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2016 - 00052 - adv plan review
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West Lafayette Road
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2610 West Lafayette Rd - 21-117-23-24-0043
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2016 - 00052 - adv plan review
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Last modified
8/22/2023 4:05:13 PM
Creation date
1/28/2020 2:15:55 PM
Metadata
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x Address Old
House Number
2610
Street Name
West Lafayette
Street Type
Road
Address
2610 West Lafayette Road
Document Type
Permits/Inspections
PIN
2111723240043
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Updated
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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 /> �O�o <br /> MailingAddress: <br /> Box 66 Permit number: o2C�/(o-b OCs - <br /> Crystal Bay, MN 55323-0066 Date received: 1-1 5- / <br /> Street Address: Received by: I'Yf f <br /> y� 4' 2750 Kelley Parkway :).k`' Plan review fee: ?" o 49. Qj <br /> l�KESH�4�G Orono, MN 55356 ` J <br /> © !( <br /> Total Fee: P - <br /> �O 5-.. <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: 2G 10 L(/2S. La?ty. ,e Rpp <br /> Will this be a Parade of Homes, Remodelers Sho, case 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 service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFQ�RMATION:: <br /> Name: /f1e�t �c <br /> cet 1k yii ufli/X/' <br /> rte• <br /> State License# SC gy2 6 82 Expiration Date: 3-3/20/7 <br /> Lead Certification Number: 4/417 - //29n-/ Expiration Date: //-2171-2 to/g <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (cell) 75,2.- /2 --/76.6 (office) -- <br /> Mailing Address: /3o 33, late 'eciezA bA, 04. 32'/ City:,tteimii ea ZIP:S-S-30 - <br /> Contact Person: J04,1 /Pt a Go Applicant is:Cror ctor ' Homeowner (Circle One) <br /> Email and/or Fax: j 0in Q c G.04,0QA est yA it/4j1, c 0,6-, <br /> PROPERTY OWNER INFORMATION: t� <br /> Name: C/)1,10.- -1, V j s-2L <br /> Phone (day): 61.z - 3$2 - p <br /> Address: 2fo 1O GteeSr- La � f / 0ed City: ©r0/70 ZIP: S-.S.1??/ <br /> Email and/or Fax: c tine or,e/z i . c c <br /> PROJECT INFORMATION: Overall project description: /i7741-rA ` /'e/eecXe7 9- 'A" 'j`/W Xe--46 <br /> Type of Project: Any earth movement may also require <br /> 71-Door(s) RemodelMCWD review&permits: <br /> 0 Fire Damage <br /> ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 15320 Minnetonka Blvd <br /> 0 Re-roof, cedar <br /> 0 Restoration ❑Water Damage Minnetonka, MN 55345 <br /> ❑ Re-roof,other(specify) N'Siding ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ,181.W i n d o w(s) www.minnehahacreek.orq <br /> Estimated Construction Valuation of Project(excluding land) $ /$O, Ooa ` - <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 information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> You refuse to supply the information the application ma not be issued. <br /> Applicant's Signature: 4-60‹` Date: /-/5--/G <br /> Owner's Signature: Date: <br /> Last Updated:January 2015 <br />
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