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HomeMy WebLinkAbout2016 - 00834 - refacing outdoor pillars only CITY OF ORONO MI III III. II II 111111 II 0. * 20 1 6 - 0 0 8 3 4 2750 KELLEY PARKWAY DATE ISSUED: 07/19/2016 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2160 WAYZATA BLVD W PIN : 34-118-23-21-0002 LEGAL DESC : UNPLATTED 34 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : OTHER ACTIVITY : 0/S BUILDING-UNDEFINED VALUATION : $ 2,000.00 NOTE: APPROVED BY ROGER-REFACING OUTDOOR PILLARS ONLY APPLICANT PERMIT FEE SCHEDULE 77.40 STATE SURCHARGE(VALUATION) 1.00 Orono Station West PLAN REVIEW 50.31 ERICKSON,BRAD&CHRISTY 2486 BOBOLINK RD TOTAL 128.71 LONG LAKE,MN 55356- Payment(s) (612)490-2371 CHECK 78.40 CHECK 50.31 OWNER Orono Station West ERICKSON,BRAD&CHRISTY 2486 BOBOLINK 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. 7/c I\� 4cAi� � I ( plicant Permitee Signature Date Issued By Signature Date of Orono rwrai c �c� City an Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) ��f V Mailing Address: Permit number: /0- 83 O PO Box 66 r� Crystal Bay, MN 55323-0066 Date received: /—����t� Street Address: Received by: /�� y� 2750 Kelley Parkway Plan review fee: — t L Orono, MN 55356 �/ rxFs H o�ti Total Fee: +� l� 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. (P1 ase print) GENERAL INFORMATION: /, U (4)4472- Z�� �/ �� Job Site Address: ( t/" dddlll��� I Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? D Yes `WI o 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: State License# Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (office) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORM 10 Name: ra.../ i6! ccscY\ Phone (day): ;. a •r 2 gve, � �/�Address: 2(6J (A) Gt) Zt City: 13ZIP: X535-6Ef tEmail and/or Fax: �,�-�-,,-,brad p y , C PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require MCWD review&permits: ❑ Door(s) Remodel ❑ Fire Damage o Re-roof, asphalt 0 Repair 0 Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof,cedar 0 Restoration 0 Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) 0 Siding 0 Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 0 Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ :Z , (1C1 v 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 supply the information,the application may not be issued. . z Applicant's Signature: / Date: Owner's Signature: �_ _ Arg Date: / Last Updated:January 2016 !' 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