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From:ALLSTAR CONSTRUCTION 17634796900 09/14l2015 14:58 #157 P.002/002 City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �O�O Mailing Address� Permit number `��'�t�-(,`)I, � 1 Pp Box 66 Crystal Bay,MN 55323-0066 Date received: — ��D —(�� Street Address: Received by: � " , � �' 2750 Kelle Parkwa yF L� Y Y Plan review fee: t Q�, Orono,MN 55356 �K�s�� Total Fee: �' � �L� �� Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and aA required information must be submitted. � `1�i I� Incompiete applications will be returned. (Please prrnt) �_rti\� � I GENERAL INFORMATION: Job Site Address: 3048 North Shore Drive-Orono, MN-PID-a9-117-23-32-0004 Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes No !f yes,a specia!event permit is required with Police Qepartment and City Council approva160 days prior to the event. Shuttle bus service will be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events wil!not be allowed. CONTRACTOR/APPLiCANT tNFORMATION: Name: Allstar Construction Residential-5145 Industrial Street, Suite 103-Maple Plain, MN 55359 State License# BC690352 Expiration Date: March 31,2016 Lead Certification Number: NA Expiration Date: (for work on homes thai were constructed prJor to 1978 Phone: (cell) 612-865-8262 (office) 763-479-8700 Mailing Address: 5945 Industrial Street,Suite 103 Ci : le Plain ZIP: 55359 Contact Person: Braden Larson Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: braden@allstartoday.com PROPERTY OWNER INFORMATION: Name: Kathryn Kallas Phone(day): Address: 3048 North Shore Drive City: Orono ZIP: 55391 Email and/or Fax: kathryn.kallas@gmail.com PROJECT fNFORMATION: Overall ro'ect descri tion: Type of Project: Any earth movement may also require ❑Door(s) ❑Remodel ❑Fire Damage MCWD review�permits: �]Re-roof,asphalt,+'ARTiA�[]Repair ❑Storm Qamage Minnehaha Creek Watershed District(MCWD) 18202 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55391 ❑Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑WiRdow(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ o Chatge- arranty epair- 8,090 value APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is irue and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If ou refuse to su t the inf io , e a lication ma not be issued. Applicant's Signature: pate: �� .r Owner's Signature: Date: Last Updated:03/06/2013