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Home My WebLink About2017-01351 - addn/remodel/repair ` '` CITY OF ORONO * 2 0 1 7 - 0 1 3 5 1 * 2750 KELLEY PARKWAY DATE ISSUED: ll/13/2017 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 345 SPRING HILL RD PIN : 25-118-23-43-0008 LEGAL DESC : REG.LAND SURVEY NO. 1429 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 23,000.00 NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) BATHROOM REMODEL APPLICANT PERMIT FEE SCHEDULE 402.69 STATE SURCHARGE(VALUATION) 11.50 A.K.ANDERSON ENT.INC TOTAL 414.19 241 HALSEY AVE NE Payment(s) BUFFALO,MN 55313- CREDIT CARD 4498 414.19 (612)308-7194 Minnesota State License#:BUIL-BC341-022 OWNER RILEY,ROGER 345 SPRING HILL RD WAYZATA,MN 55391- AGREEMENT AIYD 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 perniit 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 goveming this rype 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 an time for du caus �< < /�-... �� l 3 � I Z Appli Permitee Si e Date Issu By Signature Date . . �> �;� � , � �> City of Orono Building Permit Application for Maintenance / Replacement/ Remodel — Residential ONLY (E.e. �ir��L��, dr,o��, siding, �t-roofi, et�. — NC1 ��RUCTURAL EX�'�l�SiON) �O� Mailing Address: �v� 7 �� -' - / PO Box 66 Permit number: � �_ 0 Crystal Bay, MN 55323-0066�, Date received: � U -1 � � � I t ,I j Received by: �F � � Street Address: �, p' t� �;; ; �`y�, � 2750 Kelle y Parkwa y� /� ;;�i ' P l a n r e v i e w f e e: /• �� Orono, MN 55356 � qKfSH�� 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 returned. (Please print) GENERAL INFORMATION: � � � / � Job Site Address: Will this be a Parade of Homes, Remodeler Showc� 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 su�cient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APP ANT IN RMr TION: Name: _,��7�'�l'/P�� y!`7`, ��c State License# � 3c// G�L Expiration Date: Zp�� Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) �/Z- 3 _ 7 (office) Mailing Address: Z1,// /��,/ � ,�� " City: �; � ZIP: SS.3/ Contact Person: Applicant is: Cont_ ractor / Homeowner (Circle One) Email and/or Fax: � , � � PROPERTY OWNER INFORMATION: Name: v 4 �,�., � t � Phone (day): �2 J � �� Address: 3�� s'�.^„-,c ; � City: r�y�� ZIP: 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.minnenahacreek.orq Estimated Construction Valuation of Project(excluding land) $ Z 3.� 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 altemative 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 1 the information,the a lication ma not be issued. ApplicanYs Signature: /� . �L�.dL.t,�:.� Date: IC� � ��- �� Owner's Signature: Date: Last Updated:January 2016