HomeMy WebLinkAbout2018-00511 (siding) iIII iiI IIIIIiii ii iI IIiiiiII 11
CITY OF ORONO * 20 1 8 - 00E 1 1
2750 KELLEY PARKWAY DATE ISSUED: 04/24/2018
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 3845 BAYSIDE RD
PIN : 05-117-23-23-0006
LEGAL DESC : AUDITOR'S SUBD.NO.203
: LOT 062 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 43,500.00
NOTE: SIDING
APPLICANT PERMIT FEE SCHEDULE 648.18
STATE SURCHARGE(VALUATION) 21.75
CORY CONSTRUCTION&REMODELING MAIL-IN FEE 2.00
1001 6TH STREET S
HOPKINS,MN 55343- TOTAL 671.93
(952)934-7600 Payment(s)
Minnesota State License#: BUIL-BC431519 CREDIT CARD 8715 671.93
OWNER
BERG,MARK&DAWN
3845 BAYSIDE 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 cause.
Applicant Permitee Signature Date Issued By S ture Date
To: Page 2 of 2 2018-04-23 19.15:06(GMT) 19529556894 From. Patrick Coty
. .,
, .
City of Orono
Building Permit Application for Maintenance I Replacement i Remodel- Residential ONLY
(Le,windows, doors,siding, re-roof,etc.-NO STRUCTURAL EXPANSION
-------- maging Address; O : 'op i i• , /
' Perrnit number; Nom*
*OAF\ PC Box 55
/ 0\ I Crystal Bay,MN 55323-0066 ' Date received:
ioloso.,
_
Street Address. i Received by:
--.-
\ '7.',, 1 , '•i ' Plan review fee
2750 Kelley Parkway
'"\• i"..‘4C"\ ,i.`"?
Crone,MN 55366
t,
; Total
Mein: 952-2494600 Fax 052-249-4616 r.tww.gi.orpno,mb,us l Fee: 77• j
_
,...
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print) :..
GENERAL INFORMATION: ... :2 ,
Job SiteAddress
Will this be a Parade of Homes,Rernodelers S4 wcase Home or other Display Home? 0 Yes 12:1116 ,.
If yes.a special event permit is required with Police Depattment and City 1,ouri0 approval tiO days poor to the event. Shirtde Pus service will Lie
required unless applicant demonstrates sufficient on-site parking is 'ails ale Non-permitted events will not be allowed.
CONTRACTOR I APPLiCANT INFORMATION
Name: '
,...... :-,. , 'ic.,___, ". - r ,, -„, es4+1.
State License# ..._,, ,,.. ,: , .).,,_ ,_ _______ Expiration.Date.' 3/1.5,,„/,•-•,...,,r)
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Lead CertifiCatiOn Number: itirdi F-. ii----,h,-.• 1.2 - -2.: -' - • Expiration Date:
t ., . , .:,
(for work on homes that were constructed prior to 1978
Phone: (Cell) (OffiCe) ‘,
Mailing Address i(,)0 i _6 # • ) 1 _ ..).. City /41.L.4<i.0 ....e• ZIP: _:..,'.;,-:::::,3ë/3
Contact Person: ',....- ,, .-,, „.—..;.,....„, -.,._ Applicant is: -- rr / Homeowner forcieono
1/4.+.-----....-m-''
Email end/or Fax: C.,„rm :,ft 6,)JC"C:s ly ("0,V2Z`76)e'nfo,i 4"—.1"".7
PROPERTY OWNEIFORMATIONs
Name;
Y"': "-I5 k
Phone(day): ...q...„. ..,9":7- ,;t_gyi_l_e1 .,...,,,. .J
Address
Address: „5._10:3 .....>r,t_44 s( ” ,i-,: f.. City; L/.1.,.• -1.€,P ZIP: :'-':-., .,,..--- .... -4
Email and/or Fax: __......61 n ,-K .'. ;,,/4 c. bp„-;,,,,.-. ,,,,,vri ,t,, r,_,<,...p.01
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PROJECT INFORMATION: Overall project description;
..,,
Type of Project: My earth movement may also require
ermits:
0 Door(s) 0 Remodel 0 Fire Damage MCWD review&p
0 Re-root asphalt 0 Repair 0 Storm Damage
Minnehaha Creek Watershed District(MCWD)
:15320 Minnetonka Blvd r-.
. ,
0 Re-roof,cedar 0 Restoration 0 Water Damage Minnetonka,MN 55345
rtu...0--: Phone, 952471-0590
0 Re-roof,other(specify) Lz-olding 0 Other:(specify) ,
Fax: 952-471-0682 .
. 0 Window(s) wmv.minnehahacreek,org,
Estimated Construction Valuation of Project(excluding land) $
APPLICANT ACKNOWLEDGEMENT: :.
. Agrees to provide all information required or requested by tne Building Depanment:
• 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 alternatve but to
reject,;t until it is complete;
.i;
* 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 apOicabon ma not be l
issued. '...
Aplicant'sSignatue: , --..— Date:
.......•.;:
..._
Owner /'s Signature: „' Date:
L.,15,it Updated'January 20te
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