HomeMy WebLinkAbout2015-00351 - kitchen remodel CITY OF ORONO * 2 0 1 5 — 0 0 3 5 1 *
,r 2750 KELLEY PARKWAY DATE ISSUED: 03/27/2015
ORONO,MN 55356-
- 952 249-4600 FAX: 952 249-4616
ADDRESS : 4215 NORTH SHORE DR
PIN : 07-117-23-43-0006
LEGAL DESC : ORCHARD BEACH
: LOT 002 BLOCK 000
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 80,000.00
NOTE: PLEASE FILL IN TI-IE FOLLOWING:
VALUATION OF PERMIT:$ 80,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: KITCHEN REMODEL
PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00353
APPLICANT ADVANCED PLAN REVIEW 618.96
MALESKA CUSTOM BUILDERS TOTAL 618.96
Payment(s)
10282 HAWTHRONE RD NW CREDIT CARD 4031 618.96
RICE,MN 56367-
(320)251-7898
Minnesota State License#:BUIL-BC 109531
OWNER
WALDOCH,DOUGLAS&DIANE
4215 NORTH SHORE DR
MOUND,NIN 55364
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shatl 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 goveming this type of work
shall be compied with whether or not specified herein.l'his permit will
e�cpire 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.
1'he 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 B ignature Date
City of Orono
,�`uilding Permit Application for Maintenance / Replacement / Remodel
. ��.�e e�6����s, c�o�€°�; �e�6Q��, ��-����'9 ���e � �� ��'�U���R�.� �����S90��
Mailing Address: Permit number. `?
���0 PO Box 66 _
Crystai Bay,MN 55323-0066 Date received:
Street Address: �
y�, �` 2750 Kelle Parkw � �� .
. Y Y� �� Plan review fee: . 9Ca •
��KESHO��G Orono,MN 55356 �
Total Fee:
Main: 952-249-4800 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 applicatlons wlll be returned. (P/ease print)
GENERAL INFORMATION:��)�� �, J �,�r_ � � � /
Job Site Address: o I/ !-Y/�''G �'✓C ?r'r�v�-+'1�1 V�1�
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes No '
1/yes,a specJa/event permft is requlred wlth Pollce Departmer►t and City Council approva/60 days pdor to the eveirt Shuttle bus se►v�e wlll be
requl�ed un/ess applkanf demonstrates suflicierrt on-site parkirrg is evailable. Non�ermitted events will not be allowed.
CONTRACTOR/APPLICANT INFOR ATION:
Name: pi,,�.- � �vi. '�jc,�r ��L,r-S
State License# Expiration Date: ,�—�)_)�'�_
Lead Cert�cation Number: Expiration Date:
(for work on homes that were constructed prfor to 1978
Phone: (cell) (office) ?v7 0 "'Z�)— 7g�1 �
Mailing Address: D � rn , � City: — ZIP: � '�
Contact Person: - Applicant is: Contractor Homeowner �ci�ie o�e�
Email and/or Fax: ��g� �_ �� ,�
PROPERTY OWNER INFORMATION: 9
Name: ,� �. �/l�A-�p`
Phone(day): y � g D �' � �
Address: � �Y S�yJ a�L ,�i City: ZIP: � r t p�
Email and/or Fax:
PROJECT INFORMATION: Overall ro'ect descri tion:
Type of Project: Any earth movement may also require
c�-'C hGr� MCVYD revlew�permtts:
❑Door(s) �.Re odel ❑ Fire Damage
Minnehaha Creek WatersherJ District(MCWD)
❑Re-roof,asphalt ❑ Repair ❑Storm Damage 1g202 Minnetonka Blvd
❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven, MN 55381
❑Re-roof,other(specfy) ❑Siding ❑Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ �
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 rec�gnizes 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
rejed it until it is complete;
• Some or all of the inforrnation 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 t�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 govemmental agencies r�uired by law. If
ou refuse to su I the information,the a lication ma not be issued.
ApplicanYs Signature: � Date: 3����/
Ovmer's Signature: �f�'1..( ��i.�f (�C�'1 Date: �LO I/.�J
Last Updated:January 2015