HomeMy WebLinkAbout2010-00969 - siding CITY OF ORONO PERMIT NO.: 2010-00969
� 2750 KELLEY PARKWAY
� ORONO, MN 55356- DATE [ss[1En: 10/11/2010
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2515 COUNTRYSIDE DR
P 1 IV : 04-117-23-11-0007
LEGAL DESC : COUNTRYSIDE MANOR
: LOT 003 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING -UNDEFINED
VALUATION : $ 30,000.00
NO"I'E: "CHIS PERMI"1'INCLUDES SIDING. RGROOFING, DECK RESURFACING, WINDOWS,DOOR
APPLICAIYT PERMIT FEE SCHEDULE 466J5
BUILDERS BY DESIGN STATE SURCHARGE(VALUATION) 15.00
21185 VIKING BLVD.
WYOMING, MN 55092- TOTAL 481J5
Minnesota State License#: 20026555
OWNER
KAHLER,CHRIS& DELPHINE
2515 COUNTRYS[DE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The���ork for evhich this permit is issued shall be performed according to
thc approved plans and specitications,applicable City approvals,and the
State Building Code. This pemlit 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[his 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 I 80 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 in conformance H�it e State Building Code.This permit may be
revoked at an� � � ause.
-�— `— / / / /
pplic t Permitee Signature Date Issued B ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
..
City of Orono
• Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.j
Mailing Address: Permit number: `b—
�,0,�. PO Box 66 � �
0 � � Crystal Bay, MN 55323-0066 Date received:
,� ���'' Received by:
a��x �, Street Address:
�'F, '� q� �� 2750 Kelley Parkway Plan review fee:
L�xESHOg'� Orono, MN 55356 �
Total Fee: ( ��� � �
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us T
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: z��J �o� �-� �✓' j i cr'(,e r_
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 I A PLICANT NFORMATION:
Name: ��^� (�j�, ,`
State License# � p � Expiration Date: G � O!
Phone: � - ,3 - b Co office � 76 t � cell
Mailing Address: U'• v Cit : (,J e,� ,�,z ZIP: SS09 Z
Contact Person: r,,-t �� Applicant is: Contrac or / � eowner (Circle One)
Email and/or Fax: �-✓1
PROPERTY OWNER INFORMATION:
Name: �' �.�^ �S � �� � � a�� �we �4. �- � C��
Phone (day):
Address: �S(S pv,ri v.� S ��r �v- City: �rar o ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review&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 Dama e www.minnehahacreek.orq
Overall Project Description: < < �,.c � ��,,,, p�� �
Estimated Construction Valuation of ject(excluding land) $ ��_ pCSC�
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 whic enerally cannot be given to eithe the public or the subject of the data. Our
purpose and intended use of this inform 'o is to annually pdate recor and records of other governmental agencies
re uired b law. If ou refuse to su I e' formatio e lic � ma be issued.
ApplicanYs Signature: Date: ��� �C�
LastUpdated: 05-04-2009