HomeMy WebLinkAbout2009 - 00754 - addn/remodel/repair CITY OF ORONO PERMIT NO.: 2009-00754
2750 KELLEY PARKWAY
' ORONO, MN 55356- DATE ISSUED: 10/28/2009
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1085 WILLOW VIEW DR
PIN : 28-118-23-41-0010
LEGAL DESC : WILLOW VIEW
: LOT 015 BLOCK 001
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 1,250.00
NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE)
REPAIR DECK
ADV.PLAN REVIEW FEE COLLECTED 10/26/09 2009-00753 $33.15
APPLICANT STATE SURCHARGE(VALUATION) 0.63
DYVIG LAND DEVELOPMENT&CONST. LLC MISC FEE 17.85
13418 EXCELSIOR BLVD.
MINNETONKA,MN 55345- TOTAL 18.48
(952)452-2227 PAID WITH CC# 1523
Minnesota State License#:20629808
OWNER
GUIDERA, WILLIAM&AIMEE
1085 WILLOW VIEW DR
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 goveming 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 perio. •f 180 days at any time after work has commenced.
The applicant is 4.0 .le for assuring all required inspections are
requested in c•. f.- w' the State Building Code.This permit may be
revoked at.1 y t. e fo i • •ause.
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Applicant P itee Si ature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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City of Orono 6 !�
Building Permit Application for Internal Work ,DAS S 1 ��
(windows, doors, siding, re-roof, etc.) E ( X
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Mailing Address: Permit number: 2.DOq_ DD 7511
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°° PO Box 66
0 Crystal Bay, MN 55323-0066 Date received: /D- --Q�f
Street Address: Received by: 'a�S
At Gtiti 2750 Kelley Parkway Plan review fee: x`33-!S p bq CG
g Ho., Orono,MN 55356
Total Fee: ad0�DD
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Itb ►12U7{A1•
This application form must be completed in full and all required information must be submitted. Y
Incomplete applications will be returned. (Please print) Y'e(i
GENERAL INFORMATION: Ip w
Job Site Address: 1 O `biij `J ii[-Lb V i rE\JJ ►1
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 Ill be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: r y J iG i—I 0 D ,*(nr;T 1, C":in iit jib^\ Lu-C-
State License# #91.04, Vile)s Expiration Date: 3 -- 3 I - I 0
Phone: (1_c, - i- 5 - D,). .-7 (office) ) SD.-,-15-,1- 3,;X7 (cell)
Mailing Address: 134 Is EXc LL.arcc< �.)i-EV\f:0 City: Irrnn z7cr1K4 ZIP: 5s3y5
Contact Person: -r iia r^\I L 'i)-( J 1 C- Applicant is: ontracfcir Homeowner (Circle one)
Email and/or Fax: D y v, c e.g e.l (f.(>ia n-s c( , (6 n
PROPERTY OWNER INFORMATION:
Name: lUG16+n GCt
Phone(day): `j S.c)- 1-f l 1 - 6,'J c <3. /
Address: `O$ W I t_t^o 1,,,i U,`l v) IAN"; City: P--orZIP: r 3 Db
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review&permits
❑ Door(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) "u] Repair ❑Storm Damage 18202 Minnetonka Blvd
Deephaven,MN 55391
0 Siding I(T4 Restoration 0 Other. (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-roof 0 Fire Damage www minnehahacreek.orq
Overall Project Description: P.(-,A fp,„,(', f 0 l j\,5 m E:x,si-t 6 G t(.Ic) f r:--A I `- 6`'X 6`i f oSi s
Estimated Construction Valuation of Project(excluding land) S 4 a 0 .00 To VEkrl
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.
4. 1
Applicant's Signature: / Date: /0 p - 0 1
Last Updated: 05-04-2009 I n \/ /t p ..
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