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Home My WebLink About2011-01506 - adv plan review CITY OF ORONO PERMIT NO.: 2011-01506 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 12/01/2011 j 952 249-4600 FAX: 952 249-4616 ADDRESS : 315 TONKAWA RD PIN : 06-117-23-14-0021 LEGAL DESC : REG.LAND SURVEY NO.0540 : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 175,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 175000.00 TYPE OF PERMIT THIS PAYMENT IS FOR:SMALL ADDITION FOR ELEVATOR PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-01507 APPLICANT ADVANCED PLAN REVIEW 979.39 JENSEN HOMES 601 CARLSON PARKWAY#1225 TOTAL 979.39 MINNETONKA,MN 55305- PAID WITH CC# 2152 (952)475-0548 Minnesota State License#: 1156 OWNER Waycrosse,Inc. MACMILLAN,MARTHA E 15407 MCGINTRY RD W WAYZATA,MN 55391- 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. (.el ��City oOrono Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: L'� .Y D,� PO Box 66 OO Crystal Bay, MN 55323-0066 Date received: a Street Address: Received by: 2750 Kelley Parkway Plan review fee: L9kESs0Orono, MN 55356 Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.usN/ (,e(el V d i -7 -LO l This application form must be completed in full and all required information must be submitted. 2Q1 Z_CM1(D Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: .315 -ronKawo, t oQe;(,_ SS 3a(o 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 se ice will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: f..b►'f -S State License# !I S(o Expiration Date: 3t �Ol Lead Certification Number: N prt- - 10(0 1$9 - I Expiration Date: (for work on homes that were constructed prior to 1978 Phone: q 5� _ 4-7s—o—_,49 (office) (cell) Mailing Address: (00) r....oa.! 1 a-. City: f41nne+c„V.0,. ZIP: 55 3o.G Contact Person: JOuV,eT .eye� Applicant is: Contractor / Homeowner (circle one) Email and/or Fax: `tiv►�(� 1e�S�r�erines• care-, PROPERTY OWNER INFORMATION:` Name: mag-+(11 mGt.01 li� ic1,W hwics.(un Phone (day): 9,5e1- I-,--7 3 - 5(o-1 3 Address: -3L5 T-gmkzo-L . o,.- 12oad_ City: 0v-U-nc) ZIP: �2F>35(p Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) 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) $/ 1-75 000 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 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 you refuse to sW61y the information, tO6 application may not be issued. Applicant's Signature: Date: Last Updated: 08-09-2011