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Home My WebLink About2009-00883 - doors � , •. CITY OF ORONO PERMIT NO.: 2009-00883 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEn: 12/08/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 1449 SHORELINE DR PIN : 11-117-23-21-0001 LEGAL DESC : UNPLATTED 11 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : G � ��` ��l • ; � _� i CONSTRUCTION TYPE : DOORS ACTIV[TY : O/S BU[LDING - UNDEFINED VALUATION : $ 800.00 APPLICANT PERMIT FEE SCHEDULE 34.75 NELSON, ROBERT&CAROLYN STATE SURCHARGE(VALUATION) 0.50 500 SE STH AVE- S802 BOCA RATON, FL 33432 TOTAL 35.25 OWNER NELSON, ROBERT&CAROLYN 500 SE STH AVE- S802 BOCA RATON, FL 33432 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the State Quilding Code. This permit is for only the work described and does not grant permission for additional or related work which requires scparate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specitied herein.This permit will expire and become null and void if construction authorized is not commenced within l80 days of the date of issuance,or if construction is suspended for a period of 180 days at any timc after work has commenced. The applicant is responsible for assuring all required inspections are requeste n conformance with the Sta[e Building Code.This permit may be revok a ,��ne -- � / � / 4 / D�"/ (� Applicant Permitee Signature Date Issued Signature ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �� ° .�� "�Y '^'� ,_�,�T;F'i �.^P 5 r q r'F:a�'� fR� � , � �� i ,�=i'..,,,t ��iy�n ln �`". �i City of Orono � � � � Building Permit Application for Internal Work �F, ��t (windows, doors, siding, re-roof, etc.) #;' � �� Mailrng Address: Permit number: � ^ ' �v�,� PO Box 66 � �' Crystal Bay, MN 55323-0066 Date received: � � � �� I S 1 �� !� �� - Received b � � ; �� ;��!,, �, Street Address: Y� � �� ' p� � 2750 Kelle Parkwa ""�"�� , � � Y Y Plan review fee: �. �� 'kESH�'� Orono, MN 55356 �, � Total Fee: � Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 4; � This application form must be completed in full and all required information must be submitted. � '� � Incomplete applications will be returned. (Please print) _ � GENERAL INFORMATION: �, y'J � �;' Job Site Address: / / � `5 q(/��j jt/� j��, �� '' Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No �; � /f yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle 6us service wi/l be � _ required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. ;� z�a �� CONTRACTOR/APPLICANT WFORMATION: y; Name: ��: �a State License# Expiration Date: � ; Phone: (office) (cell) �' Mailing Address: Cit : � �� Contact Person: Applicant is: Contractor Homeowner ircle One) e t� Email and/or Fax: �. rt..:- � F��' :t_ �-.�' PROPERTY OWNER INFORMATION: f }� Name: ft/U�h„�� j¢��i�!/j�- � �7 � Phone (day): q`� c,/ � �� Address: �� city:�iv� ziP: 5�3�1 � � Email and/or Fax � � � ; PROJECT INFORMATION: Type of Project: Any earth movement may require � �' MCWD review& permits � �'� �Door(s) ❑ Remodel ❑Water Damage �N°: Minnehaha Creek Watershed District(MCWD) �3 ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd �, : Deephaven, MN 55391 '� ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 �: �:, Fax: 952-471-0682 °� ,.: ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq K� Overall Project Description: F� E Estimated Construction Valuation of Project(excluding land) $ � �� . � APPLICANT ACKNOWLEDGEMENT: � ffi • 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 compfete 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 taw as either private or � h ` confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the 3� � . 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 ;� re uire d b law. I f ou re fuse to s I t he in formatio t he a lication ma not be issued. � h � `O � Arrlicant's Signature: �ate: � '4 '� s-.: `� � Last Updated: 05-04-2009 � ;�-�.. � � ti ,�?��x� ��` u-�� ,: ' ., s1� "�t�s E �- � "�, � �' . ,..::.�+�z.�,. _ _.. _ ,..s�.,��_��,n... ..��,...m� �`.,�.�:w.3.��e��+.�.,�.,��am�!�.��.Ux�Y��,�.....�a r�v_.��_ �., .�..w sf,�,we�.