Laserfiche WebLink
t 1 7�(, 36 <br /> City of Orono <br /> 'Building Permit Application for Maintenance / Replacement / Remodel <br /> (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) <br /> Mailing Address: <br /> V PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: Received by: lJ <br /> y <br /> 2750 Kelley Parkway Plan review fee: <br /> t <br /> kfsHol�, Orono, MN 55356 <br /> g <br /> Total Fee: / '7 t/. 3� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: 1100 Town Line Rd, Maple Plain, MN 55359 <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus sen ice wd"be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Lindus Construction, Inc. <br /> State License# BC007644 Expiration Date: 3/31/16 <br /> Lead Certification Number: NAT-58924-1 Expiration Date: 6/10/15 <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (cell) (office) 651.967.0379 <br /> Mailing Address: 879 Hwy 63 City: Baldwin,WI ZIP: 54002 <br /> Contact Person: Amy J Jilk Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: amy@lindusco.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Douglas Deakins <br /> Phone(day): 480.229.0894 <br /> Address: 1100 Town Line Road City: Maple Plain,MN ZIP: 55359 <br /> Email and/or Fax.- <br /> PROJECT <br /> ax:PROJECT INFORMATION: Overall project description: <br /> Type of Project: Any earth movement may also require <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: <br /> Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 18202 Minnetonka Blvd <br /> ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> ❑ Re-roof,other(specify) ❑Siding ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.org <br /> Estimated Construction Valuation of Project(excluding land) $ $8000 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to <br /> reject it until it is complete', <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is ' ormation which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of tinf mation is to 4nn ably u ate our records and records of other governmental agencies required by law. If <br /> you refuse to su I the ifformation,t e a i n ftnot be issued. <br /> Applicant's Signature: Date: 5/15/15 <br /> Owner's Signature: Date: <br /> Last Updated:January 2015 <br />