HomeMy WebLinkAbout2014-01421 - advance plan review fee � . CITY OF ORONO * 2 0 1 4 - 0 1 4 2 1 *
2750 KELLEY PARKWAY DATE ISSUED: 12/1 U2014
ORONO, MN 55356-
952 249-4600 FAX: (952) 249-4616
ADDRESS : 3399 CRYSTAL BAY RD
PIN : 17-117-23-44-0021
LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B
: LOT 018 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 250,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 250000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION
PERMIT#THIS PRE-PAYMENT IS TIED TO:2014-01422
APPLICANT ADVANCED PLAN REVIEW 1,271.89
TOTAL 1,271.89
COMMAND BUILDING SERVICE Payment(s)
15405 N EDEN DRIVE CHECK 22704 1,271.89
EDEN PRAIRIE,MN 55346-
(612)708-6085
Minnesota State License#: BUIL-BC636753
OWNER
V MCKINNEY, STEVE SOBIENIAK/
339 CRYSTAL BAY 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 rype 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
. _ �
CITY OF ORONO
BUILDING PERMIT APPLICATION
FOR NEW STRUCTURES OR ADDITIONS
Mailing Address:
�O� PO Box 66 Permit number: Q –Q
� Crystal Bay, MN 55323-0066 Date received: /� //–/
� ��
StreetAddress:' Received by:
��. G1�� 2750 Kelley Parkway 7 lan reviewfee: �Q/ �– /
t SH Orono, MN 55356 � ��Z �.7,8,
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Main: 952-249�600 Fax: 952-249-4616 www.ci.orono.mn.us � � . '�S'
This application farm must be completed in full and all reguired inf�rmation must be submitted.
lncomplete applications wiii be retumed. (Please print)
GENERAL INFORMATION: <'i' `''
Job Site Address: � , � � �
Will this be a Parade of Homes, Remodelers Showcas ome or o er D� lay Home? ❑ Yes No
If yes,a special event permit is required with Police Department and City ouncil approval 60 day prior to the event. Shuttle bus service will6e
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APP CANTINFORMATI N: /
Name: ,�� � , [ �, a�,�
State License# �xpiration Date: �3 � -
Phone: cell _ _- p � office fl � ��
Mailing Address: '- / Cit : � ZIP:
Contact Person: � Applicant is: ontractor / Homeowner (Circle One)
Email and/or Fax: � % � % ,�
PROPERTY OWNER I R ION: ; � � 31�0 1
Name:
Phone(day): _ �¢r t� �I
Address: <�,� 5?��,�-�,�4,-, ,�� Citv: ZIP:
Email and/or Fax
ARCHITECT/ENGINEE INFORMA ON:
Name: f-� f ...�.
Phone (day): ��-- — �p
Address: Cit : ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of pro�ect:
1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8�
❑ New Construction Water Supply
in le Family with �esidence
.�.Addition attached garage ❑Garage/Accessory Bldg. �ublic Sewer
❑Accessory Building ❑ Single Family with ❑ Deck
❑ Relocation detached garage ❑Office/Commercial
❑Other: (specify) ❑Multi le Famil /Condo ❑ Private Sewer
p y ❑Warehouse
❑ Public ❑Storage ❑ Public Water
*"Any earth movement may also require ❑Commercial ❑Other(specify)
MCWD review&permits. ❑ Industrial
❑ 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.or
Estimated Construction Valuation (excluding land) $ �. �Q. p(lj c� --��