HomeMy WebLinkAbout2009-00668 - addn/remodel/repair ` . CITY OF ORONO PERMIT NO.: 2009-00668
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 10/05/2009
(952) 249-4600 FAX: (952)249-4616
ADDRESS : 790 OLD CRYSTAL BAY RD S
PIN : 04-117-23-43-0007
LEGAL DESC : AUDITOR'S SUBD.NO.229
: LOT 026 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 25,000.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,SEPTIC,ELECTRICAL(STATE)
REMOVING AND REPLACING BASEMENT WALLS DUE TO WATER DAMAGE.
APPLICANT PERMIT FEE SCHEDULE 413.00
BAKER,KAREN STATE SURCHARGE(VALUATION) 12.50
790 OLD CRYSTAL BAY RD S
WAYZATA,MN 55391- MISC FEE 0.00
(612)247-1560 TOTAL 425.50
OWNER
BAKER,KAREN
790 OLD CRYSTAL BAY RD S
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 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 nformance w' the %te Building Code.This permit may be
revok y time for),..�aus /
/1/ --1 / e57 6 7 lin .!A._ /Oi 45-, O 5
Applicant Permitee Signature Date A
Issu.L :y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono 35 353, ----
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address. Permit number: o2d09—De g
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\ Cr Bax 66 /•0 \ Crystal Bay, MN 55323-0066 Date received: �D/bSO?
`"' Received by: _Z-O.
A ` ��%, A, Street Address:
1, 1�,�ii Gtiti 2750 Kelley Parkway Preview fee: ,.�
11(61-i 4S Orono, MN 55356
---------
Total Fee:. i 5' `-
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 0,e155 FAA-1-v% 5
This application form must be completed in full and all required information must be submitted. 1✓,iv/av
Incomplete applications will be returne. (Please print)
GENERAL INFORMATION: c,; � �r . —�3
56
Job Site Address: L 000, tJ�
Will this be a Parade of Homes, Remodelers Showcase Hq, e or other Displa Home? n Yes [ No
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 I APPLICANT INFORMATION:
Name:
State License# Expiration Date:
Phone: (office) (cell)
Mailing Address: City: ZIP:
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFO MATION:
Name: KA ir,,e A c3 !\K-e.2_
Phone (day): (N—e--c2-12 f e (2 '�l criI 5-6o 0
Address: 6 S 1---P- A.)t. , La- e City: O'`zp-v -e� ZIP: Sc-3 J
Email and/or Fax t (3 j-¢1 - C t `f 7 �d cj t .cow(
PROJECT INFORMATION: �—'
Type of Project: J [UAL �Lk; Any earth movement may require`J naU��� �� g finrfi MCWD review& permits
❑ Door(s) p(emodel&i tI ll bYl []'Water Damage
Minnehaha Creek Watershed District(MCWD)
)2'Window(s) 2epair ❑ Storm Damage 18202 Minnetonka Blvd
�/ Deephaven, MN 55391
❑ Siding ❑ Restoration Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-roof E Fire Damage www.minnehahacreek.orq
Overall Project Description: /Qin ,,,Zn„0,36,2S ) ( 1A4-o Lk.)di—lt:Ct—GQ-01.4v41
Estimated Construction Valuation of Project(excluding land) $ 775;c0c/ ,,%, )1t7—(piaede.5
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 I
required by law. If you refuse to s,•.l the inform;on, the a.•lication ma not be issued.
7/
"Iiirre - 0Applicant's Signature: Date: C�Q; �
Last Updated: 05-04-2009