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billiiiii------------ <br /> City of Orono <br /> Building Permit Application for Maintenance ovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: / — ,e)". <br /> (CO <br /> , PO Box 66 <br /> ik \\ Crystal Bay, MN 55323-0066 Date received: /0 -2 <br /> `` .t.4 ` I Received by: D/�-1)/08 V <br /> ,� a; Street Address: q <br /> "�, s Z.'. 2750 Kelley Parkway Plan review fee: /5 / <br /> �l ��,:ti-- <br /> h+k._+GOrono, MN 55356 <br /> \ xO4 <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: 680 Orchard Park Road Orono,MN 55356 <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 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: RIC,Inc. <br /> State License# BC 639105 Expiration Date: 03/31/2014 <br /> Lead Certification Number: NAT-119967-1 Expiration Date: 12/29/2016 <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (952)736-5930 (office) (612)220-1851 (cell) <br /> Mailing Address: 7675 Highway 13 West City: avage ZIP:55378 <br /> Contact Person: Wade Kranz Applicant is: CContractor Homeowner (Circle One) <br /> Email and/or Fax: wade@ric-mn.com <br /> PROPERTY OWNER INFORMATION: <br /> Name: Matt Wegge <br /> Phone(day): (612)803-8762 <br /> Address: 680 Orchard Park Road City: Orono ZIP: 55356 <br /> Email and/or Fax thoris81@yahoo.com <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ® Door(s) IN Remodel ❑ Fire Damage MCWD review&permits: <br /> Minnehaha Creek Watershed District(MCWD) <br /> ❑ Re-roof,asphalt 0 Repair ['Storm Damage 18202 Minnetonka Blvd <br /> ❑ Re-roof,cedar ❑ Restoration IDWater Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> ❑ Re-roof,other(specify) 0 Siding ❑ Other: (specify) Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.org <br /> Overall Project Description: 0-c_1(1.:0-11 ----- -e___.in(Lz oa <br /> Estimated Construction Valuation of Project(excluding land) $ 45,500 <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 alternative <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 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 <br /> data. Confidential data is information which generally 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 records and records of other governmental agencies <br /> required by law. If you refuse to su ly the information,the application may not be issued. <br /> Applicant's Signature: --- Date: 10/23/2012 <br /> Last Updated: 08-09-2011 <br />