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Home My WebLink About2015-00008 - adv plan review CITY OF ORONO * z 0 1 5 - 0 0 0 0 8 * 2750 KELLEY PARKWAY DATE ISSUED: 01/05/2015 '�� ORONO, MN 55356- , 952 249-4600 FAX: 952 249-4616 ADDRESS : 3020 NORTH SHORE DR PIN : 09-117-23-32-0003 LEGAL DESC : CRYSTAL BAY PARK : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 150,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$150,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: REMODEL PERMIT#THIS PR�PAYMENT IS TIED T0 20 1 5-00009 APPLICANT ADVANCED PLAN REVIEW 881.89 BRIAN STEPHENSON CONST. INC. TOTAL 881.89 2025 PAWNEE RD Payment(s) CREDIT CARD 3122 881.89 MEDINA,MN (612)889-0477 Minnesota State License#: BUIL-20222459 OWNER SWENSON,J&K 3020 NORTH SHORE DR 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 dces not grant permission for additional or related work which requires sepazate 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 conswction 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. / / Applicant Permitee Signature Date Issued By Signature Date / 5�� lo� �---= City of Orono i Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �o�o Mailing Address: Permit number: 0�0/5 — �� PO Box 66 Crystal Bay, MN 55323-0066 (� Date received: /S'�S �� Received by: ir� Street Address: i C p� yF G� 2750 Kelley Parkway `1`�1�� Plan review fee: �p �, 0 `�kESHO�� Orono, MN 55356 �D�� p 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 submitted. Incomplete applications will be returned. (P'ease print) GENERAL INFORMATION: JobSiteAddress: 3010 �1�27�-SHO(ZE hRtVE Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes,a specia/event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shutt/e bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: g21f�N STED�-EN$ON CON�T/ZUGI LOf� INL. State License# (�C �a a 4 5�j Expiration Date: 3 j 3! J6 Lead Certification Number: Nf�T- 11 0 I 9 8� � Expiration Date: 5l 4� �b (for work on homes that were constructed prior to 1978 Phone: (cell) �, �� - g 8 q- p y -� � (office) 7(,�- 4 Z 8- (o SC�a1. Mailing Address: a0 a S P yvN E E R�A City: j-E�}j��, L Z�P: 55 3 4 D Contact Person: ►3 2!!�N 5?"�PI-f E N S D N Applicant is: Contractor / Homeowner (Circle One) Email and/orFax: �S-��pHC ONST@YPrHOO.Co%/� PROPERTY OWNER INFORMATION: Name: JACk �- K,4T�+RrN SwEnt snn� Phone (day): Address: 30a,D No2r� s�oR�. DlztvE C�tY�WftYZl�T� Z1P� Ss34� Email and/or Fax: PROJECT INFORMATION: Overall ro"ect descri tion: Type of Project: Any earth movement may also require ❑ Door(s) � Remodel ❑ Fire Damage MCWD review 8 permits: ❑ 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 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ r5D 000. o0 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 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 Sig ture: � ` Rate: Owner's Signature� ate: �/ Last Updated:03/06/20