HomeMy WebLinkAbout2015-00058 - adv plan review CITY OF ORONO * 2 0 1 5 - 0 0 0 5 8 *
A 2750 KELLEY PARKWAY DATE ISSUED: 01/20/2015
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 970 TONKAWA RD
PIN : 08-117-23-12-0002
LEGAL DESC : AUDITOR'S SUED.NO.217
LOT 000 BLOCK 000
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADVANCED PLAN REVIEW
VALUATION $ 235,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 235,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00059
APPLICANT ADVANCED PLAN REVIEW 1,274.06
WELCH FORSMAN ASSOCATIONTOTAL 1,274.06
6026 PILLSBURY AVE S Payments)
MINNEAPOLIS,MN 55402- CREDIT CARD 1460 1,274.06
Minnesota State License#: BUIL-BC005890
OWNER
BAKER,GARY
970 TONKAWA RD
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 at any time for due cause.
/ / I
Applicant Permitee Signature Date Issued By Signature Date
City of Orono
BuVdin' Permit Application for Maintenance / Replacement / Remodel
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
�
0 A, Mailing Address:PO Box 66 Permit number:
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
6� Gti� 2750 Kelley Parkway Plan review fee: �
O�
SHO1�1 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.
GENERAL INFORMATION:
Incomplete applications will be returned. (P/ease print)Job Site Address: X10 I&*/X* Z
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes KNo
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: Et-Ct-t -S+w�� Si�G � .
State License Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office) fZ - E3i,-7 —qq S_S�
Mailing Address: (�� �(S L5���� d4j��. o _ City: /..-(PC, ZIP: �524tq
Contact Person: Applicant is: _orJ Homeowner (circleone)
Email and/or Fax: T�v>V G (A)! (-C-y{�r�—S'"-t ��"I
PROPERTY OWNER INFORMATION:
Name: At�Y floc—yam
Phone(day):
Address: q-70 -0r,.1jGt6t)A P—b City: ,�-,)-,RL� zip:
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Doors MCWD review 8 permits:
( ) Remodel El Damage
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
El Re-roof,cedar 15320 Minnetonka Blvd
❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other:(specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreQKgM
Estimated Construction Valuation of Project(excluding land) $
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 o is l ation is to annually update our records and records of other governmental agencies required by law. If
ou refuse to u I t1he ipp,the application may not be issued.
Applicant's Signat re: Date: ( - 2.-0 -k5
Owner's Signature: Date:
Last Updated:January 2015