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Home My WebLink About2012-00608 - adv plan review CITYOFORONO * 201z - 00608 * 2750 KELLEY PARKWAY DATE ISSUED: 06/26/2012 ORONO, MN 55356- � . (952)249-4600 FAX: (952) 249-4616 A„T'.�DRESS : 2990 SUSSEX RD . PIN : 04-117-23-31-0020 LEGAL DESC : FOX BEND : LOT 3 BLOCK 4 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 275,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$275,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: BATHROOMS AND MASTER CLOSET REMODEL PERRMIT#THIS PRE-PAYMENT IS TIED TO:2012-00609 APPLICANT ADVANCED PLAN REVIEW 1,369.39 WILLIAM POHLEN 15623 NORMANDY LANE TOTAL 1,369.39 MINNETONKA,MN 55345- PAID WITH CC# 4038 Minnesota State License#:20267452 OWNER KELLY,JUSTIN&SUSAN 2990 SUSSEX RD LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be perfortned 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 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 are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. City of Orono Building Permit Application for Maintenance / Renovation � .� (windows, doors, siding, re-roof, etc.) � Mailing Address: Permit number: ��t�—�U� 5 �,0,�. PO Box 66 O U 0 Crystal Bay, MN 55323-0066 Date received: 'oZ�P� a � '�� a, Street Address: ceived bv: 7�' . �,�, '� �titi 2750 Kelley Parkway f►'� Plan review fee: � 9. �/ �'�gESHo�'� Orono, MN 55356 �d d �a - oz� �o � Total ee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � � o? ��- � This application form must be completed in full and all required information must be submitted. �-Ms�� z� Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: �� Job Site Address: ` � (� �v 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 approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �� (i�QN'1 �c`��i��Y► State License# 2 �2�'7l..��'� Expiration Date: �?z�3 � ��o(3 Lead Certification Number: Expiration Date: (for woik on homes that were constructed prior to 1978 Phone: �� —�4� — �,"7'�� (o�ce) (cell) Mailing Address: 1 �6 L.3 o✓rv►li L�n city: M-n � ZIP: rj 5 L� Contact Person: ;( Applicant is: ontractor� / Homeowner �c�r�ieo�e� Email and/or Fax: b� � � Ul,i i G�D LI,D�.�5 a C(7� PROPERTY OWNER INFORMATION: ` '/- Name: �V SGZIr'1 C�+1G� c�C.JS'J)�ri �.E',��-�1 Phone(day): Address: '� Cj(� Sus�2,� pGp� City: Q�'-p�•yD ZIP: �j��j�p Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) �Remodel ❑ Fire Damage MCWD review 8�permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,asphalt ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 Phone: 952-471-0590 ❑ Re-roof,other(specify) ❑ Siding ❑Other: (specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.or4 Overall Project Description: $qc�'L�,.-opv►•�S Gcn�( M.Gt6^�-ev- �oS.e.�— 12,�i�.,�v�� Estimated Construction Valuation of Project(excluding land) $ ��5, p�,c�C� 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 re uired b law. If ou refuse to su I the information,the a lication ma not be issued. Applicant's Signature: `�--�� r Date: �'( Z � ��Z Last Updated: OS-09-2011