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Home My WebLink About2011-00245 - siding � . CITY OF ORONO PERMIT NO.: 2011-00245 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE [ss[1ED: 04/28/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 776 BROWN RD N PI IV : 34-I 18-23-1 1-0001 LEGAL DESC : REG. LAND SURVEY NO. 1275 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PRO{'ERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : SIDING ACTIVITY : O/S BUILDING -UNDEFINED VALUATION : $ 41,400.00 NOTE: RESIDE APPLICANT PERMIT FEE SCHEDULE 595.75 CRAFTSMAN'S CHOICE, [NC. STATE SURCHARGE(VALUATION) 20.70 26219 FREMONT DRIVE#105 ZIMMERMAN, MN 55398- MAIL-IN FEE 2.00 (763)6�3-1390 TOTAL 618.45 Minnesota State License#: 20384780 OWNER BARBARA LUIKENS, RICHARD BENSON/ 776 BROWN RD N LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT l he work for wh�ch this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the State 13uilding 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 bc compicd with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within I 80 days oY the date of issuance,or if construction is suspended lor a periud of 180 days at any time after��rork has commenced. "l�he applicanl is responsible tbr assuring all required inspections are requcsted in conformance with thc State Quilding Code.This permit may be revok at any time for due cause. ' �a�� / � Ap icant ennitee S��nature Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . � • RECEIVED City of Orono APR 28 20�uilding Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) -- Mailing Address: �//_� a �� / �,�,�j��\ PO Box 66 Permit number: , 0A,, Crystal Bay, MN 55323-0066 Date received: �� /� ��,� �°��T�� _.. �,�j SfreetAddress: Received by: �\ ��u� ��'% 2750 Kelley Parkway Plan review fee: ��'�gESHog�� Orono, MN 55356 `— ' 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. (P/ease print) GENERAL INFORMATION: Job Site Address: �1 (D (V�s(-�1r1 �L�,� �(�, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Ck �-IS �S �: ��Fl State License# aO3�t�}'�� Expiration Date: j � Lead Certification Number. (�(�I - IO5�� Expiration Date: '3 (�y ��p (for work on homes that were constructed prior to 1978 Phone: `�� _ ��' -. f�j9 Q (office) (cell) Mailing Address: �,1� t'�rv�0�'1 ' #I � City: rmc1N ZIP: ��`�3q S� Contact Person: ' ry-� ��v Qn S Applicant is: ontractor / Homeowner �c�►�ie one� Email and/or Fax: �� 3.-�� -. I 3q I �tn�o @Cx��m0.n�Chr�i�� Cl�tYl PROPERTY OWNER INFORMATION: Name: 'Qu � .(�n�� Phone (day): qr-�� - a�l a- �7 �'j Address: 11� City: � ZIP: rjFJ3-r�, Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd Deephaven, MN 55391 Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 ❑ Re-roof ❑ Fire Damage Fax: 952-471-0682 www.minnehahacreek orq Overall Project Description: -{�p„� � (�� ;r�� Estimated Construction Valuation of Project(excluding land) $ �}�i 4OD • O� 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 information is to annually update our records and records of other governmental agencies re uired b law. If ou refuse to s I the information, the a lication ma not be issued. ApplicanYs Signature: Date: �aCo/�� Last Updated: 03-01-2011