HomeMy WebLinkAbout2011-00824 - addl state surcharge CITY OF ORONO PERMIT NO.: 2011-00824
-, 2750 KELLEY PARKWAY
. ORONO, MN 55356- DATE ISSUED: 08/09/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 3]5 HOLLANDER RD
PIN : 25-118-23-43-0014
LEGAL DESC : HOLLY ACRES
: LOT 001 BLOCK 002
PERMIT TYPE : ADDITIONAL STATE SURCHARGE
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITIONAL STATE SURCHARGE
NOTE: "1'f lIS WAS AN ADDITIONAL STATE SURCHARGE THA"C WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011.
FOR PERMIT#:2011-00743
ISSUED:07/27/2011
City of Uror�o
��a Kelley ParkNay
Qranu M�1 55355 952-24�-46C�v
Receipt Na: 3.G05173 Rug 9, 2011
Ladahl Ir�.
Previous Balance: •��
PerAits
�ditional 5tate �•�
Surcharge 2011-�1743 3l5
Hoilander Rd
1(�1-�G802
Due to gavts-5tate
---------4.5C�
T��t al:
�dew Balance: 4.�'�-
APPLICANT Check M
LODAHL INC. Check No: 27403 4,5fj 4.50
667 WARNER AVE S �ayor: 4.50
MAHTOMED[, MN 55115 �"��1 I�� 4.5�
(651)470-9946 Total Applied: '__��_______
Minnesota State License#: BC 2043408 Char�ge Tendered: +_____�_ �{�_
08/0'�/2{}11 03:OfiPl1
OWNER
FAGRE,NATHAN&CONSTANCE
315 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 Codc. This permit is for only the work described and does
not gran[permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall bc 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 afrer 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. , �1
/�� �
l l `�� � (. ' � �� 1 / ��l��`���
Applicant Permitee Signature Date Issued By ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE.
.
04°�o C ITY O F O RO N O MONTH: July
�� �- P.O. BOX 66
� 11 �`��"'-
�, � ��' ORONO, MN 55323
��f.�V�,G
��Ko$ (952)249-4600 fax (952)249-4616
DETAILS OF INVO/CE -
Customer
Name Lohdahl Inc. Date Created 7/28/2011
Address 667 Warner Ave S
City Mohtomedi State MN ZIP 55115
Pi��o�e _ _ _ . _ _
�
Qty Description Unit Price TOTAL
. ____---- ---- -
-- - -
Due to the State Shutdown I
', 1 Additional Charge for State Surcharge is Due $4.50 '� $4.50 I
I Per Minnesota Statutes, Section 326B.148, Subdiv 1 ,
For: Permit#2011-00743 - Issued 07/27/2011
At: 315 Hollander Rd
- --- _______- — I
_ _ _- _ _. __�-
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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