HomeMy WebLinkAbout2016-01424 - advance plan review fee CITY OF ORONO *�6 _ 0 1 4 2 4 *
2750 KELLEY PARKWAY DATE ISSUED: 1 U10/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
RESS : 1415 PARK DR
: T000162
LEGAL DESC : SAGA HILL REVISED
: LOT MB BLOCK MB
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 117,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OP PERMIT:$ 117,000.00
"CYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-01423
APPLICANT ADVANCED PLAN REVIEW 791.06
R HOUSE DESIGN BUILD TOTAL 791.06
Payment(s)
P.O. BOX 1153 CHECK 1647 791.06
CHANHASSEN,MN 55317-
(952)393-4667
Minnesota State License#:BUIL-BC678783
OWNER
QRANTER, BRIAN
1415 PARK DRNE
MOUND, MN 55364-
AGRGEMENT 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 docs
not grant permission for additional or related��ork which requires separate
permits. All provisions of la�vs and ordinances governing this type of work
shall be compicd 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�period of 180 days at any time afrer 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 a any time for due cause. �� ���
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App ' an " er itee S�gna e Date Issued By Signature Date
City of Orono
Building Permit Application
for New Structures or Additions
Mailing Address: Permit number: t(v "'�
.�(�p,O PO Box 66
`w Crystal Bay, MN 55323-0066 Date received: l—��/
� StreetAddress:' �_ Received by:
�.� ,� 2750 Kelley Parkwa ��j��� r �
ti� ��(� � �lan revie fee: -
–..
� c,` Orono, MN 55356 �,_(�Z� ____----
q'�FSHO�� 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 wiil be returned. (Please print)
GENERAL INFORMATION: �
Job Site Address: ��� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
!f yes,a specia/event permit is�equired with Police Department and City Counci/approvaf 6b days prior to the event. Shuttle bus service will be
requi�d un/ess applicant demonstrates sufficient on-siie parking is availab/e. Non permitted events will not be aUowed.
CONTRACTOR/APPLICANT INFORMATtON:
Name: �, �t( E D���t� b�+l,l f-D
State License# f�G !o Y 'l$'?, Expiration Date: 3 /3l f iS
Phone: (cell) q52, 3ti3- '�tL�"1 (o��)
Mailing Address: ,fl. osL � Cit : S Z�P: 553 1
Contact Person: Applicant is: c o / Homeowner (Circle One)
Email and/or Fax: ,.o� ,��h�sp�,eb�7n b�t� bl • �o t�-
PROPERTY OWNER INFORMATION:
Name: (�(L! P1r� l�R-�A-ri1 �N�YL—
Phone(day):
Address: j�16 f''�IG- .0 2, City: �(1,/� ZIP: S.S.3.S�
Email and/or Fax
ARCHITECT/ENGINEER INFORMATION:
Name: (�,✓G L�i L�`.1 �b(Z.Gb�(Zi'EGTS
Phone(day): �t r Z, b�+2- £�4lSb
Address: ?�S 2'15 I►'�f�.K.G T S T; C�iY= lYI p�S Z�P: .��/D.s
Email and/or Fax: 6�-i.. �Z. - �p�j
PROJECT INFORMATION: Descri tion of ro'ect: G1A�/ � 6YY�
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8�
Water Supply
❑ New Construction �Single Family with ❑Accessory Bldg./Garage
Addition attached garage ❑Deck �Public Sewe�
Accessory Building ❑ Single Family with ❑Office/Commercial
❑ Relocation detached garage �Residence ❑Private Sewer
❑ Other:(specify) ❑ Multiple Family/Condo ftetaining Wall(s)
❑ Public 4-feet or greater �'Public Water
**Any earth movement may require ❑Commercial ❑Storage
MCWD review 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:(SpeCify) ❑Other(SpeCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.minnehahacreek.or
Estimated Construction Valuation (excluding iand) � ���, t7�70 ,
Packet Last Updated: August 2015
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