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City of Orono <br /> Building Permit Application for Maintenance / Replacement./ Remodel <br /> (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) <br /> W <br /> o Mailing Address: Permit number: i5-O00 y3 <br /> POBox66Crystal Bay, MN 55323-0061 Date received:Street Address: Received by: VJ: 2750 Kelley Parkwa (l Plan reviewf — (6-( _C!VOrono, MN 55356Eslio� /�lP V <br /> Total Fee: <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: <br /> Job Site Address: 875 Wayzata Blvd. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes Ed 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 service will 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: Kraus Anderson Construction Co <br /> State License# Expiration Date: <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (cell) 612-366-7571 (office) 612-332-7281 <br /> Mailing Address: 525 South 8th Street City: Mineapolis ZIP: 55404 <br /> Contact Person: James Beckwith Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: jim.beckwith@krausanderson.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Kraus Anderson Realty <br /> Phone (day): 952-881-8166 <br /> Address: 875 Wayzata Blvd. City: Orono ZIP: 55391' <br /> Email and/or Fax: matt.alexander@krausanderson.com <br /> PROJECT INFORMATION: Overall project description: <br /> Type of Project: Any earth movement may also require <br /> ❑ Door(s) ® Remodel 0 Fire Damage MCWD review&permits: <br /> ❑ Re-roof,asphalt ❑ Repair 0 Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar ❑ Restoration 0 Water Damage Deephaven, MN 55391 <br /> ❑ Re-roof, other(specify) 0 Siding ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> 0 Window(s) www.minnehahacreek.org <br /> Estimated Construction Valuation of Project(excluding land) $ 153, 672.00 <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 a <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but t <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 o <br /> confidential. Private da 'is information which generally cannot be given to the public but can be given to the subject of the data <br /> Confidential data is inf rrnation which generally cane.t be given to either the public or the subject of the data. Our purpose and <br /> intended use of this info ation is to anAually upd e our records and records of other governmental agencies required by law. If <br /> you refuse to supply the in arfg4tiani;tJae�pj3lic.+.n may not be issued. <br /> Applicant's Signature: lir 1/ ? Date: 1/15/15 <br /> V .,-r,. 1- 1 < . . .. .. <br /> Owner's Signature (2 f ',(L.:x--, Date: 1/15/15 <br /> Last Updated:January 2015 ... <br />