HomeMy WebLinkAbout2015-00835 - windows CITY OF ORONO * z p� 1 5 - 0 0 8 3 5 *
'" 2750 KELLEY PARKWAY DATE ISSUED: 06/30/2015
� ORONO, MN 55356-
(952) 249-4600 FAX: 952) 249-4616
ADDRESS : 1940 SHADYWOOD RD
PIN : 17-117-23-24-0023
LEGAL DESC : SHADY-WOOD
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERAT[ONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 3,482.00
NOTE: 6 WINDOW REPLACEMENTS IN EXIST[NG OPENINGS
APPLICANT PERMIT FEE SCHEDULE 108.42
STATE SURCHARGE(VALUAT[ON) 1.74
THE HOME DEPOT A.H.S. MAIL-IN FEE 2.00
2690 CUMBERLAND PKWY, STE 300
ATLANTA, GA 30339- TOTAL 112.16
(763)542-8826 Payment(s)
Minnesota State License#: BUIL-CR268257 CREDIT CARD 0174 112.16
OWNER
MACCHARLES,MALCOM&VIRGINIA
7041 HALSTEAD DR
M[NNETRISTA, MN 55364-
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 no[
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 Sta[e Building Code.This permit may be `/�,
revoked at any time for due cause. � �l
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Applicant Permitee Signature Date Issued By Signature Date
JUN/29/2�'S;��ION 1 C; 3� P�I Elder Jones Bui lding rAl No, 9�2 8��'. 4909 P, 002
� Gity of Orona
Building Perm�t Application for Ir�fiernal Work
(windaws, doors, siding, re-roof, etc.)
��-� MallingAddrRss: Permit number ^ � � �' �
�.g,O� Pa Box 66 . -
_'" � Crystal C3ay, MN 55323-0066 �ate receivad: -, � 1�
�0���,?"��. � Received by: � .V�
` � Streef Address:
\a '�'A�^��?� � 2750 Kelle Parkwa � —"-"—
� .' �`'7�� S`' Y Y Plan re�iew fee:
� ��': �, G �
� ''�t!?��"Y��9 Orono, MN 55356 .
�s�'�s���'�
�=�� 7otal Fee: � � � -��
Main: 952-249-4600 Fax: 952�249-4616 vwvw.Ci.orpn -,,,Q,mn.��s
� This application form must be completed in full and alf required information must be submitted.
Incompfete appf€cations will be rettErned. (Pleass print)
GEN�RAL INFORMATlON: L /
Job Site Address' � � �� �t') Cj C1 l� [,.1 t� u (� O
Wifl this be a Parade of Homes, F�emodelers Show se Home or other Display Home? Yes � No
If yes,a specral avent permit is requD�ed w/th Police Departmant and Gity Council approval 60 days prlor to the event. Shuttle 6us servfce wi/l ba
rBqulrad unless app!lcent demonstrates sufficient an-sif9 p��king!S aval/t�b/e. Non-permiHed events will noE be a!low9d.
CdNTRACTOR/APPLICAiV7[IV�OF2MATIOt�[:
Name: �Sa �3�15 • LbY7
state �icense� � � '�HD At-Home Sezvice, Tnc, ���,
Phone: 269Q Cu�-r�berland Pkvcry, Ste 30U (cell)
Mailing Address: .Atlanta, GA 30339-3913 ZIP� _
Contact Person: �,ic#CR26$2S7 Ph. 763/542-$826 �omeowner �c��ia o�e�
�mail and/or Fax�
PROPEf27Y OWN�R 1N�ORMATION:
Nan,e: I� � 1' �)' r /1 I Ci �c Cfi a r 11 S -----
Phone (daY)� SI S� 3 g 3 • s s 3 � c��v:u.;o.y x a-��d z�P: 5 S 3 � 1
�ddress: / 4 � O �t1 � cl v i.,e, e d ��� Q�
Email and/or Fax �_ _,_
PROJ�GT INFORMATf4N: - -
� Type of Project: i i Any earth movemont may require
MGWD review&perrr�its
❑l7oor(s) ❑ Remodel ❑Water Demage
� Minnehaha Creek Watershed District(MCWD)
Window(s) Repair ❑Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑Sidiny ❑ Restoration ❑Othe1':,(speCify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-3-oof ❑ Fire Uarr,age www,minnehahacreek.orq
Over'2!I ProJect l7escription: rp ��(��(��„� ('a Q �Q;� 0 r � b j
Estimafeci Construction Valuation of�'roject(excluding land) $ '� � � '�
�.w..._ , .—.....
