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Home My WebLink About2011-00701 - chimney repair t CITY OF ORONO PERMIT NO.: 2011-00701 2750 KELLEY PARKWAY ORONO, MN 55356- DATE�SSUED: 07/2U2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1790 SHADYWOOD RD PIN : 17-117-23-21-0025 LEGAL DESC : SHADY-WOOD : LOT 020 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CHIMNEY-REPAIR ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 1,450.00 NOTE: REBUILD THE TOP 4 COURSES OF BRICK CHIMNEY APPLICAI�TT PERMIT FEE SCHEDULE 57.50 DAYCO GENERAL INC P O BOX 278 STATE SURCHARGE(VALUATION) 0.73 LORETTO, MN 55357- MISC FEE 0.00 (612)684-1243 TOTAL 58.23 Minnesota State License#: 20266544 PAID WITH CC# 2904 OWNER EHLERS,TROY 1790 SHADYWOOD RD WAYZATA, MN 55391 AGREEMENT AND SWORN STATEMENT The work Yor which this permit is issued shali 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 does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested conformance with the State Buildi Code.This permit may be rev ke at a y time for e cause. / / / / p cant ermrtee ignature Date Issued By Si ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED A E. , ' City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: O�,L,�,�0 PO Box 66 Crystal Bay, MN 55323-0066 Date received: ,� �� Received b '�+ ,, Street Address: y� �' a�'c� ��' 2750 Kelley Parkway Plan review fee: �'�a.kES�o4� Orono, MN 55356 Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This appiication 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: j 7y� � �� _c�-�, Will this be a Parade of Homes, Remodelers owcase Home or other Display Home? ❑ Yes o If yes,a special event permit is required with Police Department and Crty Counci!approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufiicient on-site parking rs available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �.�cn ��x��r�' _�v�.� � State License# ��,,��f� Expiration Date: Lead Certification Number. ��- �G} � _ JVf�T� -7�v� 7/ - % Expiration Date: �"-j'-/�-- d�,�� (for work on homes that were constructed prior to 1978 Phone: (office) (cell) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: � r'� 1�f 5 � ra� Phone (day): Cf�� '7/-b 7� Address: City: ' � . , ZIP: ��3`�/ Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel ❑Water Damage MCWD review& permits: "` Minnehaha Creek Watershed District(MCWD) ❑Window(s) 7�Repair ❑ Storm Damage 18202 Minnetonka Blvd ❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391 Phone: 952-471-0590 ❑ Re-roof ❑ Fire Damage Fax: 952-471-0682 www.minnehahacreek.orq � Overall Project Description: � ' � �� -�=� �jri . � r �� Estimated Construction Valuation of Project(excluding land) $ 'r , 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 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 t �s information is to annually update our records and records of other governmental agencies re uired b law. If ou refus o u I th � formation, the a lication ma not be issued. ApplicanYs Signature: Date: ��./�c�b%� � Last Updated: 03-01-2011 .� �