HomeMy WebLinkAbout2012-00818 - siding CITY OF ORONO � 0 1 2 - 0 0 8 1 8 *
, 2750 KELLEY PARKWAY DATE ISSUED: O8/21/2012
� � ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 840 HUNT FARM RD
PIN : 30-118-23-44-0009
LEGAL DESC : HUNTINGTON FARM 2ND ADDN
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : S[D[NG
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 11,540.00
APPLICANT PERMIT FEE SCHEDULE 221.25
WARREN BURGIN INC. STATE SURCHARGE(VALUATION) 5.77
8031 171ST LANE NW
RAMSEY, MN 55303- TOTAL 227.02
(612)867-5469 PAID WITH CC# 7827
OWNER
W[LSON, DAVID& SUSAN
840 HUNT FARM RD
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall bc performed according ro
the approved plans and spccifications,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 type of work �
shall be compied with whether or not specitied herein.This permit wil)
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 respo ng all required inspections are
requested in form ce witl uilding Code.This permit may be
revoked at an time fo ue cause. �Z`�
Cj � '�! l ��- �—��_;� C__�_.V�.__�-�--_ / o / �'1 - f �
Applicant Permitec Sigr at re Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�i�y �� 0��-0�0
�, Buiiding Permit Appiica�ion for Mair��er�ar�ce / RenQvatio�
.• (windows, doors, siding, re-roof, etc.)
M,ailing Address: Permit number. Z v�Z -
��v 0� PO Box 66
Crystal Bay, MN 55323-0066 Date received: '
�� �. � :
, � � Received b
�a �:,: �, Street Address: ' Y�
.., � ,� E��
��'� -'� � 2750 Kelle Parkwa
o Y Y Plan review fee:
�`�.gESKo�"� 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.
Incompfete appfications will be returned. (Please print)
GENERAL INFORMATION: -, , �
Job Site Address: �.�L : �' '� ! � ; �, ,i f'� <-� , � r l<- �
Will this be a Parade of Homes, Remodelers Showcase Home or other Dispfay Home? ❑ Yes No
!f yes, a special evenf permit is required with Polrce Department and City Council approval 60 days prior to the event. Shuttle bus service wi/!be
required unless applicant demonsfrates suffrcient on-site parking is availab/e. Non-permitted events will not be al/owed.
CONTRACTOR/APPLICANT INFORMATIO� ,
Name: l,lJ.��L�tr-� �u.,�;..r� 1•��,
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on fromes that were constructed prior to 1978
Phone: �Z- g C�7 -��� (office) (cell)
Maifing Address: �o?� — �y�S f l�,.�, � i1/, 1,�,�._ Cit : ZIP: �5�� �
Contact Person: �,�Lc-,v ,S�� � Appiicant is: Contractor / Homeowner (Circle One)
Email andlor Fax: u,,,�;'� c: � : e,�s C� �j +
PROPERTY OWNER INFORMATION:
Name: i~j?-u� �- Su� �r �scs�v
Phone(day): Cl�'Z - �7S- ��la .
Address: gt� u,�,� �',��,� �� City: �,,t.��.t;� ZIP:
Email and/or Fax
PROJcCT INFORMATION:
Type of Project: �I � Any earth movement may require
❑ Door(s) I ❑ Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof, asphalt ❑ Re air ( Minnehaha Creek Watershed District(MCWD}
p ❑ Sform Damage 18202 Minnetonka Bfvd
❑ Re-roof, cedar �Wat� g I Deephaven, MN 55391
❑ Restoration Ar Dama e Phone: 952-471-0590
❑ Re-roof, other(specify) [�Sitling ❑ Other: (specify) Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
Overall Pro�ect Description:
Estimated Construction Vafuation of Project (excfuding fand) $ �� �r-c�� --
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all inforrnation required or requested by the Building Department;
• Certifies that the informafion supp(ied is true and correct to the best of his/her knowledge. The appficant recognizes that they
are sofefy responsible for submitting a compiete appfication being aware that upon failure to do so, the staff has no alternafive
but to reject it until it is compiete;
• Some or all of the information that you are asked to provide on this application is cfassified by State law as either private or
confideniial. Private data is information which generally cannot be given to the pubfic 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 tne 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 fv tne ' " e a lication ma not be issued.
ApplicanYs Signature: /' � Date: � — �.�� j �
�ast Updated: 08-09-2011