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Home My WebLink About2018-00422 - addn/remodel/repair � , � CITY OF ORONO * 2 0 1 8 - 0 0 4 2 z * 2750 KELLEY PARKWAY DATE ISSUED: 04/25/2018 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 1225 SHORELINE DR PIN : 02-117-23-34-0002 LEGAL DESC : AUDITOR'S SUBD.NO. 169 : LOT 001 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 70,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STATE) NEW KITCHEN AND BATH APPLICANT PERMIT FEE SCHEDULE 873.52 STATE SURCHARGE(VALUATION) 35.00 CHOICE WOOD COMPANY TOTAL 908.52 3300 GORHAM Payment(s) ST.LOUIS PARK,MN 55426 CHECK 085237 908.52 (612)924-0043 Minnesota State License#:BUIL-1532 OWNER DAYTON,ELISABETH 1225 SHORELINE DR 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 City approvals,and the State Building Code. 1'his permit is for only the work described and dces not grant permission for additional or related work which requires separate permiu. 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 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 aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �' . �� s,l Applic t Pe rt Sign ure Date Issued y S' ure Date + � � City of Orono Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY (�.e. win�ic�ws, �iaars; siding, re-roof, etc. — NG S� ;URAi.. �XPANSIONj '� ��` � Mailing Address: Q�g�� a� j��A,O\ Permit number: 1 y PO Box 66 _' � Crystal Bay, MN 55323-0066 Date received: ��'� 1 `� -�n,, � ' � Street Address: Received by: 'v�.� � a ,� y � 2750 Kelley Parkway �� Plan review fee: , � `�t �� Orono, MN 55356 s�� /�r��a/ �kF5H0��;% ____ Total Fee: Main: 952-249-4600 Fax: 952-249-4616 �>v�ew.c� cronc.�r,n,us This application form must be completed in full and all required information must be submitt .�O p, C� Incomplete applications will be returned. (Please print) p J GENERAL INFORMATION: � Job Site Address: Will this be a Parade of Homes, Remodelers Showcase Ho e 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 serv�ce will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. COA�TRACTOR/APPLIEANT IAIFO M�4TION: Name: ,� State License# � 5 3 � Expiration Date: � �� • � Lead Certification Number: �JC��...�� -. Expiration Date: '�. � ,�d (for work on homes that were constructed prior to 1978 Phone: (cell) � (office) ,� 1� • �Q Mailing Address: V City: ZIP: Contact Person: Applicant is: Contracto / Homeowner (Circle One) Email and/or Fax: �jH�SA��c ��- �^bM P��(�� C�M PROPERTY OWNER INFOR ATION: Name: � Phone (day): Address: City: ZIP: 3 Email and/or Fax: PROJECT INFORMATION: Overall pro�ect 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) 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www n-�;r�reer,r;nc�_:;::ek.,JiCI 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 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 th information, the a lication ma not be issued. Applicant's Signature: Date: '� ' Qwner°s_Signature. Date: ' ' Last Updated:January 2016