HomeMy WebLinkAbout2014-00935 - install thermax in basement . CITY OF ORONO * 2 0 1 4 — 0 0 9 3 5 *
* 2750 KELLEY PARKWAY DATE ISSUED: 08/21/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2024 SHADYWOOD RD
PIN : 17-117-23-31-0011
LEGAL DESC : GUST S JOHNSONS ADDN
: LOT 004 BLOCK 000
PERMIT TYPE : MINOR ALTERAT[ONS
PROPERTY TYPE : RESIDENTIAL
CO STRUCTION TYPE . UNDEFINED
;�`.•i�'v"7ir--y � C`/5 T3ldc� �...,�ci�i r�u.+
VALUATION : $ 1,000.00
NO"I'E: INSTALL TIi1;RM�X IN BASEMENI'
APPLICANT PERMIT FEE SCHEDULE 41.25
STATE SURCHARGE(VALUATION) 0.50
DEFINITIVE BUILDERS INC TOTAL 41.75
1340 27TH STREET
HUDSON, Wl 54016- Payment(s)
Minnesota State License#: BU►L-BC51 1976 CHECK 5570 41.75
OWNER
WILLETTE, PAMELA
2024 SHADYWOOD RD
WAYZATA, MN 55391-
AGREEMENT Ai�1D SWORN STATEMENT
I�he 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. "Chis permit is for only[he work described and does
not gran[permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this rype ol�work
shall be compied with whether or not specified herein.1'his 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.
1'he applicant is responsible for assuring all required inspections are
requested in conYbrmance with the State E3uilding Code.This permit may be
revoked at any time for due cause.
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Applic� t�Permitee Si r Date Issued By Si ure Date
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. City of Orono
B�ilding Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
n O�O Mailing Address: Permit number:
� PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
� �` 2750 Kelle Parkwa
�'F Gti Y Y Plan review fee:
Orono, MN 55356
��KESHO��
Total Fee:
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: D
JobSiteAddress: p,�, �/_ ����,,�l�v� �o�c� �rar�v ;/�� S��T ��
Will this be a Parade of Homes, Remodelers S owcase Home or other Display Hom ? ❑ Yes �No
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus se- rvice will be
required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: ��'�'n if'✓.l f�,c�'/�e/S �izC.
State License# /�C �'//�76 Expiration Date: ,.3 -,�/ _ /�
Lead Certification Number: ��,,� Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (ce11) �fj_�j�� _//�� (office) �S/-�/,z R '!/�3
Mailing Address: �3 c/p � 7�i �rf.��/ City: � ZIP: ,syp �
Contact Person: �, �`�- �',-���.cx Applicant is: � ontrac / Homeowner (Circle One)
Email and/or Fax: ���- �,c� 3v �i�y�% ����r�/ , C��.�
PROPERTY OWNER INFORMATION:
Name: /'����` Lc//l��/��
Phone (day): gs-a - ���_ �99/
Address: �c."o: �/ S/��c�ss�l�r.�r��� �f�� City: �i.�'ar� ZIP: �'S 3��
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage 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
❑Window(s) ��e,y'k�/ rC'✓!�il��C www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ � ,���ri'
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 knowfedge. 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 I the information,the a licatio ma not issued.
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ApplicanYs Signature: • .-� l .. Date: g�� /—���`�
Owner's Signature: Date:
Last Updated:03/06/2013