HomeMy WebLinkAbout2014-01254 - windows CITY OF ORONO * z 0 1 4 - ID 1 2 5 4 *
" 2750 KELLEY PARKWAY pATE ISSUE�: 10/27/2014
� ORONO, MN �5356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1347 REST POINT CIR
PIN : 07-117-23-31-0016
LEGAL DESC : REST POINT PARK LAKE MTKA
: LOT 004 BLOCK 000
PERMIT TYPE : M1NOR ALTERAT]ONS
PROPERTY TYPE : RESIDENTIAL �rC �C� � `
CONSTRUCTION TYPE : WINDOWS � `� ��
�)
VALUATION : $ 4,947.02
NOTE: WINDOWS
APPLICANT PERMIT FEE SCHEDULE 118.00
STATE SURCHARGE(VALUATION) 2.47
CUSTOM CHOICE INC TOTAL 120.47
3384 S. COON CREEK DR Payment(s)
ANDQVER, MN 55304-
(763)232-8039 CHECK 1055 120.47
Minnesota State License#: BUIL-
OWNER Custom Lhoire Inc
PINEGAR, WILLIAM & REBECCA Previous Balance: .00
1347 REST POINTCIR Permits
MOUND, MN 55364- P2014-01254 1347 Rest Pt 118.00
Rd
101-32530
Mechanical/Septir/Other
AGREEMENT AND SWORN STATEMENT °ermits
P2014-01254 1347 Rest Pt 2.�17
The�urk for which this permit is issucd shall be performed according to Rd
the approved plans and specifications,applicable City approvals,and the �01-20802
State Quildine Code. 'l�his permit is for only die work described and does
not grant permission for additional or related work which requires separa[e ��e t� yovts-State
permits. All provisions of laws and ordinances governing this type of work ------- ------�-
shall be compied with whether or not specified herein.This permit will TOt81: 120.47
expire and become null and void if construction authorized is not ------------
-------------
commenced within 180 days of the date of issuance,or if construction is ChOCk
suspended for a period of 180 days at any timc after work has commenced CheCk N0: 1055 120.47
The applicant is responsible for assurin,all required inspections are
requested in conformancc with the Statc Building Code.This permit may be PeyOY:
rcvoked at any time for due cause.
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�" '� r � ��5�.._�w.—.��� � cf� � �� ��-�•� � �_ L v � � �
Applicant Permitee Signature Date Issued B��Si�nature Date
City of Orono
Building Permit Appiication for Maintenance / Replacement / Renovation
�(No structural expansion. Only windows, doors, siding, re-roof, etc.)
�O�O Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Streef Address: Received by:
y� G; 2750 Kelley Parkway Plan review fee:
Orono, MN 55356
�'�KssHo��' 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.
Incompfete applications will be returned. (Please print)
GENERAL INFORMATION:
JobSiteAddress: �' ���7 Q�2S-� �O���r- ��;�'�\� � C�('cat�c'� . (�1'1rU: C�:3�`f
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,� No
If yes,a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficienf on-site parking is available. Non-permitted events wilf not be allowed.
CONTRACTOR!APPLICANT INFORMATION:
Name: C�,-t-O:'� (� �o. � 1 �1C
State License# _��+ �-��L{- �� Expiration Date: "31 � S
Lead Certification Number: �.7-=�i ��{..'� _� Expiration Date: �j , �_
(for work on homes that were constructed pr►or to 1 78 —���
Phone: (cell) �t��s� ��J� C�'�� (office) �L��c:�3��.-�Z-��j
Mailing Address: —� �. � . City: ZIP: �-�- - c
Contact Person: ��� �\ Applicant is: Contractor / Homeowner (Circfe One)
Email and/or Fax: �� �., ��L�{ ('�;\� `� "�� M ����.�
PROPERTY OWNER INFORM�ION:
Name: � ,n -
Phone (day): - O
Address: \�v-� e S� �r1.� L:,'���� City: �`�� ZIP: ���.oy
Email and/or Fax: ��T�
PROJECT INFORMATION: Overall pro ect description:
�'ype of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
�..Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding fand) $ U
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 compfete application being aware that upon failure to do so, the staff has no altemative 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 required by law. If
ou refuse to su I th information, the a lication ma not be issued.
App(icanYs Signature: c� � �) Date: /C��T��
Own�r's Signature: Date:
Last liodaied: 03/06/2013