HomeMy WebLinkAbout2016-00902 - siding c �
CITY OF ORONO * 2 0 1 6 - 0 PJ 9 0 2 *
2750 KELLEY PARKWAY DATE ISSUED: 07/29/2016
�� ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 1990 SPATES AVE
PIN : 10-117-23-42-0023
LEGAL DESC : ORA PARK ON LAKE MTKA
: LOT 015 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING-LTNDEFINED
VALUATION : $ 3,500.00
NOTE: RESIDE GARAGE
APPLICANT PERMIT FEE SCHEDULE 108.38
STATE SURCHARGE(VALUATION) 1.75
HIGHMARK EXTERIORS TOTAL 110.13
12237 NICOLLET AVE S Payment(s)
BURNSVILLE,MN 55337 CREDIT CARD 1145 110.13
(952)763-7545
Minnesota State License#:cont-20635403
OWNER
BLANKENSHIP,TIMOTHY
1990 SPATES AVE
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be parFormed according to
the approved plans and specifications,applicabie 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 requ'ves 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 authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period 80 days at any time after work has commenced.
The applicant i ponsibl for assuring all required inspections aze
onformance ith the State Building Code.This permit may be
revoke t time for ue cause.
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7Z�/ /�0 7 �����,�.
A ant Permitee Signature Date Issued Signature Date
f , -.
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
�OA TO Mailing Address: Permit number: _
i y PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Sfreet Address: Received by:
� � 2750 Kelle Parkwa
��, G� Y Y Plan review fee:
�qk'ESH�¢� Orono, MN 55356
Total Fee: ���.�3
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 retumed. (Please print)
GENERAL INFORMATION:
Job Site Address: ���b o��e,$ � v�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
ffyes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus ervic wi//be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not 6e al/owed.
CONTRACTOR/ PLICANT INFORMAT . �
Name:
�
State License# Expiration Date: — `—
Lead Certification Num er: — .� Expiration Date: --`�-'�'� ���_
(for work on homes that were constructed prior to 19 8
Phone: (cell) � �L-�pGj`j I S (office) 2 -
Mailing Address: \Z City: �(� � P: '1
Contact Person: "� � � Applicant is: ntracto / Homeowner (Clrcle One)
Email and/or Fax: �'Z— ���"� -1��
PROPERTY OWNER INFORMATION:
Name: "Ta�Vh ��►�1�QhS�.:.A
Phone(day): �SZ_L/)(o - L S$lo
Address: (c��`D s�.�� �.v� City: wayu.�.� ZIP: �S3�j/
Email and/or Fax: —T
PROJECT INFORMATION: Overall project description: � �� �'.
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8 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.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 0
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 o matio ' annually update our records and records of other governmental agencies required by law. If
ou refuse su I the i ation, e a lication ma not be issued.
ApplicanYs Signat Date: !'-Z ���
Owner's Signature: Date:
Last Updated:January 2016