HomeMy WebLinkAbout2015 - 00795 - adv plan review CITY OF ORONO 11111111111111111111111111111 II I 11111111111111
79 *
2750 KELLEY PARKWAY * 2 15 - 00 1 2 5
DATE ISSUED: 06/19/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2740 WHITE OAK CIR
PIN : 04-117-23-42-0019
LEGAL DESC : REG.LAND SURVEY NO. 1447
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 44,243.33
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 44,243.33
TYPE OF PERMIT THIS PAYMENT IS FOR: FIRE DAMAGE
PERMIT#THIS PRE-PAYMENT IS TIED TO 2015-00794
APPLICANT ADVANCED PLAN REVIEW 428.64
TOTAL 428.64
UNDERMAN CONSTRUCTION CO. INC. Payment(s)
4450 NICOLLET AVE S CREDIT CARD 9780 428.64
MINNEAPOLIS,MN 55357-
(612)825-2800
Minnesota State License#: BUIL-BC001239
OWNER
BERRELL, ROBERT&KAREN
2740 WHITE OAK CIR
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 /2f)
revoked at any time for due cause.
_ / :44.4 /l / 0 A Lti 7' ((- (C /c
Cpl' ant Permitee Si: ature Date Issued By Signature Date
..., City of Orono
wilding Permit Application for Maintenance / Replacement / Remodel
(Le. w nd ws, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
�O�V Mailing Address: Permit number: 2C,C G--Co-791-1
PO Box 66 'ti
Crystal Bay, MN 55323-0066 Date received: /9 I I S
0
Street Address:
A kG 2750 Kelley Parkw
q Plan review fee: i-� g . �-�I 7('C
Orono, MN 55356
C
1 kESHO� ')cis__�m___..w._ — Total Fee:
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; r ; i �' . .
Job Site Address: l 9 c lit i ` t-fit- r- c-i 4 f C i U
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No
/f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus s is will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: (,(,-ri f yr�� l i ( 0 i'15 i "'ff: ,, L:'ki LG' --/-11, L
State License# J `z>, ?)C• Expiration Date: 31 ,311ac17
Lead Certification Number: jj kr-b- /5-3i --„ Expiration Date: -7 I i/ o1(:j C)
(for work on homes that were constructed prior to 1978
Phone: (cell) 95,t - 33 5'_ j.z..J 1 S-- (office) (:, % ),- 5:j.5--j.- a '"Li C)
Mailing Address: W Cit ractr ZIP:
Contact Person: -e i,L1 r
-1' -. b" Applicant is: ontor �/ Homeowner (Circle One)
Email and/or Fax: Dfe iv i ve i--y-`>-fe ki 6) arc inn, I G' )
PROPERTY OWNER INFORMATION:i
Name: TC J Ck.A Ckrei 1. `)--€Pile_
Phone (day): •
(s, ) y-0 -V-12,5
Address: 0.-7i-LLQ 1,0/1 I 1 (7,-: .J.:„ ( c_ii-_ City: ( ,kc0i1,"' ZIP: 6 1) ) t
Email and/or Fax: N1
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
f
MCWD review&permits:
❑ Door(s) 0 Remodel Fire Dama a-)
0 Re-roof, asphalt 0 Repair Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof,cedar %Restoration (Water Damage N Minnetonka, MN 55345
0 Re-roof, other(specify) 0 Siding �❑` er: (specify) Phone: 952-471-0590
Fax: 952-471-0682
0 Window(s) 51'C'Ct.j'fc(C I'((f@ll/ www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 'I i ;. 1-3. 3
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 su..1 th- ' format'on,th- a..1' a'.- .r...,..a:.�ssued.
Applicant's Signature: .�� ��„, 'Lti� ,�, % C=f � Date: _�. �l� ��c/
Owner's Signature: Date:
Last Updated:January 2015