The URL can be used to link to this page

Home My WebLink About2015-00769 - advance plan review fee for 2015-00768 CITY OF ORONO * Z 0 1 5 - 0 0 7 6 9 * , 2750 KELLEY PARKWAY DATE ISSUED: 06/15/2015 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1629 BOHNS POINT RD PIN : 17-117-23-I1-0005 LEGAL DESC : REG. LAND SURVEY NO.0565 : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REV[EW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REV[EW VALUATION : $ 10,000.00 NOTE: PLEASE F[LL IN THE FOLLOWING: VALUATION OF PERMIT: $ 10,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: NEW W[NDOWS PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00768 APPLICANT ADVANCED PLAN REVIEW 130.88 TOTAL 130.88 MATTSON SCHOSTER LLC Payment(s) 332 2ND STREET CHECK 7937 130.88 EXCELSIOR, MN 55331- (612)751-0488 Minnesota State License#: BUIL-BC663107 OWNER AMPLATZ,CAROL[NE 345 LEAF ST WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work 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 onty 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 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 construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested i co ormance with the State Building Code.This permit may be revoked a �ime or e se. — i `��.s� �� l� p icant Pe ee ignature Date [ssued y Signat Date I� � City of Orono Buildi�ng Permit Application for Maintenance / Replacement / Remodel (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �O� Mailing Address: Permit number. ��" v� � O PO Box 66 Crystal Bay, MN 55323-0066 Date received: -�J- Street Address: _ Received by: , � � __ __. L y�, ti� 2750 Kelley Parkway ��r� ',�p 'r1 Plan review fee: , �� ,. � t9kESH��G Orono, MN 55356 "J � - 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 INFORMATIONi�� ys � ,� � Job Site Address: 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 service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APP ICANT INFORMATIp N: / � Name: �}�f'l1� SCi7 U d"'� � `� State License# d Expiration Date: Lead Certification Number: ^.. � �— Expiration Date: �� (for work on homes that were constructe rior to 8 Phone: (cell) �p a - ?� �a �� (office) �� 7�� —'�y�� Mailing Address: 3 � 2 �w , City: �p ZIP: Contact Person: � b Applicant is: ontractor / Homeowner (Circle One) Email and/or Fax: 6 � � , PROPERTY OWNER I FORM�AT�O�N: � / Name: � �t Phone(day): Address: �/.�. City: � ZIP: �5�� Email and/or Fax: � � '� � 2 �� '� � PROJECT INFORMATION: Overall project description: ' �'i Type of Project: Any earth movement may also require �` � ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: � � ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)- �.�.�C 15320 Minnetonka Blvd ` �� ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 '�W indow(s) www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ � d� 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 info ati is to an Ily update our records and records of other governmental agencies required by law. If ou refuse to su I t ' f tio t ' n ot be issued. Applicant's Signature: � Date: -� � Owner's Signature: Date: Last Updated:January 2015