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Home My WebLink About2012-00322 - doors CITY OF ORONO � 2750 KELLEY PARKWAY * Z 0 1 2 — 0 fd 3 2 2 * DATE ISSUED: 04/26/2012 ' ORONO,MN 55356- �" 952 249-4600 FAX: 952 249-4616 ADDRE�S : 2178 SHADYWOOD RD PIN : 17-117-23-42-0009 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 017 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DOORS ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 7,911.00 NOTE: 3 ENTRY AND 3 STORM DOOR REPLACEMENTS APPLICANT pERMIT FEE SCHEDULE 162.25 PELLA NORTHLAND STATE SURCHARGE(VALUATION) 3.96 15300 25TH AVE N.-SUITE# 100 PLYMOUTH,MN 55447 MAIL-IN FEE 2.00 (952)345-6047 TOTAL 168.21 Minnesota State License#:BC645090 OWNER ANDERSON,MR.&MRS.CURTIS 2178 SHADYWOOD RD WAYZATA,MN 55391- 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 dces not grant permission for additional or related work which requires sepazate 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 I80 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 aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cayse. `'�'k.�. (ir- / / / / Applicant Permitee Signature Date Issued By Sig ture ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . APR/23/2012/MON 09; 40 PM FAX No, 952 854 4909 P, 002/003 w � City of Orono Bu�lding Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit rlumber. o�� D 03Z Z- O.�Q,�,O PO Box 66 Crystal Bay, MN 55323-0066 Date received: L — �Z ' ` y�' ,, Street Add�ess: Received by: �' y 2750 Keliey Parkway Plan feview fee: �� +° Orono, MN 55356 �`�1t�g�o Total Fee; � (>� Z� Main: 952-249-4600 Fax: 952-249-4616 www•cl.orono.mn,.us �,� This application form must be completed in full and all required information must be submitted. . Incomplete applications will be returned. (Please prinr) GEN�RAL INFORMATION: C ,,/ f Job Site Address: v�� 7 � J�Q C� �G� � 0 Q �a Q Wiil this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No /f yes,a speGa!event permif is i epuiretl wlm Pdice Department and C�'ry Counci/approv�60 days prior to the event Shutde bus service wi!/be - iequi�ed uMess applicant damonstrates suf(cient or,�7e parking is avai�ab/e. Non-permitted events w111 not be allowed. CONTRACTOR/APPLICAN7 INFORMATION: Name- State License# �' Pella Nortb�and � e • Phone: 1�300 25th.A,ve N. Ste 100 ' s� ?�►S'•6�! ce11 Mailing Address: PI ou MN$5447 ZIP: Contact Person_ X,ic#B 645090 Ph. 763/745-1400 �omeownsr �c�.�k o�.� Email and/or�ax= PFtOP�RTY OWNER I FORMATION: Name: Q i1 n � S n Phone(day): Sa �/7� ' J Address: ,Z o �✓ Ci : A aT a ZIP: �s.34 / Email and/or Fax PROJEGT INFORMATION: Type of Projsct: Any earth movement may require MCWD review 8�permits G�.Dovr(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershsd Dist�ict(MCWD) ❑Window(s) [�-Repair �]Storm Damage 18202 MinnetOnka Blvd neephavsn, MN 55391 [�Siding ❑ Restoration ❑ Other.(specify) Phone: 952-471-0590 FaX: 952-4�71-0682 ❑R�roof ❑ Fire Damage www.minneh8ha�reek.ora Overall Project Description: t/1 r � /�'l e� /�d Q' J Estimated Construction Valuation of Pro ect ezcluding land $ APPLICANT ACKNOWLEDGEMENT: � • Agrees to provide all information required or requested by the Building Dep�rtment; . Certifies that the ir�fOrmation supplied is true and Correct to the best of his/her knowledge. The applicant recognlZes that they ar6 SOlely responsible fvr 5ubmltting a complete applic�tion