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Home My WebLink About2017-00509 - siding _ CITY OF ORONO * Z 0 1 7 — PJ 0 5 PJ 9 * 2750 KELLEY PARKWAY �ATE ISSUED: OS/16/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2345 BLAINE AVE PIN : 17-117-23-34-0011 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 005 BLOCK 009 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : SIDING ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 0.00 NOTE: RES[DING WATER PLANT GARAGE ONLY VALUATION OF JOB$12,000 APPLICANT PERMIT FEE SCHEDULE 0.00 STATE SURCHARGE(VALUATION) 0.00 ATKINSON CONSTRUCTION& SIDING LLC 4530 CO. RD 50 TOTAL 0.00 DELANO, MN 55328- (612)735-6292 Minnesota State License#: BUIL-20638420 OWNER (WELL NO. 3 PUMPHOUSE),CITY OF ORONO 2345 BLAINE AVE PO BOX 66 CRYSTAL BAY, MN 55323- AGREEMEIYT 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 Ihe 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. AII 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 permit may be revoked at any time for due cause. s �� -� � �,� �"� ��r�� '� � __e_� f:�� =� � / Cr� l," pplicant ermitee Signature Date Issued By Signat re Date - �c�� of �ron� ��@c�in� �er°rnit Applec�te�� $��° fV��ir�tenance / Repiacement / I�ernocle@ — Resodential OIVL� (�� r��, do��°�, ��c�€��, �y�m¢��, �tc. — !��- ��;,f� ��E�ffv!� lvlailing Address: �� i� �o�Q PO Box 66 Permit number: _ Crystal Bay, MN 55323-0066 Date received: � ��(q "`(� � � Street Address: Received by: �' - ti�, �� 2750 Kelley Parkway Plan review fee: � Orono, MN 55356 � � �kESHOR� To�F e�� . Main: 952-249-4600 Fax: 952-249-4616 �v��,�,�.ci.urunomn.u� This application form must be completed in full and all required information must be submitted. /�,,N Incoeripiete applications will be returned. (P/ease print) µ�' GEI�ERAL INFORMATtON: �f/' Job Site Address: � ,� �4f� /��/L� �J✓� �✓�l�e Will this be a Parade of Horr�es, Rerroodelers Sho�nrcase Home or other Display Home. ❑Yes f�o If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wiil not be allowed. GOI�TRACTOR/APPLlCANT IIVFORflAATION: �� Name: /��7fs� �� jG/i��j ��- � State License# ��5/�,2p Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were construcfed prior to 1978 Phone: (cell) (office) Mailing Address: �/� C� o �/,j� �� Cit ZIP: �,��' Y� Contact Person: _`�'�l�� ,�,,y.,._ ,-. Applicant is: Contractor / Homeowner (CircleOne) Email andJor Fax: PROPERTY OWNER INFORM�4TIOOV: Name: ��`,0 Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT iNFQFtMATiO�: Overall project description: Type of Project: Any earth movement may also reguire ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,cedar 15320 Minnetonka Blvd ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) [�,Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minne�i.:l,��,�.�eek.oiU Estimated Construction Valuation of Project (excle�ding lane�) $ � e' APPLICANT i4CKNOWLEDGEME�1`. • Agrees to provide all 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 required by law. If ou refuse to su I the information,the a lication ma not be issued. Applicant's Signature: �!%��'` � Date: � /��/ � - �� , � Owner's Signature: Date: Last Updated:January 2016 . . r ��: i vL; � ' ' �� .� �` <. .'�� • : ' ,y �, - -�>�,}�� Y ',� '"�', �,'f�.� y-' �.• 1� �. � ,♦ � e � � ' ��,� -�� ♦� ., `.�+,,,��•