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Home My WebLink About2013-01009 - addn/remodel/repair � CITY OF ORONO * 2 m 1 3 - 0 1 0 0 9 * � 2750 KELLEY PARKWAY DATE ISSUED: 09/27/2013 • ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 115 LUCE LINE RIDGE PIN : 31-118-23-34-0006 LEGAL DESC : PAINTERS CREEK : LOT 004 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCT[ON TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 7,997.00 NOTE: REMODI?L SI'AIRWAY-OK'D BY LYLF OMAN 9/27/13 APPLICANT pERMIT FEE SCHEDULE 162.25 LOCKMAN, STEVEN& SONJA STATE SURCHARGE(VALUATION) 4.00 1 15 LUCE LINE RIDGE MAPLE PLAIN, MN 55359- TOTAL 166.25 OWNER LOCKMAN, STEVEN& SONJA 115 LUCE LINE RIDGE MAPLE PLAIN,MN 55359- 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 governing this type of work shall be compied with whether or not specitied 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 f'or a period of 180 days at any time afrer 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. ' � .�'! -1 : 0— � /�T_ / � �- � i�� ` C--y."Ylr�!'�7 � :r,/ � .. ,' ) Applica t ermitee Signature Date ��' Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �T�-:'.^'� _ _ a;ivrr,.r _ , :�" c ."w-"e'�a; `r., � ��` �- .,,�,a:-; � � . . .. . r .. � . . ... . .... . . . . � . . � �,- Cit of Orono °;�� . � Y I Building Permit Application for Maintenance / Replacement / Renovation 3� `� � (No structural expansion. Only windows, doors, siding, re-roof, etc.) .; �� ` �O� Mailing Address: Permit number: � ` `� PO Box 66 � .. ��; � Crystal Bay, MN 55323-0066 ° Date received: �`� � Street Address: . Received by: �; y ��'' 2750 Kelley Parkway Plan review fee: '; `� �' Orono, MN 55356 t�'�ESH�� ``� ,;�� Total Fee: ; t�` 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: • q _� � � c �. � � � Job Site Address: 11 �� l. �<<t ��`�- I��c�- �_ �--� �� L� � � � ? I ��; ¢�; � � Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑ Yes No �;' If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus s rvice will be required unless applicent demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. � < �; �� CONTRACTOR 1 A PLIC�ANT INFORMATION: � :,�� Name: ��r, � �C C �6vza-o1 ; State License� Expiration Date: �� Lead Certification Number: Expiration Date: _ (for work on homes that were consbucted prior to 1978 �: ` ' Phone: (zetl) ��-0 u�v,� �5a-4-3(� - G�� (office) � �x=' Mailing Address: �l`� L�t C�L�n� ��cl CitY: �r� U ZIP: �S 3�'�j �t� s. Y�� Contact Person: �� Q �0 ��,� Applicant is: Contractor / omeowner (Circle One) -� Email and/or Fax: � �(, �SG✓�p�� "= lrVl S�1� �-C✓�-'� �' � ��, PROPERTY OWNER INFORMATION: � �� Name: `� �C V� ��C�C-'�U"YLL2-v'� �� ''��c� Phone (daY): `�5d - �f�(c .-0�2�:�G� ,� Address: �(S (�C� �.¢..r� � �� City: �,1�C:�L, ZIP: ��3�j� � Email and/or Fax: 5��%ns�� V`�5��.C i; i'� s� � PROJECT INFORMATION: Overall pro�ect description: '(�.C��tC�e � `��`�� ` _� Type of Project: Any earth ovement may also require ��- MCWD review 8�permits: � ❑ Door(s) ❑ Remodel ❑ Fire Damage �� ❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) .; 18202 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 � �. ❑ Re-roof,other(specify) ❑ Siding ❑ Other. (specify) Phone: 952-471-0590 � �:} Fax: 952-471-0682 � vy �- ;�s}Cc � C-`� ❑Window(s) www.minnehahacreek.orq � : ,�. e .;, Estimated Construction Valuation of Project(excluding land) $ � � � � _.: > � �� APPLICANT ACKNOWLEDGEMENT: '� . Agrees to provide all information required or requested by the Building Department; �� :i �y 6�' • 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. � ApplicanYs Signature: ��t.� "�- �,�� C=eVI��--'�— Date: � �z�� I� �� Owner's Signature: � ��i�'�� Date: �� . Last Updated:03/06/2013 � �S�u,Q r� � . � � _ :. • .a...�. , � . .... v.,..._ ... . _:...,_�onr,.v�€