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Home My WebLink About2013-00213 - adv plan review CITY OF ORONO * 2013 - 00213 * 2750 KELLEY PARKWAY DATE ISSUED: 04/04/2013 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 0 4655 TONKAVIEW LA PIN : 07-117-23-32-0064 LEGAL DESC REG.LAND SURVEY NO. 1036 LOT MB BLOCK MB PERMIT TYPE ADVANCED PLAN REVIEW PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADVANCED PLAN REVIEW VALUATION $ 60,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 60000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT PERMIT#THIS PRE-PAYMENT IS TIED TO:2013-00214 APPLICANT ADVANCED PLAN REVIEW 491.89 COLFAX COMPANIES,INC. TOTAL 491.89 206 MINNETONKA AVE S WAYZATA,MN 55391- (952)746-4380 Minnesota State License#: BC636394 OWNER LICURSI,ANGELO&RACHEL 4655 TONKAVIEW LA MOUND,MN 55364- 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 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 17 9 ol - 7-6 A0 Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: c,)D/3 —06 �/ Og,0 �O PO Box 66 Crystal Bay, MN 55323-0066 Date received: y/�Z65'-�3 a Street Address: Received by: 2750 Kelley Parkway Plan review fee: ,A013-00a13 �9gE$1"0 Orono, MN 55356 Lam Total Fee: 77/ Sof 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: 4 ,o 55 Tn t1i a,ne- 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 service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Q/-ya x State License# 6"%5 474 Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: — —4-5 (office) 1P/Z—ZeZ— Z 987 (cell) Mailing Address: '906P inCity: ZIP: 311 Contact Person: QIt, Applicant is: Contracto / Homeowner (circle One) Email and/or Fax: /SSG ire/ XCD .carr 452- PROPERTY OWNER INFORMATION: Name: 10 4 /* Phone(day): Address: w la City: r O n 0 ZIP: 55,% Email and/or Fax 1-aeilkG .-. hZLr5 e • irm PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) X Remodel ❑ Fire Damage MCWD review&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.org Overall Project Description: Estimated Construction Valuation of Project(excluding land) $ tpo, 000 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 informhin which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of thisrmation is to annually update our records and records of other governmental agencies re uired b law. If ou refu sthe information,the application may not be issued. Applicant's Signature: NPDate: T Last Updated: 08-09-2011