HomeMy WebLinkAbout2016-00160 - interior remodel I IN IN 1111111111 Mill 1111111111111 IN
CITY OF ORONO * 2 0 1 6 - 0 0 1 6 0
2750 KELLEY PARKWAY DATE ISSUED: 02/16/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS 102 CHEVY CHASE DR
PIN 36-118-23-41-0031
LEGAL DESC HILL O'WAY MANOR
LOT 026 BLOCK 001
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADVANCED PLAN REVIEW
VALUATION $ 120,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 120,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: INTERIOR REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00161
APPLICANT ADVANCED PLAN REVIEW 803.35
TOTAL 803.35
LAUREL BUILDERS Payment(s)
1758 CHATEAU AVE CREDIT CARD 1907 803.35
SHAKOPEE,MN 55379
(952)200-3934
Minnesota State License#:BUIL-630887
OWNER
YOKIEL,SCOTT&JENNIFER
102 CHEVY CHASE DR
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
revoked at any time for due cause.
Applicant Permitee Signature Date Issued By Signature Date
city of Orono
ung ftfn,dt Application for Maintenance l Replacement i Remo&j—Res4denflat ONLY
ki.e. windows, doors, siding, regoof, etc. - NO STRUCTURAL R 0N).
MORVAddrm-
PO Box 66 ... �_
Crystal Bay,MN W323-0066 Doe fid:
A stmt Address
2750 Kelley Parkway Plim review e: �
l 5H04' Orono,MN 55356
i
Main: 952-249-4600 Fatc 952-2494616 wvvw.�.orono.mn.us � �
This application form must be completed in full and all required utform rt?1t be WAXnftW.
Incomplete applications will be returned. (Please p*i* rev 10l _
GENERAL INFORMATION:
Job Site Address:
Will this be a Para&of Honm, Remodelers Showcom Hmne or other Day Ham?
t7�t dB117k?fl3i 8 otherpeft is SMAW310, !
CONTRACTOR l APPLICANT INFORMATION:
Name:
State License# C239 d 87 Expo Date }
Lead Certification Number: 4lttii-�- t{7 I Expiration Elite:
(for work on horses#fiat cons&ucled Poor to 1
Phone: (cep) --?go — +?09 N
Mailing Contact Person: �3 G city, t, , ZIP" �, 2.1__,x.
/4pplicant is: / Horn owrtet' tatra. j
Email and/or Fax:
PROPERTY OWNER INFORMATION
Name: /moi 1• �- "fit �n ,� s J L
Phone(day):
Arlo: lad G1, fC M � Cy;f�� ZIP ;,
Ems#arA#or Fm �'ti=+-- e i t �� w r _ .,�
, £$
PROJEEC'T'INFORMATION: Overs :
Type OfAct:
Any earth moveinent may atsd jvmf e---
0
f-0 mss) F Mreview&pe
i
VVersR €, tarQaseg6 he (MOND)
M Y UN s t ..
0 Remo#3 offer lq*ay�) 0 Siding 0 torr(specify) - 952471�05W �
do s Par. {9$2-47t-M2� g
Estknalwl Construction Valuation of Project.(excluding land)
APPLJcmNT ACKN2WLEDG
EIHENT:
A s to a aA fnfcamatican required or requested by the 63 ding
Cortities that the kfte'raaftn supplied Is true and t to the beat of his/her knowiedge, The,
w.-
# 1*60 itsper�m3g a completespptaYtcan bae3r+8 aware that u4tort 1�ure todosc�."the aff has no 0ltara�iti�re�bvt t5
-j aoms or aH of the tnfomaetion that you are asked to provide can this appacatlon is ciassifatad b
€ etdential. f�v�data is informaWn whl�fa generally cannot be given to the pubi�u but can b y :tata 6-W either pnvsets Cat
9 y 9 ,givers to..,ti+e
C�ential data is int matt on which c on ereNy cannot be given to hither the public� of the dath.
inter of this Information is to ann tally Watt,our r rds and re rda of otter the sut,�°#the . Ott'pu" t Y
you hast in s pp# information,(no i e�tlr�h rrt t bbR rid � rh rttal agencies c M-dia*. ft f
Date-
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