HomeMy WebLinkAbout2012-00754 - adv plan review CITY OF ORONO * 2 0 1 2 - 0 0 7 5 4 *
� � 2750 KELLEY PARKWAY DATE ISSUED: 08/03/2012
�. ORONO, MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 2515 KELLY AVE
PIN : 20-117-23-12-0038
LEGAL DESC : REG.LAND SURVEY NO. 1428
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 95,575.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$95,575.00
TYPE OF PERMIT THIS PAYMENT IS FOR: REPLACE DECKING,INSTALL FIREPLACE,CONCRETE&WINDOWS
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-00'f� 7 5(P
APPLICANT ADVANCED PLAN REVIEW 667.39
MOM'S LANDSCAPING&DESIGN TOTAL 667.39
12276 JOHNSON MEMORIAL DRIVE
SHAKOPEE,MN 55379- PAID WITH CC# _ 6431
(952)277-6667
Minnesota State License#:BC638384
OWNER
HARDTEN,DAVID&CHRISTINE
2515 KELLY AVE
EXCELSIOR,MN 55331-
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 dces
not grant pertnission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming 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 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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Cit of Orono I o7� - �
Y /
� 'Building Permit Application for Maintenance / Renov�ation
� (windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number: o1U l•L—aa 7
O.���.0 PO Box 66 � ' '
Crystal Bay, MN 55323-0066 p�, � Date received: -� 1�
�, Street Address: �;U Nc-���\ Received by:
�.�, Gti�' 2 7 5 0 Ke l l ey P a r k w a y "` P lan review fee:
���o�,,,w Orono, M N 5 5 3 5 6 o2C�/ � -D�7,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. (Please print)
GENERAL INFORMATION:
Job Site Address: 7,��,�_��'('�i`� ����U� � 1`� - �5�3
Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home. ❑Yes o
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic will be
required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be a/lowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �p�'��S j,¢�µpY..�P�l� �jl-l . �
State License# ���.5,���� —� Expiration Date: 3'-�— 4
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: QciZ—Z-l�—�hG, (office) ��Z—�—Z��'j (cell)
Mailing Address: • City: ZIP:
Contact Person: ��_, ��„�,r,� Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: �1� � t-,�{$J1SC1�,�,� �Tf-�,,,R ,
Phone(day): c�r�Z,—�"�,� — �c���_
Address: 7 5�c� ' ��� City:��p� ZIP: srj3�j
Email and/or Fax �� � p�„�Z,E� ,,
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door s q�Remodel ❑ Fire Dama e MCWD review 8�permits:
� � 1�d g 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 7ther: (specify) Fax: 952-471-0682
❑Window(s) www•minnehahacreek.ora
Overall Project Description: r
Estimated Construction Valuation of Project(exclu ing land) $ q rZ"'�C,�..°G._
�-
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide a�l 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 refus I the i ation,the a lication ma not be issued.
ApplicanYs Signature: Date: '��- 'Tj " l�
Last Updated: 08-09-2011