HomeMy WebLinkAbout2016-00926 - addition remodel CITY OF ORONO * z 0 1 6 - 0 0 9 2 6 *
2750 KELLEY PARKWAY DATE ISSUED: 08/OS/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1669 NORTH FARM RD
PIN : 27-118-23-44-0008
LEGAL DESC : THE FARM AT LONG LAKE
: LOT 007 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 115,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 115,000.00
TYPE OF PERM[T THIS PAYMENT IS FOR: ADDITION REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-00908
APPLICANT ADVANCED PLAN REVIEW 782.87
TOTAL 782.87
STREETER&ASSOCIATES Payment(s)
18312 MINNETONKA BLVD CHECK 103956 782.87
WAYZATA, MN 55391
(952)346-2499
Minnesota State License#: BUIL-BC-001380
OWNER
BEENDERS&PETER MONTGOMERIE,ANTOINETTE
1669 NORTH FARM RD
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 does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this rype of work
shail 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 l80 days at any time afrer work has ommenced.
The applicant is resp le for assyring all quired insp ions are
requested in con�'ormanc with th tate ilding Cod . his permit may be nI/,J
revoked�any time for ue ca� 7;' �K,'%
/ ,, / � �- �� 1�� _� 1-��- �/ � / b
Applicant �te� ' nature Date [ssued By Signatu Date
. City of Orono
Building Permit Application for Maintenance/Replacement/ Remodel —Residential ONLY
� (i.e.windows, doors, siding, re-roof,etc.—NO STRUCTURAL EXPANSION)
O MailingAddress: Permitnumber: CJ(/ �
PO Box 66
� � Crystal Bay,MN 55323-0066 Date received: ���'�
� Str t Az78ress: �7�
?� � 50 Kelley Parkway•Lu��'��o � eview fee: `�. . S�
L
�q'�'6srio��" Oro� , ,-
Total Fee:
Main: 952-249�600 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 appiications will be returned. (Please print)
GENERAL INFORMATION: / + , ��/
Job Site Address: �b� /�/o✓'� !�"� 04 �✓�J✓10 �� � ��
Will this be a Parade of Homes,Remodelers Showcase Home or other Display HomeT ❑Yes No
lf yes,a specia(event permit is required wifh Police Department and City Council approva160 days pnor to the event. Shuttle bus service i!1 be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �d'Ge�'fe� '�- �Soc�ot'�G�S
State License# \ G pp � ';$O Expiration Date: b'�j. '�� . 2p�$j
Lead Certifica;ion Number: �Pr`— 9�'�y�- Z Expiration Date: p(�, OQ'. 7 u Z,.�
(for work on homes that were constructed prior to 1978
Phone: (cell) (o�Z„ Z� , ��'7 (office) q5 Z, y 5 . 9yy t
Mailing Address: �g��Z ; �� City: (N y ZIP: 1 �
Contact Person: L Applicant is: Contractor / Homeowner �ci��i.o�,.�
Email andlor Fax: 'w,1 •�� S-}y�,L-�,f (np,/y CL, C.ov�n
PROPERTY OWNER INFORMATION: �1 � _
Name: ��b�v�e��}'e� �LC.V1ac.l�Y'S
Phone(day): °.5�2•�r� �_ $e��, n
Address: �(o�1 ti�I'1'�. �v+Y�•r+ �Zo.,eX- City: Q✓'e H o ZIP: �j S �S �e
Email and/or Fax: Gt�n+-o :✓�c�i-�c, F� ✓�'�c.. Gow.
PROJECT INFORMATION: Overall project description: � � ��LS� I �.� � '
Type of Project: Any eaRh movement may also require
�Door(s) �Remodel ❑Fire Damage MCWD review 8 permits:
❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnelonka Blvd
❑Re-roof,cedar ❑Restoration ❑Water Damage Minnetonka,MN 55345
❑Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952�71-0590
Fax: 952-471-0682
�Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ � 1 S'�t7 a�
APPLICANT ACKNOWLEDGEMENT:
• 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 altemative but to
reject it until it is complete;
• Some or all of the informatio� that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generaily 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 u te our records and records of other governmental agencies required by law. If
ou refuse to su I the i tio ,the .'li ation ma not be issued.
ApplicanYs Signature: Date: $•� • � �
Owner's Signa re�/ Date:
Last Updated:January 2016