HomeMy WebLinkAbout2016-00476 - interior remodel ,•4 � CITY OF ORONO * 2 0 1 6 - 0 0 4 7 6 *
2750 KELLEY PARKWAY DATE ISSUED: 05/19/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 215 HOLLANDER RD
PIN : 25-118-23-44-0013
LEGAL DESC : HOLLY ACRES 2ND ADDN
: LOT 000 BLOCK 001
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 4,515.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE)
(ADD INTERIOR WINDOW&RENOVATE HOME OFFICE)
APPLICANT PERMIT FEE SCHEDULE 123.87
PLAN REVIEW 80.52
KYLE HUNT&PARTNERS INC. STATE SURCHARGE(VALUATION) 2.26
18324 MINNETONKA BLVD
DEEPHAVEN,MN 55391- TOTAL 206.65
(952)476-5999 Payment(s)
Minnesota State License#:BUIL-BC-0001967 CHECK 20811 206.65
OWNER
CLAPP,THOMAS&LAURA
215 HOLLANDER RD
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 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 this rype 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 in conformance with the State Building Code.This permit may be
revoked at any time for due cause. ���TK��3
l��{LE t�UK� � , rc .
; c � 6 �� � �l �
Applicant Permitee Signature ate Issue y ignature Date
` � City of Orono
Building Permit Application for Maintenance I Replacement/ Remodel - Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
��O� Mailing Address: Permit number: 2.,O( "� (p
� O PO Box 66 �
Crystal Bay, MN 55323-0066 Date received: — ,3—
� � Received by: �
Street Address:
�2� ��� 2750 Kelley Parkway Plan review fee: C �-� f�v11
� � `� ' Orono, MN 55356
�K�s"°�� � �a� �S
`_ 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: Z, b �.,L K 1�OAD ,
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 pnor 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/APPLICANT INFORMATION:
Name: �C�( L.E F4� erT �-- E'Ps�(�Tt`�EfZS, '�N�-.
State License# Odn 19 �`t Expiration Date: 3�3� ���
Lead Certification Number: � �,-�- .. F�2�\30' 1 Expiration Date: 3�z4 ��p�qr_
(for work on homes that were constructed prior to 1978
Phone: (cell) 6 �-Z- 3�q_ z„19cj (office) �52,- y1 �,- S 99�
Mailing Address: 1 3 2� YV��N '�.TO G �L-vD City:p EP �EN ZIP: 53 �
Contact Person: �.L, �v.S E�{�. Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax: G�,�Mv 5���,.,C� �y1,e��v v�-�- (,q�r"•�—y��1r-S . C..ow,
PROPERTY OWNER INFORMATION:
Name: -T-}}am � LR.v(Z,R �-Lpr.P P
Phone (day): �s'Z— 33t-�� 3 Sa3
Address: 3a 5 H���.l'srr'aE.i2 R'�, c�ty: dRar.n ziP: 5S3gi
Email and/or Fax:
f�'U D 1 J�tT �b(� � \ tv`1l► C�W
PROJECT INFORMATION: Overall project description: ��N b�/'I��C'E }�''�v�� O F F�C-E
Type of Project: Any earth movement may also require
❑ Door(s) �.Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
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
❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ � _�1 S
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 required by law. If
ou refuse to su I the information, the a lication ma not be issued.
��Y c-E H�lyT -t- '(�T �Y � c�G.
Applicant's Signature: _ Date: Sl3�2.a1Z'�
Owner's Signature: �( Date: '����-�-�`��� F
,
Last Updated:January 2016
� PLAN REVIEW CHECKLIS.T FOR NEW STRiJCTURES 1 ADDITIONS
Address: 2,`� f7� l l��/, L/I� �,,� Permit No.:
Description of work: '7�'(�C7'Uf a �tr�'I Date Rec'd: �
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