Loading...
HomeMy WebLinkAbout2012-01165 - addn/remodel/repair CITY OF ORONO * 2 0 1 2 - 0 1 1 6 5 2750 KELLEY PARKWAY DATE ISSUED: 11/14/2012 ORONO, MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS 2575 THOROUGHBRED LA PIN 04-117-23-11-0021 LEGAL DESC OLD CRYSTAL BAY ROAD 2ND ADDN LOT 004 BLOCK 002 PERMIT TYPE ADDITION/REMODEL/REPAIR PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDN/REMODEL/REPAIR ACTIVITY 434-RESIDENTIAL VALUATION $ 3,000.00 NOTE: GAS FIREPLACE-BUILIDNG PORTION ONLY. GAS BEING DONE BY OTHER CONTRACTOR. APPLICANT PERMIT FEE SCHEDULE 88.50 LONDON POINT REMODELERS STATE SURCHARGE(VALUATION) 1.50 8661 JEFFERSON HWY MAPLE GROVE,MN 55311- TOTAL 90.00 (763)390-7618 PAID WITH CC# 4240 Minnesota State License#:20626558 OWNER SAPLETAL,STEVEN&STACY 2575 THOROUGHBRED 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 does 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 a ime a cause. 11 / 14 /20 (2_ / App cant Permitee Stgffature Date Xssunature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. City of Orono !� Building Permit Application for Maintenance I Renovation (windows, doors, siding, re-roof, etc.) Mailing Address: 0J PO Box 66 Permit number: Q/ Q © Crystal Bay, MN 55323-0066 Date received: a 9 Street Address: Received by: 2750 Kelley Parkway Plan review fee: ts-kks o4� Orono, MN 55356 : Main: 952-249-4600 Fax. 952-249-4616 www.ci.orono.mn.us Total Fee: This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: RR / Job Site Address: Z S ,¢ 4 5— TNoRov,� pz---b L.ti 40NO N(Al 5'5-3 Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,2�rNo 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 sufficient on-site parking is available. Non-permitted even will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Z e N,DoN /moo 'r' O EA-t a AFL t2 jr- T cE?v yb:�^ State License # 2O& Z& S $$' Expir tion Date: e Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: Z6p-�61� (office) (cell) Mailing Address: 3*6-reV�n-PE' o— !`Aw City '& 6A.4,6 ZIP: 3'5'_T6 Contact Person: /f,0 7r erN t.-, Applicant is: t / Homeowner (Circle One) sr� Email and/or Fax: r� /a,n ,., ma .wc .na" o �►�— �ZEat ..*mow. - fir.,Q _ �_.._ � _ PROPERTY OWNER INFORMATION: Name: S4E-VOF 5r46E7—.4 C_ Phone(day): �S'Z, ey 3 Address: ZS�S' 7'hRo�to City: ZIP: Email and/or Fax PROJECT INFORMATION: Type of Project: /any earth movement may require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: ❑ Re-roof, asphalt Minnehaha Creek Watershed District(MCWD) p ED El Damage 18202 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 Phone: 952-471-0590 ❑ Re roof, other(specify) ❑ Siding KOther: (specify) Far.: 952-471-0682 ❑Window(s) �j-q-S ��K � ,� www.minnehahacreek.om Overall Project Description: Estimated Construction Valuation of Project (excluding land) APPLICANT ACKNOWLEDOEME_NT: • 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 i[ required by law. If you refuse to su i the information,the application may not be issued. Appiicant's Signature: Date: o Z Last Updated: OS-09-2011