (office) (Qt Z - a•'t�- (�'�t�
Mailing Address: � ^� Cit : e' ZIP:
Contact Person: S��-( L--r�v���,,.� Applicant is: n rac / Homeowner �c�«ie o�e>
Email and/or Fax: S�-fN � �crn�-'� f3�L���'t�cJ;�[��S . c o�.
PROPERTY OWNER INFORMATION:
Name: �o,S ��gSL��
Phone (day): �1'SZ- 2�u - '17
Address: 3(or�3 cn>r�e Sr e,¢.� -�r� �v� City: �Q,on�� ZIP• 553's(o
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
� � -
PROJECT INFORMATION: Description of pro'ect: � � �
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Dispos I&
�struction ingle Family with ❑Accessory Bldg./Garage Water Supply
/� C
ddition attached garage ❑ Deck
❑Accesso Buildin �Public Sewer
ry g ❑ Single Family with ❑ Office/Commercial ��
❑ Relocation detached ara e �
g g $Residence ❑ Private Sewer
❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ��7
❑ Public 4-feet or greater �'Public Water
**Any earth movement may also require ❑ Commercial ❑Storage �'
MCWD review&permits. ❑ Industrial ❑Warehouse �
Minnehaha Creek Watershed District MCWD ❑ Private Well l
( ) ❑ Other:(specify) ❑ Other(specify)
15320 Minnetonka Blvd
Minnetonka, MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.or
Estimated Construction Valuation (excluding land) $ 2.��� �p'�
Last Updated: January 2015