APPLICANT ACKNOWLEDG�M�N7:
. Agrees to provide all information required or requested by the Buif(ling Denaftmen[;
• Gertifies that the information supplied is true and CorceCt to the best of his/her knowledge. The applicant reco�nizes that they
. are Solely resppnsible for submitting a complefe applic�tion being aWate that upon failure to do so, the stafF has no altern2tive
t�ut to reject it until i?is com�fete;
j • SOme Or all Of ihe information that you are asked to provide on this applicatiorl is classified by State law as either private or
confidential. Private data is information whieh generalEy cannot be givcan to the public but can be given to the subjeci of thA
d8ta. Confidentlal data is information which generally cannot be given to either the publlG or the SUbject of the data. Our
purpose and intend2d use of this information is to annually update our records and records of othe� govemmental agencies
r� uired b law. If ou refuSe io SU�p1Y tl�e infpnnation,the application may not be issued.
ApplicanYs Signature: � Date_
G � l � fl �
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Last Updated: 05-04-2Q09
JUN/29/2015/MON 10: 35 PM Elder Jones Building FAX No. 952 854 4909 P, 003
�v�u,��asu�a uepartmen�of Labor and lndustry !
Constru�c[iort Codes ar7d Licensing []ivisiat� ��censin -
Rd3 Lafayelte aaad N �7 c'1►1CI C{CftiflC�t�on ServrC���:
Phone� G67.2dq,5034 .
�aint Paul,NOV 55Ta5 �mail= L1.Lic;ense u �
Websit�: C�staic.rrtrt_lr;
�wW_qli_r�n.gov/cUd.n^,p
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CN/kI1(GE YOUR�(lSIN SS STRUC'T'UFj� D,BA TFI� HOM�DCPOT�7"_1-ip •r- ;;�RVlCI_S
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SU8M17'NEVY CERTTFlCAf�TE OF ICd$C1RAlVC� �
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- ChAngo in busir}es�'physicaf add'rass,rrtailing address, phone number, or Qtt�r�jf c�ddrps5 ~ '
• Change in carttro,f, pwners,a!(icers,dir�ctors,m�m6grs,partners I �
► Change In busines�'legaf name and/or assumed name !
• Loss of or chango in QUpC,IFYING REMpD�LFF( I �
• Chang�fn�enora!liabiiity insurance or workars'corrrpertsatfpn insurpncd coverac�c I
mmediato t�iotfeo Fiequirem�ni�—IVoClticatian tv pL►i�y,rn�ng
• Jud men�Debtor. �U fiCenseC(cp�t[raCtor h8s j5 days lo provide w ' �
debtpr based upon conduct requiNng(f�er�sure. ��ft�� noGce of ihn findinc� �l�is�t il i^ fuunU t� bt;� jucf��n���„i
� Qankrc,r le Pe(itidr't Filoci, A�icengec�contractorha5 15 days to prouic�e wriiterr notice Ihai it frf���p�,�ifr��n for borzkru cc�_
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misdemeanor, misd meanar or arry c7�ompardble aClense relafed to ttie ficehsq, incl�rdin
misrepresentation,mt�usa of funcis, tha�h, crim;naf sexual conduct,assautt, bu iar y f
iR IF1f�or�ny othor s1�te or any nther'Unifed S[ates'u �-J Y, conversic�ri qf fun�.S,r rr1li'c�{t OY proc�^,c,<i;
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Liconso : R�S117�N71Ai�I�EfVI�!]�L,Ef�t , '
: n(umaer : CR26B257 ; TI�fD AT-F-fOIViE SERVlCES fNC �
ciFvp Dato : 0�►/07/2015 DE3A T(-EE HC7l�l�p�p�T qT HOME S�R VECCS �
stion Date : 03/31/20-�7 2690 GUMBEFt�AND I� �.
' ' ATLfiNTR� GA 30839 KV1fY ST�300 � .
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DATE TIME
CITY OF ORONO cnLLED IN
iNSPECTION NOTICE SCHEDULED
PERMIT NO.ao�- b0�l�^ COMPLETED -do-/
ADDRESS /9� S�tsaP�i��aioe ��•
OWNER TELEPHONE NO. �
CONTRACTOR ��P ,f�o�''1e �T�
� DESCRIPTION ���v��'
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
v�INAL ❑ WATER HOOK-UP �FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERICOI�ITRACTOR TO MEET YiOU:_YES_NO ,
y COMMENTS: �eirrr•� /folaPe� �t.!�� ?b' G.c </ �..
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� ❑WORK SATISFACTORIf:PF�CEED �ECT COMPLETE
W ❑OORRECT WORK 6 PROCEED �ISSUE CERTIFICATE OF OCCUPANCY
0 ❑(�RRECT WORIC,CALL FOR REINSPECTION TEMPORARY
V BEFORE CdVERING PERMANENT
❑CORRECT UNSAFE CONOITION WITHIN HOURS. p pHpTO TAKEN
INSPECTOR YVILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED
❑INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspectfon 24 hours in advance. (952) 249-4600
OwnerlContrsctor on site:
Inspector. �''�^�7�—
White CopYMnapactor's FII� C�nary Copyl8lt�Notiee