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• � City of Orono �.�r-� � C���� � � �P�VQ� <br /> • . Building Permit Application for Internal Work �1�-�I r + <br /> (windows, doors, siding, re-roof, etc.) <br /> !O� Mailing Address: permit number: <br /> \ PO Box 66 r <br /> �O� �O� Crystal Bay, MN 55323-0066 Date received: �/ � �) <br /> ��- -�- Received by: <br /> 'a �j�t. �, Streef Address: <br /> �,�, ,�,� ��,'� Gti,E" 2750 Kelley Parkway �(�I �•GO Plan review fee: t� � <br /> �t '�;��r��'f'w Orono, MN 55356 <br /> �Rk�H�g <br /> -- ---- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application faRn must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: 1473 Bay Ridge Road <br /> Job Site Address: --- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> ff yes,a specia/event permit is required with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus s ice wil!be <br /> required un/ess ap�!'rcarft demonstrates suff'�cient on-site parking is avaitab(e. Non-pennitted events wiN not be atlowed. <br /> CONTRACTOR/APPUCA[�T��1FORMATION: <br /> Name: Meyer & Sons Construction <br /> _ _--- - —� <br /> State License# 20006613 Expiration Date: 3/31/2012 <br /> Lead Certification Number. Expiration Date: <br /> (for work on homes that�re�nstnsct�i�arlor to 1978 <br /> Phone: �?52-898-58f�1 (office) 651-271-4740 (cell) <br /> Mailing Address: $360 AftOf1 R01d City: Woodbury ZIP: 55125 <br /> Contact Person: Kirk Meyer Applicant is: ! omeowner �ci��bo�� <br /> Email and/or Fax: ktsl'tlnl8yer@an'��II_Cam <br /> PROPERTY OWNER 1�"'�^�?!"'�ATION� <br /> tvame: �Thomas McCune <br /> Phone(day): 45?-473-3245 �/a zata MN <br /> Address: 1473 Bay Ridge Road City: Y ZIP: 55391 <br /> Email and/or Fax tmmccune@me.com <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review &permits: <br /> ❑ Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> ❑Siding ❑ Restoration ❑Other: (specify) Phone: 952-471-0590 <br /> ,�Re-roof ❑ Fire Damage Fax: 952-471-0682 . <br /> www.minnehahacreek.ar <br /> Overall Project Descrlption: New trusses, roofing, and insulation over 65' x 26' 1960 structure <br /> _— __-- <br /> Estimated Construction Valuation of Project(excluding land) $ 24,500 <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 <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative <br /> but to reject it until it is complete; <br /> Some or all of the information that you are asked to provide on this application is Gassfied 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 <br /> data. Confldential data is information which generalty cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our reoords and records of other govemmental agencies <br /> re uired b law. If ou refuse to su I the information the a licatio�ma not be issued. <br /> ��� � Ma 20, 2011 <br /> Applicant's Signature: -� Date: Y <br /> Last Updated: 03-01-2011 Thomas McCune <br />