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Home My WebLink About2012-00948 - replace old cedar deck boards CITY OF ORONO * Z 0 1 2 — 0 0 9 4 8 * 2750 KELLEY PARKWAY nATE lssu�n: 09/26/2012 ORONO, MN 55356- �„. (952) 249-4600 FAX: (952) 249-4616 �DDRESS : 4175 FOREST LAKE DR PIN : 07-117-23-11-0006 LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN : LOT 007 BLOCK 003 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 4,000.00 NOTE: REPLACE OLD CEDAR DECK BOARDS AND SPINDLF,S ON DGTACI IED DGCK. APPLICANT PERMIT FEE SCHEDULE 103.25 THEISEN, T& S STATE SURCHARGE(VALUATION) 2.00 4175 FOREST LAKE DR MOUND, MN 55364 TOTAL 105.25 PAID WITH CC# 9759 OWNER THEISEN, T& S 4175 FOREST LAKE DR MOUND, MN 55364 AGREEMENT AND SWORN STATEMENT The work for��hich this permit is issued shall be performcd according to the approved plans and specifications,applicable Ciry 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�aork shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not conunenced within 180 days of the date of issuance,or if construc[ion is suspended for a period of 180 days at any time aCter work has commenced. The applicant is responsible for assuring all required inspections are requested in confonnance with the State[3uilding Code.This pern�it may be revoked at any time for due cause. /�j ��'7 l"l�C-:=�'t��' C %l,�,/- � / �--. �� _c._� c",)�-�c �-� � (�-- �� (` /^ Rpplicant Yermitee Signature Da�e- Issued By Signature Datc SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ��y �f C��a�� 6�c�gng �'e�rr�� p6i�a�iQn �ar tt�air��e�a�ce / F�enQ�a��o� (winaou�s, cioors, siding, re-roof, e�c.} '�` W� Mailing Address: j ��,d,� � PO Box 66 � Permit number: o2�S��-07 9 �: a Crystal Bay, MN 55323-0066 i Date received: � ,ZD-1,7.� . I t� �,` Q n 3 � I`� I�� ; r i �, �1�� ' Street Address: Received by: `�� ;F?"�� 2750 Kelley Parkway Planrreviewfee: '�'��.��SH��w Orono, MN 55356 y� Total Fee: f1 / OJ"�, �.S Main: �52-249-4000 Fax: 952-249-4616 www.ci.orono.mn.us This appfication rorm must be completed in full and ali required information must be submitted. fncompiete appiicafions will be returnecl. (Please print) GEN�RAL INFOR�ATIO�f: r Job Site Acidress: � � -�7 f P�".E— �.( !� • �'� „' �L ,��j�� Will this be a Parade of Nomes, Remodefers Showcase Home or other Display Home? U Yes ^ o !f yes, a specral event permit is required with Police Department and City Counci;approva!60 days prior to the event. 5huttie bus servrce wil!be required unless applicant demonstrates sufiicient on-site parking is avai/able. Non-permitted events wil/not be allowed. CONTRACTOR/APPLICANT INrORMATI�1�: Name: --� S;ate License # Expiration Date: Lead Certificafion Number: Expiration Qate: (for work on homes that were coRsfructed prior to 1978 Phone: (ofrice) (cell) Maifing Aadress: City: ZIP: Contact Person: Appiicant is: Contractor / Homeowner (Circie One) cmail and/or Fax: PROP�RTY OWNER INFORMATION: Name: J�/�"� '� �{� I -P Phone (day): ��L - ��'7� • 7�I C7 (G'�� C�%� �� - �% �=3 � Address: �l�7 S �2'�eS�f- LFS� '�-_ City: C's cti� �� ZIP: ,S� ��c �� Email and/or Fax ' PROJ�CT INFORM�t,TlO�: Type of Project: ', Any earth movement rrzay require ❑ Door(s) ❑ Remodel I ❑ Fire Qamage I MCWQ review&permits: Ninnehaha Creek Watershed District(MCWD) ❑ Re-roof, asphalt [-�pair ❑ Storm Qamage 18202 Ninnetonka Bivo ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 Phone: 952-471-Q59� ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (soecify) � Far 952-471-Oo82 ❑Window(s) ��,(� J�k J 4 S�--�v�;:��[S �"'�`^'�minnehahacreek.orq Overal! Project Description: j t.;�t��- �'�E'�'"� Ce��.- ��<'�,<� ��°�r��s" �` �i'��/�s� G�Y� 17�7`�rd4.G "��,f� �sfirr�ated Construcfion Vafuafion of Froject (exciuding iand) � yL 6O0 `J APPLICAI�4T ACKNOWLEDEa�McM1E i: i • Agrees tc provide all information required or requested by the Building Department; � • Certifies tnat the informaiion supp(ied is true and correct to the best of his/ner knowledge. The applicant recognizes that they � are soieiy responsible for submitfing a compiete appficaiion being aware that upon failure to do so, the staff has no aliernafive � but to re}ect it unfil it is compiete; i i • Some or all of the inTormation that you are asked to provide on this application is classified b}� State !aw as either private or ' confideniiaf. Private da;a is inforrr�ation wnicn generalfy cannot be given to the pubfic but can be qiven to the subiect of the ; data. Confideniial daia is information whicn gene�aliy cannot be given to either the public or the subjec't of tne da;a. Our � ' purpose and intended use of this information is to annually update our records and records of other qovernmen,al agencies � reauired bv law. If vou refuse to sup I the information,tne aopiication mav not be issued. � , ApplicanYs Signature: - -:'�� , G c.�� -r/� Qate: C� /�:��U %/ �- Last Updated: OS-�9-2D11