HomeMy WebLinkAbout2011-00018 (siding) CITY OF ORONO PERM IT NO.: 2011-00018
2750 KELLEY PARKWAY
. , � ORONO, MN 55356- �ATE issuEn: OU06/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2740 CAROLINE AVE
P1N : 20-117-23-31-0062
LEGAL DESC : REG. LAND SURVEY NO. 1451
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ 2,500.00
APPLICANT
PERMIT FEE SCHEDULE 88.50
SADNESS, MARK STATE SURCHARGE(VALUATION) 5.00
2740 CAROLINE AVE
WAYZATA, MN 55391- TOTAL 93.50
PAID WITH CC# 9328
OWNER
SADNESS, MARK
2740 CAROLINE AVE
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMEIVT
l�hc�vork for which this permit is issued shall be performcd according to
the approved plans and specitications,applicable Cit��approvals,and the
State[3uilding Code. This permit is for only the�vork described and does
not crant permission for additional or related work���hich rcquires separatc
permits. NI provisions of laws and ordinances goveruinc 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
conuncnced within 180 days of Uie date of issuance,or if construction is
suspendcd �ix a periud of 180 days at any time after work has commenced.
The applicant is responsible for assurin�all required inspections are
requestcd in conformancc�vith the State[3uildina Code.This permit may be
revoked at any tim for due cause. � /���
I I�I�Jt�"l V}� �./��� �� i � i � � �� (�;� ( l �l� ��,L'� / �.� ��'_ ��
Applicant N�rmitee Signatur� Dale Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
, � .
• Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
�,0,�. PO Box 66
Q � Q Crystal Bay, MN 55323-0066 Date received:
�'�'� '-— Received by:
a � ��.�; �, Streef Address:
�'�, '� -6%� �titi 2750 Kelley Parkway Plan review fee:
t`�kEsxoti`'� 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: �. `�C� �c�������nC� A�'C�
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 INFORM TION:
Name: _�rl� �G7✓1��'1��,�
State License# Expiration Date:
Phone: (office) (cell)
Mailing Address: Cit : ZIP:
Contact Person: Applicant is: Contractor / omeown f (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
�
Name: �"lu� k` `�c,���1@SS
Phone (day): � ' 7 `�
Address: �']�.�p ('�,r� ,,I�� ���7� City: O�On(_'? ZIP:s5 3��
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review 8�permits
❑ Door(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
� Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-roof ❑ Fire Damage www.minnehahacreek.or4
Overall Project Description:
Estimated Construction Valuation of Project(excluding land) $ � -rj � �---
,
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 su I the information,the a lication ma not be issued.
ApplicanYs Signature: U��Y;��L �Y�,�i�� Date: � � l
Last Updated: 05-04-2009