2017-01242 - 28 sash and full window replacements

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„ , .. 1014802-Gray City of Orono Building Permit Application for Maintenance/Rep[acement!Remodel —Residential ONLY (i.e.windows, doors, siding, re-roof, etc. —N4 STRUCTURAL �XPANSIONy Ma!lingAddress: permitnumber. � � �� a �0�� Crystal Bay,MN 55323-0066 \� Date received: d”d?✓' - � SfrestAddress: � Rec�ived by: �il�Vl..l.u�� y `'` 2750 Keliey Parkway � �� Plan review fee: ��qkfSH��`'�G Orono,MN 55356 Total Fee: � �, �� Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono,mn.us This application form must be completed in full a�d all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL iNFORMATION: Job Site Address: 880 Partenwood Road, Lon Lake, MN 55356 Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? Yes No If yea,a special event pe�mft!s required w�h Polke Department and CJty Counci!approval 60 days prla to the evenl. ShuttJe bos servke wlU be requlred unless appl'Kanf demonsGates suh"rclent on-slle paAcing is avallable. Non-perm�Tted events wpl not be sllowed. CONTRACTOR I APPLICANT INFORMATION: Name: PCS Residential State License# BC593158 Expi�ation Date: 03/31/2018 Lead Ce�tification Number. �oT_F�Q��_� � Expiration Date: �7/A1l�(LO (for work on homes that were constructed prlor to 1978 Phone: (cell) (office) Mailing Address: 2005 Pin Oak Drive City: Eagan ZIP: 55122 Cont2Ct PeI'SOt1: Pam Pomerenke Applicant is: Contr�Ctor / Homeowner cc�ro�e o�o} Email and/or Fax: ppomerenke@pcsrenew.com Fax: 651-994-6806 PROPERTY OWNER IPIFORMATION: Name: Jerry&Cindy Gray Phone(day): 952-�71-801B Add�ess: 880 Parternvood Road Clty: Long Lake ZIP: 55356 Email and/or Fax: jerry.e.gray1 @gmail.com PROJECT INFORMATION: Overall r 'ectdescri tion: tg '�� ' �'�t� W�w1uy �t�ll�4rw��,. . Type of ProJect• . Any earth movement may also require ❑Door(s) . ❑Rernodel ❑Fire Damage MCWD review&permits: ❑Re-roof,asphaft [yRepair ❑Storm Damage Minnehaha Creek Watershed Distrlct{MCWD) 15320 Minnetonlca Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Minnetonka,MN 55345 ❑Re-roof,other(spectfy) ❑Siding ❑Other:(speciiyj Phone: 952-471-0590 Fa� 952�71-0682 ��y��W�g� 28 Sash&1 Full Wind Replacemen�.minnehahacreek.orq Estlmated Construction Valuatfon of Project(excluding land) $ � APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all information required or requested by the Building Department; . Certifies that the informaUon supplied is true and correct to the best of his/tier knawledge. The applicant recognizes that they are solely responsible for submitting a complete applica6on being aware that upon failure to do so,the sfaff has no a{temative but to r�eject it until it is complete; • Some or all of the inforrnaaon that you are asked to provide on this application is classified by State law as aither private or confldential. 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 eithe�the public or the subject of the data. Our purpose and intended use of this inform ' is to annual[y ate our records and records of other govemmental agencies required by law. If ou refuse to su the' ation t e a c 'on ma nof be issued. ApplicanYs Signature: '�- �� Date: 10/2/2017 Owner's Signature: Date: last Updated:January 2016