HomeMy WebLinkAbout2013-00855 - siding CITY OF ORONO II1 111 11 II11 11I II
1 * 2 0 1 — 008555
2750 KELLEY PARKWAY DATE ISSUED: 08/26/2013
ORONO, MN 55356-
!(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 435 OLD(CRYSTAL BAY RD S
PIN : 04-117-23-31-0002
LEGAL DESC : AUDITOR'S SUBD.NO.230
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 5,000.00
NOTE: SIDING
APPLICANT PERMIT FEE SCHEDULE 118.00
HEMMEKE,MELISSA A STATE SURCHARGE(VALUATION) 2.50
435 OLD CRYSTAL BAY RD S
LONG LAKE, MN 55356- TOTAL 120.50
OWNER
HEMMEKE, MELISSA A
435 OLD CRYSTAL BAY RD S
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 Ciapprovals,and the
State Building Code. This permit is for only the wor described and does
not grant permission for additional or related work w ich requires separate
permits. All provisions of laws and ordinances gove ing this type of work
shall be compied with whether or not specified herei .This permit will
expire and become null and void if construction auth rized is not
commenced within 180 days of the date of issuance, r if construction is
suspended for a period of 180 days at any time after ork has commenced.
The applicant is responsible for assuring all required'inspections are
requested in conformance with the State Building CO de.This permit may be
6revoked at time for du cause.
{ e1261 /Z i- o3" l211 /3
Applica ermit Signature Date Iss 3 By Signature Date .
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
Building Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
eVLoA Mailing Address: Permit number: dp —/%A "1 5
O PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by.
2750 Kelley Parkway Plan review fee:
es? c, Orono, MN 55356 '1
�K£SHOF yyf�'('
Total Fee: / Z9
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. (Please print)
GENERAL INFORMATION: /�
Job Site Address: /73 '' � � � 'C � /L
A C(
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
/f 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. G,,'-'O
CONTRACTOR/APPLICANT INFORMATION: CJ
Name:
State License # Expiration Date:
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: /14•E/-/S:)71 '7 e <
Phone (day): j 2 - 3 q.3 • :5—
Address:
Address: y City: . 4' ,1-)D ZIP: g
Email and/or Fax: gQl
PROJECT INFORMATION: Overall project description: -S'/ .� //I)
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ElFire Damage MCWD review& 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.org
Estimated Construction Valuation of Project(excluding land) $ j coo
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"`",, Date:
Owner's Signature: - _ Date: //2 i
Last Updated: 03/06/2013