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Home My WebLink About2015-01090 - adv plan review CITY OF ORONO * 2 0 1 5 - 0 1 0 9 0 * 2750 KELLEY PARKWAY DATE ISSUED: 08/27/2015 � ORONO,MN 55356- � 952 249-4600 FAX: 952 249-4616 ADDRESS : 3422 LIVINGSTON AVE PIN : 17-117-23-43-0022 LEGAL DESC : NAVARRE HEIGHTS : LOT 021 BLOCK 002 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 93,386.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$93386.00 TYPE OF PERMIT THIS PAYMENT IS FOR: FIRE REPAIR-INTERIOR REMODEL PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00992 APPLICANT ADVANCED PLAN REVIEW 690.66 SYNERGY BUILDERS TOTAL 690.66 900 NORTH 3RD STREET Payment(s) CREDIT CARD 8570 690.66 MINNEAPOLIS,MN 55402- (612)305-7090 Minnesota State License#:BUIL-BC689368 OWNER ANDERSON&MATT LABODA,LUKE 3422 LIVINGSTON AVE 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 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 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 are requested in conformance with the State Building Code.This pertnit may be revoked at any time for due cause. / / Applicant Permitee Signature Date Issued By Signature Date ' City of Orono • Building Permit Application for Maintenance / Replacement / Remodel {i.e. windows, dvors, siding, re-roof, etc. — NU STRUCTURAL EXPANSiON) Mailing Address: -s l �� PO Box 66 Permit number. p 0 S— oc..� Crystal Bay,MN 55323-0066 Date received: C�"' — S Street Address: Beceived by: �� , �� 2750 Kelley Parkway v-)� Plan review fee: ��• � G Orono,MN 55356 � � � �k�sx�� 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 mitted��w`� Incomplete applications will be returned. (P/ease print)� GENERAL INFORMATION: Job Site Address: �'�1� �11i1 ►� 5�{� � � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No !f yes,a special event permit is required with Potice Department and City Council approval 60 days pnor to the event. Shuttle bus s ic will be required un/ess app/icant demonstrates s�cienl on-site parking is available. Non-permitted events will not be aUowed. CONTRACTOR/APPLICANT INFORMATION: Name: S�n��„� (�U;i��ers LLC State License# �L 6�"�( �6 g Expiration Date: �3 j3�b Lead Certification Number: NAT � 1 b b �o t7�-� � I Expiration Date: }3 �,� � � � ! {for work on homes that were constructed prior to 1978 Phone: (cell) �o�Z- ��j — � �,1 $ (office) �l� -�� - � o Mailing Address: � �, � City: (�p� S ZIP: S'�v\ Contact Person: � Applicant is: Contrac r / Homeowner (Circle One) : Email and/or Fax: � � _ � ` PROPERTY OWNER INFORMATION: Name: (��-� L c�� c�N � Phone(day): �}�Z_ ] 2� � '�`' Address: ""� Z Z �,�h r City: w�, � ZIP: � Email and/or Fax: .N, �. � � ' PROJECT INFORMATION: Overall ro�ect descri tion: I� +�' ce, (�ut�„ r t- i 'uI' �j`��j� ` Type of Project: Any earth movement may also require �/ MCWD review& ermits: ' ❑ Door(s) ❑ Remodel 1�4Fire Damage p T Minnehaha Creek Watershed District MCWD e-roof,asphalt �epair ❑Storm Damage � � ❑ Re-roof,cedar 18202 Minne#onka Blvd ❑ Restoration ❑Water Damage Deephaven,MN 55391 Phone: 952-471-0590 ❑ Re-roof,other(specify) �Siding ❑Other. (specify) Fax: 952-471-0682 ' Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ � ,�e„�, �OK f'r•�c 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 fhe 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 required by law. If ou refuse to su I the info tion the a li ation ma not be issued. q Applicant's Signature: Date: L� l�� Owner's Signature: �� —"��'�'� Date: �I� I I j Last Updated:January 2015