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2016-01541 - windows
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65 Ferndale Green - 36-118-23-44-0026
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2016-01541 - windows
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Last modified
8/22/2023 5:05:45 PM
Creation date
12/19/2016 11:27:23 AM
Metadata
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x Address Old
House Number
65
Street Name
Ferndale
Street Type
Green
Address
65 Ferndale Green
Document Type
Permits/Inspections
PIN
3611823440026
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DE�•/?4/2016/WED 02; �9 PM Elder Jones Building FAX No, 952 854 4909 P. 002 <br /> City of Orono <br /> Building Permit ApplOcati�n fior Ma�ntenance / Replacement/ Remode! �- Resld�ntial ONI.Y <br /> (i.e. windows, doors, siding, re-roof, etc. --NO S7RUC7URA,L �XPANSION) <br /> �� ` O Mailing Address: Parmit number: l C^1 - ; ( �, '`• <br /> ��Y PO Sox 66 <br /> Crystal Bay, MN 55323�0066 I�ate received_ j �I � I�s <br /> Str�et Address: Raceived by: � �'�� <br /> �y�, ti� 2750 Kelley Parkway Pfan revlew fse: — ' <br /> � <br /> �' Orono,MN 55356 <br /> ����H�Maln; 952-249-4600 Fex: 952-249-4616 www.ci.orono.mn.us Totel Fee: ( ��� I ��� <br /> This application form must be completed ir�full and all required informati�n must be subrnitted. <br /> Incomplete appllcatlons wi11 be returned. (Please print) <br /> GENERAL INFOaMATION: �� �,� _/� / <br /> Job Site Address: 4 � Q � G r� �,n <br /> Will this 6e a Parade of Homes, Remodelers Showcase Home or other Dlsplay Home? Yes ❑ No <br /> /f yes,a special avant permi�is required with Police Department and City Council approval 60 days pBor ro tha event. Shutt�e bus service wil!be <br /> requrred un�ess applicant demonshates sufficient on-sife parking!s avallabls. Non-permiited eventa wi!!nof be allowed. <br /> CONTRACTOR!APPLICAN7 IN�bRIVIA"fION: <br /> Name: <br /> State License# Pella Notrt�Zland Expiration Date: <br /> Lead Certification Numbc 15300 25t�Z,A,ve N. Ste �00 �xpiration Date: <br /> (for work on homes th� ,[���n011111, MN SS�Q�� <br /> Phone: (celf Lic#�CG4509p�1�. 763/745-1400 °tfice) 9 sa���S •`d y7 �p��� <br /> Mailing Address� City: ZIP� <br /> Contact f'erson; Applicant is� Contract , / Homeowner �cir���ohey <br /> Email and/or Fax; <br /> PRpP�RTY OWN�R INFORMATIO�: <br /> Nams: �/+7 Q � �/� G <br /> Pf�one(day): 4 !� � a • �� <br /> Address: (, S a � � ciry� (,J p 7 a�� ���: 5 5 ',.! j ! <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Overa�l ro'ect descrip#ion: <br /> Type of Prqject: Any earth movemant may alSo requlre <br /> ❑Door(s) ❑Remodel ❑ Fire Damage MCWQ revlew 8�permits: <br /> ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 1532D Minnetonka Blvd <br /> ❑Re-roof,cedar ❑Restoratfon ❑W&ter Damage Minnetonka,MN 55345 <br /> ❑Re-roof,other(epecisy) ❑S1ding ❑Other (specify) Phone' 952�71-0590 <br /> Fax: 952-471-Q682 <br /> '�Window(s) www.minnehah�cresk.orc3 <br /> Estimated Construction Valuatfon of Project(excluding land) $ <br /> APP�ICANT ACKNQWLEDGEMENT: <br /> • Agrees to provide all information requirscf or requested by the Bullding Department; <br /> . Certifies that the information Supplied is true and correct to the best oF hislher knowledge. The applicant recognizes that they are <br /> solely respottslble for subrnitting a complete application being aware that upon failure tq da so,the staff has no alternative but to <br /> reject ii until it is complete; <br /> . Some or e)� of the information that you are asked fo provide on this appllcatlon is classifled by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the publie but ean be glven to the subject of fhe data. <br /> Confidential data is informatlon whleh genarally eannot be given to eifher the public or the subject of the data. Our purpose and <br /> fntended use of this information is to annually update our records and reCords of other governmental agenCfes required by law_ If <br /> ou refuse to su I the Informati the a Ilcatlon ma not be issued. <br /> Applicant's Signature: �'I Date� !'� r� �� L <br /> Owner's Signature: Date: <br /> Last Updated:January 2096 <br />
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