being aware that upon failure to do so, ihe staff has no altemetive but to reject ii until It is complete; . Some or all of ihe information that you are asked to provide on this application is class�ed by State law as either private or confidential. Private data is irrformation which genefelly c2nnot be given to the public but can be givsn to the subjeCt of Lhe data. Cor�fdential data is informaUon which generally cannot be given to either the public or the subjeot of ihe data. Our purpose and intended use of this information is to annually update our records and records of other govemmental agencies re uired b t8w. lf ou refuse to su I Che fnformation,the a lication ma not be issued. ----• S' ��y f l a Applicant's Signature: G— Date: , City of Orono ' Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) -- Mailing Address: Permit number. �� PO Box 66 - C�. �� Crystal Bay, MN 55323-0066 Date received: I �` I Street Address: Received by: �I a �,IR;✓�°a �'. >, ��'S•,� ,��',r,��d� p� �� 2750 Kelley Parkway Plan review fee: `�l ��;�nii�� w �r Orono, MN 55356 �9kEsxo�'< 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 prir�t) GENERAL INFORMATION: �/ 7 � ��C Q _/� � � � / Ra Q C{ Job Site Address: /! C1� Q — — Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes,a special event permit is reryuired with Police Department and City Council app�oval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates suf(icient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: . . _ State License#�. T' � �� e � Phone: �� '. � ` �c N. Ste 100 S� �yS 'G�y7(cell) Mailing Address � 55447 ZIP: Contact Person: � �l � � f� �1 � �0 Ph. 763/745-1400 �omeowner (Circle One) Email and/or Fa � - PROPERTY OV1 y J Name: �/p � _- Phone (day): Address: _ City: �it�a �/ Z a a ZIP: �S3� � Email and/or Fax, t � ��.,�°: >.. :; �' ��:�fig P; . . .. , � �i � ' : ' �. 83�� t PROJECT INF( J ,�;,m�ngt�n� �+iN 5�4�� Type of Project: Any earth movement may require MCWD review& permits C-��rts) - - Minnehaha Creek Watershed District(MCWD) ❑Window(s) 18202 Minnetonka Blvd -- = Deephaven, MN 55391 ❑ Siding ,_, :,,,,�. �� Phone: 952-471-0590 Fax: 952-471-0682 ❑ Re-roof ❑ Fire Damage www minnehahacreek.orq _ Overall Project Description: � �1 r r p�'/�'� �0 er /�0 !(�(,� 1 Estimated Construction Valuation of Pro ect (excluding land) $ `7 � � f 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 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 re uired b law. If ou refuse to suppl the information,the a lication ma not be issued. � .� �' 2 y �l a Applicant's Signature: Date: Last Updated: 05-04-2009 EUlinnesota Department of Labor Hnd Industry I_icensinc�and �erti(icatlon Services Conslruction Codes and Licensing Division Phone: +3;1.2II4.503�1 443 Lafayette Roed N Email: DLLlicense(a�state.mn.us Saint Paul, MN 55t55 Website; www.dli.mn.�ov/ccld.asp NOTICES NOT TRANSFERA9LE CHANGE YOUR BUSINESS STRUCTURE PELLA NORTI-ILl1 SUBMIT A NEW AI'PLICATION FOR NEW ENTITY 15300 2 AVE STE 100 RENEW OR REPLACE INSURANCE POLICY PLY UTI-I, MN 554�17 SUBMIT NEW CEf�TIFICATE OF INSURANCE �� PlQaSc � �� PQ ljc� s � � � � c�� NOTIFY TFIE DEP/1tZTMENT OF !! Ct�l/�NGL IN YOUF� BUSINESS. � /l �jl � � � Failure to do so, s+.jbjects you lo administrative penalti�s of up to $10,0 t !