HomeMy WebLinkAbout2011-00942 - additional state surcharge CITY OF ORONO PERMIT NO.: 2011-00942
` 2750 KELLEY PARKWAY
� ORONO, MN 55356- DATE Iss[1En: 08/26/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2587 KELLY AVE
PIN : 20-117-23-14-0021
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 004 BLOCK 005
PERMIT TYPE : ADDITIONAL STATE SURCHARGE
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITIONAL STATE SURCHARGE
NOTE: THIS WAS AN ADDITIONAL STATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 201 l.
FOR PERMIT#:2011-00749
1 SSU ED: 07/27/2011
APPLICANT
STATE SURCHARGE FLAT-ADDITIONAL 4.50
DORAN ENTERPRISES INC. TOTAL 4.50
1440 KELLY DRNE
GOLDEN VALLEY, MN 55427
(763)546-5066
Minnesota State License#: 58224PM
OWNER
WARE,ALEXANDER
2587 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
Statc 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 specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of[he 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
requcsted in conformance with the State Building Code.This permit may be
revoked at any time for e use.
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Appiicant Per itee S'gnature �Date � �" ���� ��' ��L��"� / / ��
Issued By S�gnature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.
o�°�o C I TY O F O RO N O MONTH: �u�y
� �,. P.O. BOX 66
�" �' ORONO, MN 55323
���$*�� (952)249-4600 fax(952)249-4616
DETAILS OF INVO/CE -
Customer
Name Wruck Excavating, Inc. Date Created 7/28/2011
Address 15096 102nd Street
City Becker State MN ZIP 55308
Phone
� Qty Description Unit Price TOTAL
Due to the State Shutdown
1 Additional Charge for State Surcharge is Due $4.50 $4.50
Per Minnesota Statutes, Section 3266.148, Subdiv 1
For: Permit#2011-00696- Issued 07/21/2011
At: 2905 Sixth Ave N
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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