HomeMy WebLinkAbout2017-01113-VOID CITY OF ORONO �
� � 2750 KELLEY PARKWAY * 2 0 1 7 - 0 1 1 1 3 *
DATE ISSUED: 09/12/2017
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2420 OLD BEACH RD
PIN : 21-117-23-22-0002
LEGAL DESC : SHORE HILLS
: LOT 001 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DOORS
ACTIVITY : O/S BUILDING-IJNDEFINED
VALUATION : $ 650.00
NOTE: DOOR REPLACEMENT
APPLICANT ERMIT FEE SCHEDULE 33.07
STATE SURCHARGE(VALUATION) 0.33
DESIGN CRAFT CONSTRUCTION INC.
TOTAL 33.40
3619 85TH AVE N#B Payment(s)
BROOKLYN PARK,MN 55443-
(612)760-0888 CREDIT CARD 0143 33.40
Minnesota State License#: BUIL-BC692134
OWNER
SANGUINETTI,JOSEPH
2420 OLD BEACH RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry approvals,and the \ �,
State Building Code. This permit is for only the work described and does
not grant permission for additiona]or related work which requires separate
permits. All provisions of laws and ordinances governing this type of wark
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 ali required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
. 1
/
� � �, _ � l l�� l/
Applican Permitee Sig ure Date Issued By ignature Date
� � City of Orono
' B��Iding Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
��A, Mailing Address:
f VO PO Box 66 Permit number:
Crystal Bay, MN 55323-0066 Date received:
� �
Sfreet Address: Received by:
ti�, G� 2750 Kelley Parkway Plan review fee:
lqkESHO�� Orono, MN 55356
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 retur ed. (Please print)
GENERAL INFORMATION: �� '� \ �
Job Site Address: (J �
Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? 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 service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APP,.�ICANT IN�OR�iM TION�O `� _
Name: uv ' � '/�/�
State License# Z Expiration Date:
Lead Certification Number: S 3 �— ) Expiration Date:
(for work on homes fhat were constructed prior to 1978
Phone: (cell) 63- 333— Z SS (office)
Mailing Address: 1,Q City: c� ZIP: S' (�.
Contact Person: F� q� Applicant is: Contracto / Homeowner (Circle One)
Email and/or Fax: �� ��j �� � �''��
PROPERTY OWNER INFORMATION:
Name: � I�Z�( �-��'1 ���f S��
Phone (day): Fj(Z Z Z 7 2
Address: S,c(/►�,e City: ZIP:
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)
❑ Re-roof,cedar 15320 Minnetonka Blvd
❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.or
Estimated Construction Valuation of Project (excluding land) $_ ,� � �
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
confldential. 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 lication ma not be issued.
ApplicanYs Signature: 1 ��'l/v C_��'��'�� Date: —1 '�Z—�1
Owner's Signature: Date:
Last Updated:January 2016