HomeMy WebLinkAbout2015-00599 - doors CITYOFORONO * Z015 - 00599 *
2750 KELLEY PARKWAY DATE ISSUED: 05/14/2015
� ORONO, MN 55356-
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 345 LEAF ST
PIN : OS-117-23-14-0003
LEGAL DESC : AUDITOR'S SUBD.NO.203
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DOORS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 11,000.00
NOTE: REPLACEMENT OF 2 PATIO DOORS
APPLICANT PERMIT FEE SCHEDULE 216.85
STATE SURCHARGE(VALUATION) 5.50
HOME CHECK PLUS MAIL-IN FEE 2.00
120 OSSEO AVE N
ST CLOUD,MN 56303- TOTAL 224.35
(320)529-4800 Payment(s)
Minnesota State License#: BUIL-26133-2 CREDIT CARD 7883 22435
OWNER
AMPLATZ,CAROLINE
345 LEAF ST
LONG LAKE,MN 55356-
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 gant pertnission for additional or related work which requires separate
permits. All provisions of Iaws 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 I80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the Sta[e Building Code.This permit may be �
revoked at any time for due cause.
��� �, 1 Y� �s
Applicant Permitee Signature Date Issued By Signature Date
May. 14. 2015 11 : 33AM Dale Gruber Constructio� No. 0395 P. 2
t�ity ot urano
�uilding Permit Application for Maintenance 1 Repiacement / Remodel
(i.e. windows, doars, siding, re-roof, etc. — NO STRUCYURAL EXPANSION)
�0�� Ma11IngAddress: permit number: 2�� �� �
PO Box 66 I' �
Crysial Bay,MN 55323-00B6 Date recelved: '�^�
Sfroet Address: Recefved by�
��, G�� 2750 Kelley Parkway Plan review fee: (� Qt-
�,�k�sHo��, Orono.MN 55356 �
Total Fee� ��� � �
Main: 952-249-4800 Fax: 952-249-46'f6 www.ci.orono.m�.us
This application form must be completed in full and all requlred fnformatfon must be submitted.
Incomplet�appficatlons wlll ba returned. (Please print)
GENERAL INFORMATION: �
Job Site Address: �y� G�/� S�'��; Q�Q/t�l�! �y .�'�„$�
Wllf thls be a Parade of Homes�Remvdelers Shawc'ase Home or other Dlsplay Home? ❑Yes �No
I/yes,a speclal even!permlt 1s requlreal wifh Police Department and Cify Couna!apprnvaJ sp days prior Ip the event- Shuflle bus se�vlce w/A be
required unless appllcanf demonslrates sull�rGent on-site padcing ls available. Non permilfed evenls will nof be a!lowed.
CONTRACTOR/APPL CANT INFORMATION:
IVame: �
State License# � �, Expiration Date; � � �, �
Lead Certification Number: � Expiration Date: .�
(!or work on homes�hat woere cons ructed p or to 978
Phone: (cell) p— z (office) ,��p_-��9— �f�0 p
MailingAddress: l�o �S��7j ��-�,� p�� Cify:�}-, �'�� ZIP: � 7��
Cantact Persan; � Applicant is: �/ Homeowner �c�rc�.oee�
Emailand/orFax; � ��L �jy��yf��Ls � �'0vvl orr �����.�'��' 3/9��
PR�P�RTY OWNER I FORMATION:
Name: .{� [
Phone(day): /� -- /
Address: �� City:Q/��/p ZIP: J.��
Email and/or Fax: Cyl1� L/ C
pRQJ�CT INFQRMATION; Overall ro'ect descri tion: n�� it7r" D d �/ �d�/��-
Type of ProJect: Any earEh movement may also requlre
�Door(s) ❑Remodel ❑�'ire bamage MCWD revlew B permlY,s;
❑Re-roof,asphalt �Repslr ❑Storm Damage Minnehaha Creek Walershed Dislrict(MCWO)
18202 Mlnnetonka Blvd
❑Re-roof,ceclar ❑Restoration ❑Water Damage Oeephaven,MN 55391
❑Re-rooF,other(specl(y) ❑Siding ❑Olher�(speClfy) Phone� 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.ara
�stimated Construction Valuation af Project(excluding land) $ �
APPLICANT ACKN�WL�DG�M�NT:
• Agrees lo prpvide all Informatbn requ(red or requested by ihe euilding Depariment;
• Cerlifies thal ihe informalion supplied is inia ahd correcl io tha besk of hislFiar knowledge. The applica�i recognizes ihal lhey are
sofely responsible for submilting a complefe applicalion being aware thal upon faifure io do so, Ihe slaff has no alterrtalive bul io
reJect It unt+l It Is complete;
• Some or a0 of the inFormation lhat yo are asked to pravide an ihis application is classified by Slate law as eiiher private or
confidenlial. Pnvate dala is Informa n hlcn general[y cannoi be gfven lo Ihe publlc bu!can be glven to(he subJect oFihe dala.
Canfidential data is' maiion wh' ge erally cannof be given Io either the public or Ihe subject of the data. Our purpose and
intended use oF fhi info tion is an alty updafe our records and records of olher gpvern ental agenaes required by law. If
ou refuse io su I the inf a' ,1h licalion ma not be issued.
Applicant's Signature: bate: � `
Owners Signature: Date:
Last Updated�January 2015