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Home My WebLink About2010-00028 - doors CITY OF ORONO PERMIT NO.: 2010-00028 � 2750 KELLEY PARKWAY � ORONO, MN 55356- DATE ISSUED: OU2U2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 2695 PHEASANT RD � PIN : 21-117-23-23-0012 � LEGAL DESC : PHEASANT LAWN : LOT 008 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENT]AL CONSTRUCTION TYPE : DOORS ACTI VITY . O/S GE�I£��L r��,��i �:� ;� ��-, t :,..:� . ;.� ��, .,�,__� VALUATION : $ 2,024.00 NOTE: REPLACE FRONT DOOR APPLICANT PERMIT FEE SCHEDULE 88.50 NORTHERN EXTREMES REMODELING LLC STATE SURCHARGE(VALUATION) 1.01 13326 HIGHWAY 65 TOTAL 89.51 HAM LAKE, MN 55304- (763)434-0025 Minnesota State License#:20342345 OWNER JOHNSON,ADAM &CATHERINE 2695 PHEASANT RD EXCELSIOR,MN 55331- AGREEMENT AND SWORN STATEMEIYT "Che work for which this permit is issued shall be performed according to the approved plans and specitications,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.This permit will expire and become null and void if construction authorized is not commenced within l80 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 inspec[ions are requested in conformance with the State Building Code.This permit may be revoked at time for�ye cau . � �-•,� �.1�`" -� _ � l�- 1 / / ` � �� f�`l %� � l l Appl' ant Permitee Si�nature Date Issued By Si ure ;'�a�e SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE_�' � .. . �^��r � � � A,4 . _ I �& -� City of Orono � ` _ � 4�� Building Permit Application for Internal Work � �` (windows, doors, siding, re-roof, etc.) ,� �� ¢ Mailing Address: � '€' �.,0,� PO Box 66 Permit number: �. � Crystal Bay, MN 55323-0066 Date received: � �a�: O �4; O . `�aYf; I • '�� a �"��•-��'- a, � St�eet Address: Received by: �:; s,"k�� ; ��t '' ''� �ti 2750 Kelley Parkway Plan review fee: � � 9kESIIOg'� Orono, MN 55356 � � ��z" 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 applications will be returned. (Please print) �� GENERAL INFORMATION: .� ��_ �; ; ; � ,�� JobSiteAddress: ��,;; /� �'��='�� t �� . �x Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No �� , lf 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 ,�� r�� required unless applicant demonstrates sufficient on-site parking is available. Non-permitfed events will not be allowed. a� �'a, �9 R� �� CONTRACTOR/APPLICANT INFORMATION: ) �,, �5,. Name: � '�� =l -r �� 4� �� State License# �; ��_ .,2�t; � y13 �-f � Expiration Date: 3 3 /�> �� Phone: '7�,� � t, .- office cell `� _; Mailing Address: � Cit : � �ti2• U; �: �c �° ZIP: ��C� �; �� Contact Person: a Applicant is: racto� / Homeowner (CircleOne) � �`� Email and/or Fax: 7� - 7 � �� * � �; � �� PROPERTY OWNER I FORMATION: k� �� Name: ��.Gi,;.� - .,�� n� �� a� Phone (day): � � - c.�- /_ � �:: Address: (;, `3' - �t '�' Cit : ZIP: °� � Email and/or Fax �;� �� PROJECT INFORMATION: �� Type of Project: Any earth movement may require MCWD review&permits .� �'-I �Door(s) ❑ Remodel ❑Water Damage �: ��` Minnehaha Creek Watershed District(MCWD) ;� ❑Window(s) [�Repair ❑ Storm Damage 18202 Minnetonka Blvd � � � � ,= Deephaven, MN 55391 � ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 � Fax: 952-471-0682 �� ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq �� $ �� Overall Project Description: � ��- i':; .� �� -,2-� , . �� ,� � � . '" � � lL' ' -�,� 1�� _ � Y�, _ Estimated Construction Valuation of Proj�ect(excluding I nd) $ D�c� cv � � 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 � t i• but to reject it until it is complete; �.�, ��t: • 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 F� 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 G� re uired b law. If ou refuse to su I the information,the a lication ma not be issued. =a ;� ;�� ,/ � �,: ApplicanYs Signature: 'G�'�� Date: � � /L�- . � F�;;, Last Updated: 05-04-2009 � � � � ' � �.; :� ; . -- " ,�;,. �n .,��k. �_, F, � • -. _.._.�m. . �c .._. �� ,xn.�,�.��T..�..s,..;�..,.a.,,,.,s.r.�.��.