HomeMy WebLinkAbout2014-01375 - adv plan review • CITY OF ORONOI �il I� �' 111!1' �'I 11I�!11 H
City of Orono * 20 14 - 01375 *
2750 Kelley Parkwa; 2750 KELLEY PARKWAY DATE ISSUED: 11/26/2014
Orono MN 55356 952-249-4600 ORONO, MN 55356-
Receipt No: 3.012375 Nov 26, 2014 ,) 249-4600 FAX: (952) 249-4616
Schwarz Builders 3 LAKE RD
Previous Balance: .00 014
Permits PION
2014-01375 450 Old Long 1,271.89
Lake Rd LOCK 001
101-34410 'LAN REVIEW
Plan Check/Site Exam Fees
Total: 1,271.89
'LAN REVIEW
Credit Card TIAL
Check No: 1993 1,271.89
Payor:
Schwarz Builders
Total Applied: 1,271.89
Change Tendered: .00
11/26/2014 12:55PM
ITION
1.01376
I agree to Pas above total amount
according to card issuer agreement
(Merchant agreement if credit voucher)
Irj ,NT ADVANCED PLAN REVIEW 1,271.89
v.
TOTAL 1,271.89
Payment(s)
Merchant Coax .TE 2 CREDIT CARD 1993 1,271.89
THANK You.
HAVE A NICE DAY. -BC003922
OWNER
POLICINSKI, CHRISTOPHER&ANNE
450 OLD LONG LAKE 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
revoked at any time for due cause. /
�/ �/ y
Applicant Permitee Signature Date lssu By Signature Date
'IOW
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: �D/,
�T PO Box 66 Permit number: 7��3�
�Of VQ Crystal Bay, MN 553230066 Date received: //- .7-47 -1`/
Street Address:' Received by: i T-
2750 Kelley Parkway �__—..
y� � �Plan review fee: X2/:7151------
,
c` Orono, MN 55356
�1kesxov-f' Main: 952-259-4600 Total Fee: -_/3T_`-
Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submit'id.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: 1
Job Site Address: 96D 01-6LI1JC7 ,( KE Pc ) l 2 cd /Nti 553"
Will this be a Parade of Homes, Remodelers Showcase Home or other Dislay Home'? ❑ Yes 3 o
If yes,a special event permit is required with Police Department and City Council approval 60 day prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permi**- '-vents will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: Sckt,Lc r'7 • ,L�
State License# gC ;P „ Expiration Date: 373//P 0/G
Phone: (cell) (Q/2- 3 (e-gq4/3 rt' (office) 95. -976 - 7(0.'
Mailing Address: clic) Il'l t Qnr oakct /lye S .,rife „20y
o of Cit : f. z cj ZIP: 5539/
Contact Person: kart Se r.JQ.rz Applicant is: ontracto ' / Homeowner (Circle One)
Email and/or Fax: . rt @) 5Cki.Jcl_rZ-11 lrs . Co n'l
PROPERTY OWNER INFORMATION:
Name: r j.rjst kr !e otlr C fl ski
Phone (day): S - 3 5-.2S-00
Address: 4/55 old. L.ovi . � o{ City: L�)a(i-ze. c ZIP: 553''
Email and/or Fax c; 1;e_i nski ) IInc./..a.4b10 iss ,C o ryt II
ARCHITECT/ ENGINEER INFORMATI N•
Name: . /IL A % S 27 1
Phone (day): g5, - 9.'3G - 7gcl l
Address: QLD /ylihncto uc S.) Scaife AC j City: l,.Ja y R ZIP: 5 S 3 9 1
Email and/or Fax: _ski a rck 97 Co qui l . C._671.._
PROJECT INFORMATION: Description of project:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
Water Supply
❑New Construction Single Family with ,I8Residence
ddition attached garage Garage/Accessory Bldg. ,Public Sewer
❑Accessory Building 0 Single Family with 0 Deck
❑ Relocation detached garage ❑Office/Commercial 0 Private Sewer
❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
0 Public 0 Storage 0 Public Water
*`Any earth movement may require 0 Commercial 0 Other(specify)
MCWD review&permits. 0 Industrial Private Well
Minnehaha Creek Watershed District(MCWD) 0 Other: (specify)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.orq
Estimated Construction Valuation (excluding land) $ o5.5°y c)QC)
Packet Last Updated: 04/1912013
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