HomeMy WebLinkAbout2016-00719 - adv plan review CITY OF ORONO * 2 0 1 6 — 0 0 7 1 9
2750 KELLEY PARKWAY DATE ISSUED: 06/21/2016
ORONO,MN 55356-
r (952)249-4600 FAX: (952) 249-4616
ADDRESS 220 NORTHGATE RD
PIIS 36-118-23-41-0051
LEGAL DESC NORTHGATE TWO
LOT 001 BLOCK 007
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 200,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 200,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00718
APPLICANT ADVANCED PLAN REVIEW 1,130.95
CYCLONE CONSTRUCTION TOTAL 1,130.95
2876 FAIRWAY DR Payment(s)
CHASKA,MN 55318- CREDIT CARD 1603 1,130.95
(651)398-3622
Minnesota State License#:BUIL-429008
OWNER
SEE,HENRY&GAIL
220 NORTHGATE RD
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. All 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 responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revok 7 time for due cause.
R", -fs
Aprfflcan;4'errfiitee Signature Date Issued By Signature Date
CITY OF ORONO
BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
Mailing Address: Permit number: -(-)C)7/
V PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Received by: /2!✓
Street Address:' _ p
y� G. 2750 Kelley Park wa -'`l (' (,�0,1 1 I Plan review fee: Q q
ESHo�� Orono, MN 5535;"_D� "__
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.
GENERAL INFORMATION: Incomplete applications will be returned. (Please print)
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servicev8ill be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR /APPLICANT INFORMATION:
Name:
State License # CSL-lZ`f oos Expiration Date: S}3/ + -7
Phone: (cell) LSI _ �S„� _ 3� ZZ (office) -
Mailing Address: Cit ZIP:
Contact Person: �_� Ste- Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: (y�� S��i �•i�.
Phone (day):
Address: City: ZIP:
Email and/or Fax
ARCHITECT/ ENGINEER INFORMATION:
Name: Ocs-.=- -J
Phone(day): Pq y_ C o tiz
Address: City: °�>--, ZIP:
Email and/or Fax: M:
PROJECT INFORMATION: Description of project: _�,
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal &
❑ New ConstructionWater Supply
Singie Family with ❑ Accessory Bldg./Garage
❑Addition attached garage ❑ Deck
E]Accessory Building El Single Family with ElOffice/Commercial Public Sewer
❑ Relocation detached garage ❑ Residence ❑ Private Sewer
[ Other: (specify) L_E:�t ❑ Multiple Family/Condo ❑ Retaining Wall(s)
❑ 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) El Private Well
15320 Minnetonka Blvd ❑ Other: (specify) ❑ Other(specify)
Minnetonka, MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.m innehahacreek.orc
Estimated Construction Valuation (excluding land) ZcxU � Oc)v
Last Updated: January 2015