HomeMy WebLinkAbout2012-00672 - adv plan review CITY OF ORONO * z 0 1 2 - 0 a 6 7 2 *
2750 KELLEY PARKWAY DATE ISSUED: 0'7/16/2012
' ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
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ADDRESS : 1376 PARK DR
PIN : 07-117-23-41-0096
LEGAL DESC : SAGA HILL REVISED,HENNEPIN CO
: LOT MB BLOCK 013
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 6,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 6,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: STOOP OFF HOUSE&WALKWAY
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-00671
APPLICANT ADVANCED PLAN REVIEW 86.29
LARSON&TERESA,DAYTON TOTAL 86.29
1376 PARK DR
MOLTND,MN 55364- PAID WITH CC# 8064
OWNER
LARSON&TERESA,DAYTON
1376 PARK DR
MOLJND,MN 55364-
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 rela[ed 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.
/ / � �
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: •� j "-,`) �
� �. 0
Crystal Bay, MN 55323-0066 Date received: a7 /4� /-�--
� �'�m-�'` �, Street Address:' Received _ _ �
�,'�'�, ��' 2750 Kelley Parkway Plan re w fee: �' • Zr� �/
�tg�o�.'�' Orono, MN 55356 �
_ �24;
'-- Total Fee:
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: � �N�
Job Site Address:
Will this be a Parade of Homes, Remodelers S ow a e Ho e o other Display Home? ❑ Yes o
If 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 permitted events will not be allowed.
CONTRACTOR I APPLICANT INFORMATION:
Name: �yTpN t ��cDnl
State License# Expiration Date:
Phone: qs',� y 7� �,,����^ (office) (cell)
Mailing Address: Cit : ,,.}U
Contact Person: _S'�}M[.^ � Applicant is: Contractor / omeowner �c�r�ie o�e�
Email and/or Fax: j J„„ �� f e_ S3 � �o ;,,��,,,�.L
PROPERTY OWNER INFORMATION:
Name:
Phone(day): q . , �
Address: Cit : c� N ZIP: ' 6
Email and/or Fax � ,� Q � �� ,�� ? �Tr��� �1.C2•�
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone(day): �
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal&
❑ New Construction Water Supply
❑ Single Family with ❑ Residence
❑Addition attached garage ❑ Garage/AccPssory Bldg. �j Public Sewer
❑Accessory Building �Single Family with �Deck
�Relocation 1 detached garage ❑ Office/Commercial ❑ Private Sewer
Other: (specify) 7D 4Z-W� ❑ Multiple Family/Condo ❑Warehouse
❑ Public ❑ Storage ❑ Public Water
""Any earth movement may require ❑ Commercial ❑Other(specify)
MCWD review 8�permits. ❑ Industrial �rivate Well
Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeClfy)
18202 Minnetonka Blvd
Deephaven,MN 55391
Phone: 952-471-0590
Fax: 952-471-0682
www.m i n ne ha hacreek.o
Estimated Construction Valuation (excluding land) $ �; ��(�: (�D