HomeMy WebLinkAbout2017-00166 - refund request ��IVO
`,„kf S H�Rti
February 27, 2017
Peter,
Attached is a refund request from Mike Hinck,for permit#2017-00166 located at 1749 North Farm Rd.
Per the attached letter they pulled the permit in the wrong city.
They would like a refund. Rob (Roger's Backup) has agreed to refund the cost of the permit, minus the
State Surcharge and Mail-In Fees.
Please refund Mike Hinck$92.89 for the cost of the permit only.
Thank you,
gacheL Dodge/
Rachel Dodge
Administrative Assistant
Send refund check to:
Mike Hinck
4738 Galway Road
Mound, MN 55364
ico
(1-4,)/e9 rini-(1 cf) vti to 4 (4 a__ 6$9J,(,,,,_,
p- nit'0 0_11-b
?- k1,1, (eJ oV5/ 7 >O 6 / ;,
1 1/7 itoid-)16-Ah-\ 4ii/jo
6126 fra) ..-- - 4046,Air cijie c, ,
1 in V _ 721,-fi-Le
iFt-n, /73
1g /94t,ti ,_22/ 6 ,1-0
cik,,Ctc- \\
4 \ MO (A wa m,it 5--,s',3 y
/
v,«, u.
FED 272017
CITY OF ORONO
/--)-- -meted & ,
.6
. -
_
._
_
-
ete.
CITY OF ORONO 1111 1 11 i7 1I11I1111111 11 111
2750 KELLEY PARKWAY DATE ISSUED: 02/22/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1749 NORTH FARM RD
PIN : 27-118-23-41-0003
LEGAL DESC : THE FARM AT LONG LAKE
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 3,000.00
NOTE: VALUATION OF PERMIT:$3,000.00
ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO
WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED.
SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE.
ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED.
APPLICANT PERMIT FEE SCHEDULE 92.89
MIKE HINCK STATE SURCHARGE(VALUATION) 1.50
4738 GALWAY ROAD TOTAL 94.39
MOUND,MN 55364 Payment(s)
(612)472-1321 CREDIT CARD 8555 94.39
OWNER
KREIDBERG,GILBERT&JULENE
1749 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 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 construction 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 ca
Applicant Permitee Signature Date Issued By jf. ature Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
3.0 A Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
a
Street Address: Received by:
ti4.
e L� 2750 Kelley Parkway Plan review fee:
•kESH05-
IOrono, MN 55356
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 applic tions will be returne . (Please print)
GENERAL INFORMATION: /
Job Site Address: /i y q u , -40,, ,4,/ gyp/
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yeso
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION;
Name: hil 1 R //;(VG K,
State License# � (6 S6G 4p Expiration Date: 7
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: ) 1,9 4,›( ba
Phone(day): [r,/2 ,-.,, � ---27L'5C)/ U J l
Address: /7 y4 u)471,9 - 1_..,r✓ �. P City: (0 17 14 g( ZIP:
Email and/or Fax: 7�
PROJECT INFORMATION: Overall project description: _
Type of Project: Any earth movement may also require
❑ Door(s) 0 Remodel 0 Fire Damage MCWD review&permits:
Re-roof,asphalt 0 Repair 0 Storm Damage Minnehaha Creek Watershed District(MCWD)
'
15320 Minnetonka Blvd
❑ Re-roof,cedar
0 Restoration 0 Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) 0 Siding 0 Other:(specify) Phone: 952-471-0590
Fax: 952-471-0682
0 Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ Ydod'
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
you refuse to supply the information,the application may/ not be issued.
Applicant's Signature: `�' /� �'7 v' Date: � ---- )' '7 2
Owner's Signature: Date:
Last Updated:January 2016