HomeMy WebLinkAbout2015-01250 CITY OF ORONO * z 0 1 5 - 0 1 z 5 0 *
2750 KELLEY PARKWAY DATE ISSUED: 09/28/2015
ORONO, MN 55356-
(952 249-4600 FAX: 952) 249-4616
ADDRESS : 4375 BAYSIDE RD
PIN : 06-117-23-12-0008
LEGAL DESC : LJNPLATTED 06 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING- UNDEFINED
VALUATION : $ 60,000.00
NOTE: NEW SIDMG&WINDOWS
APPLICANT PERMIT FEE SCHEDULE 794.64
STATE SURCHARGE(VALUATION) 30.00
DAKOTA CRAFTSMAN TOTAL 824.64
4011 GLENDALE DRIVE Payment(s)
EXCELSIOR,MN 55331- CREDIT CARD 5019 824.64
(612)760-0628
Minnesota State License#: BUIL-20637448
OWNER
WH(TE, STEVEN& PATRICIA
4375 BAYSIDE RD
MAPLE PLAIN, MN 55359-
AGREEMENT AND SWORIv STATEMENT
The work for which this permit is issued shall be performed 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 goveming 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 conswction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be �)�,.�
revoked y time for d us � �-��
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Applicant Permitee Signature Date [ssued By Signature Date
Sep.28.2015 06:41 AM Dakota Craftsman 6127600628 PAGE. 1/ 1
_....
. � City of Orono
Building Permit Applica#�on for Mainfienance I Replacement / Remodel
(t.e. windows, doors, sidin , re-roof, etc. � NO STRUCTURAL EXPANSION)
Mailing Address; C � ,� Z �
���0 PO Box 66 1'ermit number: , i I.�
Crystal Bay,MN 65323-0086 Date recelved: `� �2 0��
StreetAddress: Received by, �_.��Q
y � 2750 Kelley ParkwBy Plan reviewfea: � �— I �� •
`� � Orann, MN 55356 �/��
(�'�F S N��'"� � ��� `T
t Total Fee:
M�in: 952-z49�600 Fax: 952-249�3616 www.ci.orono.mn.us
This application fvrm must be completed in f�Ul and all requlred hiformation must be submitted,
Incomplete applicatfons wlll be retumed. (Please print)
GENERALINFORMATtON:���� �Q�SG�� �� .
Job Slte Address: �
Wlll thls be a Parade of Hnmes,Remodelera howcase Home or other Display Home7 Yes Nn
!f yes,a special evanf pe�mrt is required with Pollce D�palfmant and Glty CouncN epproval 60 days pnor to the event. Shuttle bus service will tre
raqulled unless applicant damonstrates suffrciant on•slte parking!s avalla619. Npn-pArmQtAd eV�nf6 Wl1I 11ot bB allOWed.
CONtRACTOR/AP ICANT INFORMATION;
Name: �-q
State Lipense# 4 G Expiration Aate� - � r
Lead Certification Number: Expiration Date�
(for work on homes that were consfnrcted prlor to f97d
Phone: (cel!) Q� (offlce)
Mailing Address: � ��U City: ��py^ ZIP: �
Contact Persan: u Applicant is ontrac o / Homeowner (Clrcl�on�)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: � �h 1
Phone(day): ..,�5,�-4�3�. d�, p� I I
Address: L(37� f�uStC�C -�o� --- -- --- C{ty: I1�L1�1� �lCfc,ll�' ZIP:
T
Email and/or Fax:
PROJECT INFOFtMAT10N: overall ro ect descrl tion:
7ype of C'roject: Any earth movement may also requlre
❑Dovr(s) ❑Remodel ❑Fire�amage
MCWD review 8 p�rmitg:
Mlnnehaha Creek Watershed plsMct(MCWD)
❑Re-roof,asphelt ❑Repair ❑Storm�amage 18202 Mlnnetanke Blvd
�Re-roof,cedar ❑Restoration Q Water Damage Deephaven,MN 55391
❑Re-roof,other(specifar) �Siding Q Other:(specify) Phone: 95z-471-0590
Fax: 952-a71-0682
�Window(s) www,minnehahacreek.ori�
�stimated Construction Valuation of Projeck(excluding land) $ �,Ck�`--"=- ��� �T,�„
APPLICANT ACKNOWLEDGEMENT; �C� G'C�C� DC5
. Agrees to provida al)information required or requested by the Bullding Department;
• CBrtffleS that the Intortnation supplied is true and correct to the beat af hlslher knowledge. The appUcant recognizes that they are
solely respansibfe for submitting a complete applfostion being aware that upon failure to do so,the staff has no altemative but to
reject it until it is complete;
• Some or all of the fniormatlon that you sre asksd ta provide on this application is classified by State lew as either private or
confidential. Private date Is lnformation which generally cannot be given to the public but can be glven to the subJect of the data.
Confidentia)data is informatinn whloh generalty c8nnot 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
ou refuse fo su I ihe I atlo thg 8 (ication ma not be issued.
Applicant's 8ignature: pate: ` 2� 1 �ulS
Owner's Signature: �� Date: �'-' � ��G�S
Last Updated,January 201b