`i-Day N�tice f7equirement--Fornis availr�Ule onl�ne at www_dli^mn��oy/CCLD/LicUlxlat s�� . r;hanqe in b��>inr��,,�;' �:�liysic;ril ailcire:��,rn�iilinc� address,��lione numl�^r. r�r em�il ;idclres,; • i;h;in�e�n c,oiilrol, owrir-;r:�, r-i((icrns, directars, f11rr77�efs.partners . . a i•h,�nc��in Inisi�ir,r,s Icr�„i ri,:un�:�:inc:l/or�:tss�arncdn,.:une • I o�;•:ril or r:l�;uii�rr iii tJI.I,�Lll�=1'INC'� f3Ull_D1.=Fi • C:Iiani:�r.�in c�c:�ri�,�r:�l Ii�lIllllly Ifl;;�.ir�<�nc:e f)1'WOf'{tf,?I'S�CQfTI�f)I1S711011 IIISLll�9(1Ct�rOVt;f<iC�i' I��uii.�ciiatc Nali<:c Fir_qulr�n�enl--fJotitic..�iian to DLI in writing - .liiii��irtc•nt f:)nl�t�.;r. .n lieensr:d .r,c>nlr:�cic�r h�s 15 day^, la provicic� wrillr��n no(ice c.�l lPi�i fincline Ifi;t� it is lound lo bo a judqrnenl rlc��t��or f��,�s�.>ri ��x;n cnnrl��c:!rc�c�uninc) licens�.irr... • I;arilvu��l�:y Pr�tilir�n 1 ilr:�cl /1 lic;c:�ri�;�d r,or7U�ar.lor Ii�s 1'�dr�ys tc�providr, �vrill�n nolice th�.it it liled a pelition (or bankruplcy. �� e::;oiivir.,�ion Nnlicc /� lici�ns;ed r,or�lr<+r..tor h::is 10 d�ys lo provicJe wriU�n nc�lice Ihnt il h�s bcen found guilty ol a lelony, gross �iiisdrririr:r.u�oi, ir�isdc+rne,ini�r or any comparable of�rnse relalecl lo Ilie li.r,en,��, inr;luding convictions ol fraud, �nisrepres�?nl,�lie�i�, n7isii�;e c;i funcis, Ilicll, ..r,rii7iin�l sexir:�l eanduc:t, �s��iulL I�i,irc�l;ir��, r.onverrii�n of funds, or thelt ol pror_eeds in Ilii��nr nny r;llie�r sl;�Ir� �:�r ;iiiy olhrr l.Jnit�.-�d S(ales ji.irisdir.tior�. YC:iUff �:EFiTIFIC/1'�1= IS fi1:L.C1W �fl)(_ PERF=ORAI"IOPJ. SI10W CE.FiTIPI�/1TF.':WHEN OE3TAINING PEFlMITS. �t:!'••�� ,� � �,,�N.��^ �,��..,,"�"" �„ RESIDENTIAL F3LDG CC)f�T�i/�CTOR i�#�y Ul�OI'� 13c INI7USTI�ti' .. .. �;��mtlnir.Oni::.:n�l��•��:inrl I I��.rrm:in��I)niir;u.�n !ir.c!n!:inn��ul(:�tililir:;�ili�7n Sr.rvicr,, .i,l"1 1 n�ay�rllr+Rnnd N SI.f';tul,MN.5515'i VJ��Ir.w� ww•v,�Ci inn{��W.r�:Ll,ri�;�� 1`�rnniL �1hJi��iisqoi�sl.ylr,,n�n_i.is ��'Inaiye9: /i'i1.?045034 I I��. „ i,�,,�rhl� ili:ii Ilir rrililir,il�.• liul�frr is lirrnsi•�J �is :i ItF:tilf)I?N'1'Ir11. 111111.1)IN(:.� ("(.)�I'll'.:1(`I OI� in Ilir>;I,ilr of\liiincsola and is in ��nii�lcinrr ��ith A-tinm•snia .`;lalulr.,< ;?(�It.h11;, :inil in�i�� buil�l rr:;i�.l�•iili:il rral rslntc, c��nlr:irt ur��fl'rr I��niiu:�ct �vi�h an n«mcr lo bnil�l ��,i,l�nu.il rc;�l rsl:� �. .niJ rununrl ��r��Ili•r i�� nnUai•1 �ti1h ,in oa�ni:r Ic, iittrrcivc cxislint?r��si�iirnli:il rc?:il cs1:Uc; ��r��•idccl 1!ic ��.��,�;,,:il�lr ivulu;il is :it ;ill linii•s ,i �;)11,11.11�1'IN(.i [il lll.l)f�:R micl Ihcrcrlitic:ur h��liJrr m;iintains r�,ni��linncc� �vilh Ih�.�rcquircd�,cncral 'i il,�!Ilv . �<u1:�nCt'. :u ��I •.i•�--;'�•n�l��t�•11.c111��11 I:��'S. L�r.ens� : 12FSIDrN�fl/1L f3LDG CONTRACTOFa i Ln:. P�Umbrr : ifL;G�t'.iu'::�Ci f'I_I_.I_/1 NOHT"f-ILANf_) � f Jf�rc ivc Datr. : �'11;:'7;'::'I')1::' 1_`i3C)O 25 fl�I /1V� �l F l Of_1 f3 i_ t x�:�irali n [)3IL' ; !1;S/;�I/..�Ol;i I'I YMOUTf-I, MN �i'i�147 C i ':�f_f{IPY UP-TU-DArf.-: ST'/�TU`i, f30ND, AND INSURANCEINFO ATwww.dli_mn.,c�r�v/c;cl.d/LicVerify..is�� (rNTER NUMBER). �' I�i 'I . i ,... _ �i �- -. � . ,.-� . . �I r.,,,,,.., '^ - �I • ��w:V�r��,�I�'�a i 1 ' , �;; �;�'�{�i,'' �� ,�'1'",�' �� , ; . w ��1', '; �... , + ��,,:��.�, r�P �J . '� " .� ,,, �; '�A.� p�I� '��Sa1� , „_. �� .� �-' - ��,,n4tr,�t�,r ��4JIa' 'I�!;7��9�1� � I , .� t�� - _ }} �� .',�.� � I ��r�„�,. �_. ` I III - I n�,•." ..`l .... 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