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Home My WebLink About2011-01217 - remodel permit/interior only CITY OF ORONO PERMIT IYO.: 2011-01217 ,, � 2750 KELLEY PARKWAY � ' ORONO, MN 55356- DATE ISSUEu: 10/10/2011 � 952 249-4600 FAX: 952 249-4616 ADDRESS : 1685 FOX ST PIN : 03-117-23-44-0004 LEGAL DESC : HANSER ADDN : LOT 002 BLOCK 001 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RES[DENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 450,000.00 NOTG: PLEASE FILL IN THG FOLLOWING: VALUATION OF PERMIT: $ 45Q000 I'YPI?OF PERMIT"fHIS PAYMENT IS FOK: REMODEL PERMIT, INTERIOR ONLY PERMIT#THIS PRGPAYMENT IS TIED TO: 2011-01216 APPLICANT ADVANCED PLAN REVIEW 2,051.89 AULIK&ASSOCIATES T(1TAI 2,051.89 6401 WAYZATA BLVD ST LOUIS PARK, MN 55416- (952)591-I500 OWNER crea Mts `�, MACMILLAN,NNIN 1685 FOX ST WAYZATA, MN 55391- "�V?4U'.; �:t7l�3P?('c3 AGREEMENT AND SWORN STATEMENT s��? -,;�.... The work for which this permit is issued shall be performed according to 'f''`��'. the approved plans and specifications,applicable City approvals,and the �t-"�� State Building Code. This permit is for only the work described and does 1 dYl !. not grant permission for additional or related H�ork which requires separate y� permits. All provisions of laws and ordinances governing this type of work �`"�'' _ shall be compied with whethcr or not specified herein.This perniit will -'•� ��art�£; ___ � _�•� expire and become null and void if construction authorized is no[ � commenced within l 80 days of the date of issuance,or if construction is �.�� suspended for a period of 180 days at any time atter work has commenced. ;;J y�„ The applicant is re ponsible for assuring all required inspec[ions are ;;, �� _ requested in,confo � ance witt�ihe State E3uilding Code.This permit may be � . , revoked at n e d ause. �:��`�,__ �l/L�� l l/( '�� l. � ( '/� �C /�( `G`/ %(_;� ��1 —� � ' � /�- � i i Appli-'nt Permitec Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . � - City of Orono Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc.) �-- Mailing Address: � ��,�,�.� PO Box 66 Permit number: �,G � � �- (��Z I(� /� Q\� Crystal Bay, MN 55323-0066 Date received: I C - ��-1( i ''�� y j.�1iC�r� � F� �:_� �� ' � /" Received by: Zj� �a `��,�� ,�i Street Address: �_ (� �� Z. I � ��,�� '�� ti/ 2750 Kelley Parkw�y��'� Plan review ee: � 2, � S� � S� �kESH�4j 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: �f � I� 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 approva160 days prior to the event. Shutfle bus servrce will be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLI A T NFORMATION: � Name: p�-- � � State License# �� Expiration Date: .- -/Q Lead Certification Number: � - Expiration Date: `�-�,/-/s (for work on homes that were cons ructed prior to 1978 Phone: - _ v� office) �� - ��-�� (cell) Mailing Address: � , City: ,�� ZIP:�j�f� , Contact Person: � G Ap licant is: Contractor / Homeowner (Circle One) Email and/or Fax: ��1 �J � �� PROPERTY OWNER INFORMATION: Name: �� //y� Phone (day): qs�,- R _ �� Address: �� city: ��1D ZIP: Email and/or Fax ��lr�� q� � ,� PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) �,Remodel ❑ Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 Phone: 952-471-0590 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek orq Overall Project Description: , � Estimated Construction Valuation of Pr �ect(excluding land) $ o � 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 e formation, the a lication ma not be issued. ApplicanYs Signature: Date: ��l� Last Updated: 08-09-2011 l _,, „ C,_._ . L . ..�r,✓�.��-