HomeMy WebLinkAbout2015-00529 - kitchen remodel CITYOFORONO * Z0 15 - 00529 *
2750 KELLEY PARKWAY DATE ISSUED: OS/04/2015
ORONO, MN 55356-
, (952) 249-4600 FAX: (952) 249-4616
r
ADDRESS : 3115 NORTH SHORE DR
PIN : 09-117-23-32-0013
LEGAL DESC : REG. LAND SURVEY NO.0269
: LOT 000 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 70,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$70,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: KITCHEN REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00530
APPLICANT ADVANCED PLAN REVIEW 567.74
TOTAL 567.74
SCHRADER&COMPANIES Payment(s)
9723 VALLOM VIEW DR CHECK 8851 567.74
EDEN PRAIRIE,MN 55344-
(952)465-3582
Minnesota State License#: BUIL-BC592473
Ci�y oi ii,ono
;'?50 Kelley Parkway
OWNER �n ono MN 55356 95�-249-460ci
CONNELLY,THOMAS keceiFt No: 3.013312 May 4, 2015
3115 NORTH SHORE DR
WAYZATA, MN 55391- �chrader� & Compar�ies
Frevious Balance: •��
Pe�mi ts
�015-00529 �E�7.74
101-34410
AGREEME1vT AND SWORN STATEMENT Plan Check/Site Exam Fees
The work for which this permit is issued shall be performed according to (�;td 1: 567.74
the approved plans and specifications,applicable City approvals,and the =�____�____-____
State Building Code. This permit is for only the work described and does ('fi��,k
not grant permission for additional or related work which requices separate Check No: 8851 567.74
permits. All provisions of laws and ordinances governing this type of work Payor:
shall be compied with whether or not specified herein.This permit will I :�chrader & Compan ies
expire and become nu11 and void if construc[ion authorized is not u ta 1 App 11 ed: 56?•�4
commenced within 180 days of the date of issuance,or if construction is
Cfianye Ter�der�d: ���
suspended for a period of l80 days at any time after work has commenced. —
--____--------
The applicant is responsible for assuring all required inspections are 05 f U4/2015 10:35AM
requested in conformance with the State Buildin ode.This permit may be
revoked at any time for due c se.
/^ ��
� �-� � 1/ /,J ��[ , ;- ',� � ��-yy1 C � 67 �/ � �S -
,___,
Applicant Permitee Signature Da e Issued By Signature Date
' City of Orono
� Building Permit Appiication for Maintenance 1 Replacement / Remodel
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSI4N)
O M�Hinq Adclmss: P�rmit rwmber. ��S'C��
� �TO PO Box 66
C►ystsl Bay,MN 55323-0066 Date recehreci: �� �(1 (�
Streef�Iddr�ss: " Received by; __..._.___ -
s�, fi 2750 KelleY P�ckwa Cy i �'a p �ian review tee: �., "-�y�___
-�
��XESHO �'` Orono�AAN 5�356 ��'�1 �� _ �
R _ _ . .__u_ -_
_�_ _
`�.__ _ - --- --- 7otal Fea:
Matn: 952-249-4600 Fax: 952-249-4646 �nrww.ci.orono.mn.us
TF�s application form must be completed�futl and atl req�dred information must be sul�n�ted.
Incomplet��pplications wiil be return�d. (Pk�se print)
GENERALINFORMATION: ��/� A� �+�/�_,�� �n• ����� yy�iv SS39/
Job Ske Address: /v J 7a7L
Will this be a Parade of Homes,Remodslers Shawcase Home or othor Diapiay Home? Y�s No
H yes,a apecla!event psmHf ls r�qutred wkh PoNce Daps�tmerM and C!ry CouncA approva!60 dsys p�lor to tl►e event. Sh�tk Gus servke wiN be
requked unl�ss�µpC�csr#der►wnstratas suA'ic�ent on-s�e parking fs avaHsble. Non-permRted evsrds wdl not be alloHnad.
CONTRACTOR/APPLICANT INFORR�ATION:
Nam�: _„SGl�h2l��'J�- 1Ls5
State Ucense# '7 Ex�ration Date: � 3! /� _
Lead Cerfification Number: �ItT /N / 9 Expiraiion�ate: �
(for wor�on homes itu►t were construc d prbr to l978
P��: ���a . . y� (offtce) � qsZ•Y6 s� 35 S z
Maf�ng Address: City: �' p ZIP: 3
Contact Person: �Npy � Appti�n#1s: ract I Momeowner �ckd.a+et
EmaN and/or Fax: ��p ��;,�,�pP,yl, eryp�t��5.C.oM
PROPERTY OWNER INFORMATION:
Name: T��1f?'S L'ONN�"LC�I
Phone(day): ��fG • !{25• �f5 0 8'
Acfdress: �i�5 N S�i�� T?IZ �tY� �KZ1�t'� ZtP: �53� �
K
Email�nd/or�ax: -t-r•,�„��J�,`,�, /� 4Yh1'�1 j�
PROJECT INfORMATION: Ov�r�� 'ect descri tion: Cl�'L� ���a��7--"'
Type of Proj�ct: Any earth movement may aiso requtre
❑Door(s) �Remodal ❑Fire Damage MCWD revfew�permits:
❑Re-rooi,asphait ❑Repair [)Siorm Damage Minnehaha Creek Wa4ershed District(MCWD)
98202 Mir�etor�ca Blvd
❑Re-root,cedar ❑Restor�tfon ❑Water Damage Deephaven,MN b5391
�Re-roof,other;speciry) p s�a;rg p oit,er.t�Pecxyj �►�� 952-471-Ob90
Fax: 952-471-0682
�WindoHr(s) www.minnehahacreek.orq
Estlmated Constructton Valuation of Project(excluding land) s D. �''
APPLICANT ACKNOWLEDt�EMENT:
• Agrees to provide a!I information recp�red or requested by the Building Oepartment;
• Certlfies thal the Mtormation suppNed 1s true and corred to the best of hislher knowledge. The app6caM recc�gnizes that they�re
sotely respon�tble br s�mttt�►g a complete appHcation being aware th�t upor►fsFlure to do so,the atatt has no atiemati� but to
reject#t un1N H is c�mplete;
• Some ar aN of the �formaUon that yau �re esked to prov3de on q�is appicaiian 1s classified by State law as �ther p�ivate or
con�dent(al, Private data is N�formation which Qenerally cannot be given to!he ptrblic bt�can be given to the aut�ject ol lhe dala.
Conftdential data l�Mformation wFdch gener�lly cannot be giv�n to Eiti�er the pub�c or the aubject oi the daia. Ou'purpose end
k�tended use af Ifiis fnformatlon is lo anrtusNy updale our records and records of other govern+r►erital agencies required by law. �f
ou refwse to s t informatbt� !h� ' ibn ma not be i�sued.
�ppticant's�nature: ��te:
Owner's Sigr�at�xe: „� ��x• r..�� Date: �f��?oJS
Las!l)pdated:January 2015