HomeMy WebLinkAbout2016-00623 - adv plan review � `�` CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 6 — 0 fd 6 2 3 *
DATE ISSUED: 06/OU2016
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 1360 RAILROAD AVE
PIN : 10-117-23-31-0007
LEGAL DESC : UNPLATTED 10 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 76,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 76,0000
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00622
APPLICANT ADVANCED PLAN REVIEW 598.52
TOTAL 598.52
LEMMERMAN CONST. INC. Payment(s)
9037 CTY.RD 17 SE CHECK 7175 598.52
DELANO,MN 55328
(763)972-3003
Minnesota State License#:BUIL-4854
OWNER
LASHER,MICHEAL
1360 RAILROAD AVE
F�A��1 1J�3a.yza�} 11/1f►�.1
� - Ss 3 9 I
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or celated work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if co�truction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of I SO days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the Staoe Building Code.This permit may be
revoked at any time for due cause.
/ /
Applicant Permitee Signature Date Issued By Signature Date
, � City of Orono � � 5g� �
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
A, Mailing Address: Permit number: (�/ (J �
��l VO PO Box 66
Crystal Bay, MN 55323-0066 Date received: —� —� �
Street Address: Received b •
� � 2750 Kelley Parkway a-o�l�-O (pf�� • � � � 5
�'F� L d. view fee: � �
qkESHO�� Orono, MN 55356 � .,� (��j
�'i'���o `B� �aj
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: /�
Job Site Address: � 3��; Ra� �`�- ti�'�• ��� �� M� 55�� )
Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? Yes No
If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: L e`�yv1 Crrr�an L�S�'��c.-�;vv� �. r�C •
State License# '�j�, C�O� Expiration Date: 31 1�Ai2. 1 �
Lead Certification Number: �[ RT - (2(p�1�{ - � Expiration Date: 2'� ''"6tIJ ��
(for work on homes that were constructed prior to 1978
Phone: (cell) -i63 - 229 - 236Q (office) 1��q
Mailing Address: 9c� �( (,�, fz • �7 s City: Qraho ZIP: 553'��
Contact Person: "'rp-� �,�„��,Y-mo�-•� Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax: LQv,r�Gc�u`� �:�,C Y"tgr� �'e l'. C.�1'�
PROPERTY OWNER INFORMATI�N:
Name: ���'� G�.. �o�.(� 1��v 2.S
Phone (day): 7(�3 - j(� - ���
Address: p C� _ i�c,7r 4(�( City: (� W�,uwt� ZIP: ����o
Email and/or Fax: t^{�, �,$$' � �,� . �yp,r�,
PROJECT INFORMATION: Overall pro'ect description:
Type of Project: Any earth movement may also require
� Door(s) �Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof,asphalt �Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,cedar 15320 Minnetonka B►vd
❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other: (speciiy) Phone: 952-471-0590
Fax: 952-471-0682
�Window(s) www.minnehahacreek.ora
Estimated Construction Valuation of Project(excluding land) $ 7
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Certifies that the information supplied is true 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 altemative 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 u ate our records and records of other governmental agencies required by law. If
ou refuse to su I the information,the a li ' n ma not be issued.
ApplicanYs Signature: !af' i Date: � t�V� 1�0
Owner's Signature: � ` Y"� Date: � I � /�
Last Updated:January 2016 C/`� /_`/� //
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