HomeMy WebLinkAbout2014-00550 - adv plan review CITY OF ORONO * 2 0 1 4 — 0 PJ 5 5 PJ
•••. 2750 KELLEY PARKWAY DATE ISSUED: 06/03/2014
a ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS NORTHERN AVE
PIN 17-117-23-34-0002
LEGAL DESC REG.LAND SURVEY NO.0763
LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADVANCED PLAN REVIEW
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 325,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 325,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADVANCED PLAN REVIEW NEW STRUCTURE
PERMIT#THIS PRE-PAYMENT IS TIED TO: 2014-00551
APPLICANT ADVANCED PLAN REVIEW 1,564.39
ATLAS HOMES INC Payment(s) TOTAL 1,564.39
14450 117TH AVE N CHECK 15299 1,564.39
DAYTON,MN 55369-
(763)691-9044
Minnesota State License#:BUIL-BC20269686
OWNER t,.� + J
4751 i<pl ley
REAL ASSETS,LANDSOURCE `Ir`':") tl 55,3at
550 25TH AVE N r: i e3p` N t;.! ).i t:; tit°,
ST CLOUD,MN 56301- s .vvt l
{IEism'i %.11
PY?V;ous itil3Ylep,
AGREEMENT AND SWORN STATEMENT I tr aas
L t�,_riy5�rra 37)0 jlkr'G`iern
The work for which this permit is issued shall be performed according to r.
the approved plans and specifications,applicable City approvals,and the lU -sqj;
State Building Code. This permit is for only the work described and does News
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work ,nU is 1,56
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not �y efii 4 xf
commenced within 180 days of the date of issuance,or if construction is fAec'k too; 15c+5 ����4•�'
suspended for a period of 180 days at any time after work has commenced. Paw,
�ti.as nows -• Real ASSUt L-LL'
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. -
Applicant Permitee Signature Date Issued By Signature Date
CITYOF ORONCS 5w o
A
BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
O�r Mailing Box 66. Permit number: CA
1 YO Crystal!Bay,MN 55323-0066 Date received: 3
Street Address:'
`C 2750 Kelley Parkway Plan review fee: c
G Orono,MN 55356 �Sd1619 /5 3
SH04� [
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. (Please print)'
GENERAL INFORMATION: 37 � - P to OAteX
Job Site Address: '7 oar n.��'�
Will this be a Parade of Homes, emodelers Showcase Home or other Display Home? ❑Yes [X No
/f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-pennitted events will not be allowed.
CONTRACTOR/APPLICT+t6L5
T INFORMATION:
Name: Ho e> Pllc-
S
tate License# f.3e,2lioP® Expiration Date:
Phone: cell 7(0Z,`11 0q office '163 `I ZS 3333
Mailing Address: k 6iw b I M AJ Ci ZIP: 5'S 3
Contact Person: tl� Applicant is: on' ctor i Homeowner (eimie one)
i
Email and/or Fax: Ina VK-0 wi+v1 ,cea ks3 D�39
PROPERTY OWNER INFORMATION:,
Name:
' Phone(day): �15 f05 Zc'c'
Address: 2 �-� ,� /u city., S-I' c t o�� zip: S'6 30 3
Email and/or Fax u �55/x. `iGt3 ® 4 v+n ca. Le
ARCHITECT[ENGINEER INFORMAT ON:
Name v-D i ; n �c
Phone(day),. 1(o3 -7 5-7 5-10%41
A c 1
Address: - !a l *!"I, f:h A. A)kJ City ZtP:
Email and/or Fax: '7(03 7 !j-7 !3
PROJECT INFORMATION: Desai tion ofproject:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal
Water Supply
New Construction �4 Single Family with Residence
Addition attached garage 0 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 jPubiicWater
**Any earth movement may also require ❑Commercial; ❑Other(specify) -
' MCWD review&permits. 0 Industrial [I Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other.(specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.o
Estimated Construction Valuation(excluding land) '
i .