HomeMy WebLinkAbout2014-00903 (siding) • CITYOFORONO * 20 14 - PJ0903 *
� 2750 KELLEY PARKWAY DATE ISSUED: 08/15/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
AllDRESS : 3510 BAYSIDE RD
PIN : OS-117-23-13-0016
LEGAL DESC : AUDITOR'S SUBD. NO. 203
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING - UNDEFINED
VALUA"TION : $ 5,000.00
APYLICANT PERM[T FEE SCHEDULE 118.00
STATE SURCHARGE (VALUATION) 2.50
LARSEN, GREGG & STEPHANIE
3510 BAYS[DE RD TOTAL 120.50
LONG LAKE, MN 55356- Payment(s)
CHECK 17011 120.50
OWNER
I_ARSEN, GREGG & S"I'EPHANIE
3510 BAYS[DE RD
I.ONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
'i'he work for which this permit is issued shall be perfornled accordine to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 'I'his permit is for only the work described and does
not,rant permission for additional or related work which requires separate
permits. All provisions of laws and ordinunces governing this typc of work
shall be compied with whether or not spcciticd hcrein.'I'his pernlit wiil
expire and become null and void ifconstruction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended tbr a period of 180 days at any time after work has commeneed.
I�he applicant is responsible lor assuring all required inspections are
requcsted in conformance with Ihe State Quilding Code."�his permit ma��be
revoked at•ny time for due cause.
�'�) '�� / /
i1p I� � Permitee Signature Uate [ssued By nature Date
. City of Orono
Building Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
�O�O Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
� � 2750 Kelle Parkwa
y�. G Y Y Plan review fee:
Orono, MN 55356
`qkFSH04� Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: 3��� s�'� �oae(. O�n�'
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 se i e will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: ���� �,���
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (�/? _—7�q_ �.(�(�7 (office)
Mailing Address: Z�S�o ��5�� � City: j�y�y� � ZIP:�'��
Contact Person: � � Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: ��� (����
Phone (day): ��Z_-��9 �-(`-��1
Address: 3.�/.� �c.�s,�z.G� ,�.�.t._ City: �yV� ZIP:���(�
Email and/or Fax: �.��-��� c� t��r�. c�,,�
PROJECT INFORMATION: Overall pro�ect description: S:r.l-� G� ��� -L
Type of Project: Any earth movement may al require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof, other(specify) �Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $
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 infor tion is to annually update our records and records of other governmental agencies required by law. If
ou refuse to su I t tion,the a lication ma not be issued.
Applicant's Signature: Date: � /-�
Owner's Signature: - Date: � ��l � �
Last Updated:03/O6/2013