HomeMy WebLinkAbout2017-01195 - doors � .
CITY OF ORONO * 2 0 1 7 - 0 1 1 9 5 *
2750 KELLEY PARKWAY DATE ISSUED: 09/25/2017
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2975 SOMERSET LA
PIN : 04-117-23-24-0018
LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN
: LOT 001 BLOCK 004
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DOORS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 1,200.00
APPLICANT PERMIT FEE SCHEDULE 50.12
MON-RAY INC. STATE SURCHARGE(VALUATION) 0.60
7900 EXCELSIOR BLVD#140 TOTAL 50.72
HOPKINS,MN 55343- Payment(s)
(763)543-6263 CHECK 61842 50.72
Minnesota State License#:BUIL-0005111
OWNER
LAHTI,TERESA
2975 SOMERSET LA
LONG LAKE,MN 55356-
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. This permit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. 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 suthorized 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 in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Iss d By Signature Date
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City of Orono
Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY
(i.e. windows, doars, siding, re-roof, etc. - NO STRUCTURAL EXPANSI4 )
�O O\ Mailing Address: Permit number:
PO Box 66 �CE1VE
1 Crystal Bay, MN 55323-0 Date received:
� y SEP 2 5 2017 Received by:
l � � Street Address:
`\yF � 2750 Kelley Parkway Plan review fee:
t � Orono, MN 55356
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��,� CITY OF ORON -�
Total Fee: Cj�.' � � �.
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. (P/ease print)
GENERAL INFORMATION;.7,,. �_ ��l,` , � ,1_�
Job Site Address: `
Will this be a Parade of Homes, Remodelers Showcase 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 serv will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �%' ���, �1-,
State License# � v v'� Expiration Date: 3 y
Lead Certification Number: � � � Expiration Date: ��
N A'�-,��.i i�1 -�_-
(for work on homes that were constructed prior to 1978
Phone: (cell) (office) —7(;��S �`� 3 -7y�.
Mailing Address: �e����)��� �. �(y;,- � ,,� �(�-i(, City: H���S ZIP:�;�, ; t 7
Contact Person: --Y-AI,a C c���.�1 Applicant is: � ontra r / Homeowner (Circle One)
Email and/or Fax: �-c��r�> „�ti, ,, �l c�,n^
PROPERTY OWNER INFORMATION:
Name: n � i-c �., ��."'tii1J
Phone(day): + ��-� � _� ��� ^ � ��{v
Address: �a,,,.�� �� ��,-�,p City: ZIP:
Email and/or Fax: �,,��a,� {�;� ��� �5�, <<��,
PROJECT INFORMATION: Overall pro�ect description:
Type of Project: Any earth movement may also require
�Door(s) MCWD review&permits:
❑ Remodel ❑ Fire Damage
❑ 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.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ (,2 �
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 i annually update our records and records of other governmental agencies required by law. If
ou refuse to su I the in ,the a lication ma not be issued.
Applicant's Si ature: � '� Date: �- � 5 c 1 �
Owner's Signature: Date:
Last Updated:January 2016