HomeMy WebLinkAbout2011-00989 - state surcharge CITY OF ORONO PERMIT NO.: 2011-00989
2750 KELLEY PARKWAY
�� ORONO, MN 55356- DATE ISSUED: 09/OU2011
' 952 249-4600 FAX: 952 249-4616
ADDRESS : 2650 FOX ST
PIN : 04-117-23-41-0003
LEGAL DESC : REG. LAND SURVEY NO. 1249
: LOT 000 BLOCK 000
PERMIT TYPE : ADDIT[ONAL STATE SURCHARGE
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : ADD[TIONAL STATE SURCHARGE
NOTE: THIS WAS AN ADDITIONAL SIATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011.
FOR PERMIT#:201 1-001]0
ISSiJED:07/20/201 1
APPLICANT STATE SURCHARGE FLAT-ADDITIONAL 4.50
BURNS EXCAVATING, [NC. TOTAL 4.50
3470 CO. RD 21
MAYER, MN 55360-
(612)685-4303
Minnesota State License#: 1888
OWNER
PAULSON, STEPHEN
2650 FOX ST
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
�I�he w�ork 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 specitied herein."I�his permit will
expire and become null and void if construction authorized is not
commenced within 1.80 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 inspec[ions are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. n '�� ,/�//� � � ,��
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Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
,
o�°�o CITY OF ORONO MONTH: July
`�, -^ , P.O. BOX 66
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'�, ����i µ��� G��' ORONO, MN 55323
��H a�' (952) 249-4600 fax (952) 249-4616
DETAILS OF INVOICE -
Customer
Name Burns Excavating Inc. Date Created 7/28/2011
_ - --_
Address 3470 Co. Rd. 21
City Mayer State MN ZIP 55360
^hGn� - - -
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____ __ __ _ _---
Qty Description Unit Price TOTAL
_
Due to the State Shutdown ,
1 Additional Charge for State Surcharge is Due $4.50 $4.50 ',
I Per Minnesota Statutes, Section 326B.148, Subdiv 1 �
For: Permit#2011-00110 - Issued 07/20/2011 i
� At: 2650 Fox Street i
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__-- - _ _ --- -- I
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Sub Total $4.50
, - --�
TOTAL DUE $4.50
Please return payment to City of Orono with a copy of this invoice included.
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