HomeMy WebLinkAbout2014-01180 - doors ' CITY OF ORONO * z 0 1 4 - a 1 1 8 0 *
2750 KELLEY PARKWAY DATE ISSUED: 10/10/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4040 DAHL RD ��
PIN : 07-1 17-23-I I-0021 � ��r / � �
LEGAL DESC : PIRATES COVE ���(�✓�`e' �
: LOT 017 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DOORS
ACTIVITY : O/S BUfLDfNG - UNDEFINED
VALUATION : $ 750.00
NOTG: REPAIR DOOR
APPLICANT PERMIT FEE SCHEDULE 34.75
STATE SURCHARGE (VALUATION) 0.38
FLOORS BY BECKERS TOTAL 35.13
825 1ST ST N W
ST. PAUL, MN 551 12- Payment(s)
(612) 597-5989 CREDIT CARD 9926 35.13
OWNER
LEPPLA, MR& MRS JOHN
4040 DAHL RD
MOUND, MN 55364
AGREEMENT AND SWORIV STATEMENT
The work for which this permit is issued shall be performcd according to
the approved pians and specitications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work�vhich requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specitied 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 am time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit ma� be �
revoked at any time for due cause.
9
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App cant Permitee Si�nature Date Issued B��Signature Date
e
- City of Orono
�
�uilding Permit Appiication for Maintenance / Rep�acement / Renovation a ���
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
�O�O Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
�r � 2750 Kelley Parkway Plan review fee:
`� � Orono, MN 55356
`�KESHO�� 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.
fncompfete applications will be returned. (Please print)
CENERAL INFORMATION: � ��
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Home or other Dispfay Home? ❑ Yes No
!f yes, a special event permit is required with Police Department and City Council approvaf 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-srfe parking is available. Non-permitted events wifl not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �1�1��1" ` t�«�12�
State License# �� ����7� Expiration Date: � ,S"
Lead Certification Num er: uf�-�-_ �l)�3g"s.... � Expiration Date: �?Q/
(for work on homes that were constructed prior to 1978
Phone: (cell) 6�Z �C�"�_��� (office)
Maifing Address: g'2 S ��t' f�T J�/(,� City: c�7' ��� ZIP: Ss�/'Z
Contact Person: ����q.� � Appficant is: Contractor / Homeowner (Circle One)
Emai! and/or Fax:
PROPERTY OWNER INFORMATION:
Name: J� �
Phone (day): 52— ' 31�.'�
Address: t.�Ot�.0 �Hy f�j� CityD�U� ZIP: ����
Email andlor Fax:
PROJECT INFORMATION: Overall project description:
i ype 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)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
cstimated Construction Valuation of Project(excluding fand) $ 7 SQ� V�
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 responsibfe for submitting a compfete application 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 information that you are asked to provide on this application is cfassified by State taw as either private or
confidentiaf. 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 required by law. If
ou refuse to su I the information,the a lication ma not be issued.
Appficant's Signature: Date: IF��d ��
Owner's Signature: Date:
�ast Uodatec: 03/06/2013