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HomeMy WebLinkAbout2016-00542 (advance plan review) CITY OF ORONO * 2016 - 00542 * 2750 KELLEY PARKWAY DATE ISSUED: 05/18/2016 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS 1185 WYNDMERE RD PIN 26-118-23-41-0009 LEGAL DESC WYNDMERE LOT 003 BLOCK 001 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:$ 175,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00541 APPLICANT ADVANCED PLAN REVIEW 1,028.57 STREETER&ASSOCIATESTOTAL 1,028.57 18312 MINNETONKA BLVD Payments) CHECK 102890 1,028.57 WAYZATA,MN 55391 (952)346-2499 Minnesota State License#:BUIL-BC-001380 OWNER WLAZLO,TONY&MICHELLE 1185 WYNDMERE RD 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 n revoked at any time for due cause. ((/ Applicant Permitee Signature Date Issued By Signature Date City of Orono ,l +Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) � OT Mailing Address: Permit number: 2_ _ l)�VO PO Box 66 ©I � �jnl)a-rbsr Crystal Bay, MN 55323-0066 Date received:'— Street Address: R b tie 2750 Kelley Parkwa P �0154D (o-Z_-g90 �krs x oRti Orono, MN 55356 P �� cv`� 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. (Please print) Job Site Address: I lISS W yt.J prnERE_ 'RoA-D ; VJkYz-.A r-A . MN �5 � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o 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: ST��C i�.R A- kSSeC_I4ATf_:-_5 State License# ec-.-bot 3`sp Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (,i2y723 r6g5 (office) 952-3q(,-2_1/99 Mailing Address: t 3tZ t^tlwilirvro p: City: LAX ZArA ZIP: 5-5239 Contact Person: Ki p Sc+ti20 Applicant is: ontrac o / Homeowner (Circle One) Email and/or Fax: k 5c h;r,o l ��{re�herh6meS, c�t�r� PROPERTY OWNER INFORMATION: Name: 'To-rJY 4 1Aib4F_L_E r,ULRZLO Phone (day): Address: IISG LyNbffi& C- 'PxA-0 City: LVA-YZ47-A ZIP: 5539/ Email and/or Fax: PROJECT INFORMATION: Overall project description: ��`t Type of Project: Any earth movement may also require ❑ Doors MCWD review& 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: 952471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.org Estimated Construction Valuation of Project (excluding land) $ / '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 supply thq information, pplication may not be issued. Applicant's Signature: Date: Owner's Signature: Date: Last Updated:January 2016