HomeMy WebLinkAbout2011-01262 - add state surcharge CITY OF ORONO PERMIT NO.: 2011-01262
2750 KELLEY PARKWAY
.,.,
ORONO, MN 55356- DATE ISSUED: 10/18/2011
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 519 FERNDALE RD N
PIN : 36-118-23-14-0008
LEGAL DESC : UNPLATTED 36 l 18 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITIONAL STATE SURCHARGE
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : ADDITIONAL STATE SURCHARGE
NOTE: "I'HIS WAS AN ADDITIONAL STATE SURCHARGE THA"I'WAS COLLECTED DUE TO THE S"CATE SHUTDOWN IN 201 l.
FOR PERMIT#:2011-00626
I S SU ED:07/21/2011
APPLICANT STATE SURCHARGE FLAT-ADDIT[ONAL 4.50
PATNODE BROS TOTAL 4.50
23200 ]09TH AVE
ROGERS, MN 55374
(763)428-7393
Minnesota State License#: 95
OWNER
MICHELETTI, TOM
519 FERNDALE RD N
WAYZATA, MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Quilding Code. This permit is for only the work described and does
not grant permission for addi[ional or rclated work which requires separate
permits. nli 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 no[
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time aRer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Bu�lding Code.This crmit may be
revoked at any time for duc iause� � ,. 1
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Applicant Permitee Signature Date Issued By S g ature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
.
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�,o�°�o� C I TY O F O RO N O MONTH: July
��( '* � P.O. BOX 66
\�� ,l�i�,�i�;;� ,�`j, ORONO, MN 55323
�`�'�a������� (952) 249-4600 fax (952) 249-4616
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DETAILS OF INVOICE -
Customer
Name Patnode Bros Date Created 7/28/2011
Address 23200 109th Ave 10/12/2011 .�.,,,,� -��>,-
- _ _ _ _ _ _ _ _
City Rogers State MN ZIP 55374
Phone _ _ _ _ _ _
Qty Description - - __ _. _ Unit Price ! TOTAL
� Due to the State Shutdown '
! 1 �Additional Charge for State Surcharge is Due $4.50 $4.50
� Per Minnesota Statutes, Section 326B.148, Subdiv 1
For: Permit#2011-00626 - Issued 07/21/2011 � i
, At: 519 Ferndale Rd N I
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Sub Total' $4.50 �
TOTAL DUE $4.50
Please return payment to City of Orono with a copy of this invoice included.
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