HomeMy WebLinkAbout2015-00443 - doors � CITY OF ORONO * Z 0 1 5 - 0 0 4 4 3 *
2750 KELLEY PARKWAY DATE ISSUED: 04/16/2015
� ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2695 SHADYWOOD RD
PIN : 21-117-23-24-0056
LEGAL DESC : CHAPMAN ADDN
: LOT 002 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DOORS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 8,250.00
NOTE: 2 PATIO DOOR REPLACEMENTS IN EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 185.87
STATE SURCHARGE(VALUATION) 4.13
THE HOME DEPOT A.H.S. MAIL-IN FEE 2.00
2690 CUMBERLAND PKWY, STE 300
ATLANTA,GA 30339- TOTAL 192.00
(763)542-8826 Payment(s)
Minnesota State License#: BUIL-CR268257 CREDIT CARD 0174 192.00
OWNER
PAULSON, STEPHEN&BOTHAINA
2695 SHADYWOOD RD
EXCELSIOR,MN 55331-
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 sepazate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.l'his permit will
expire and become null and void if construction authorized is not
commenced witt►in 180 days of the date of issuance,or if conswction is
suspended for a period of I80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
APR/16/?015/THU 12: 40 AM FAX No, 952 854 4909 P, 002
.
City of Orono
Bu�iding Permit Ap�lication for Internal Work
(windows, doors, siding, re�-roof, etc.)
MailingAddress: p�rrttit number. 2�� 'rJ'v�
���,d,j� PO Box 66 . I t-
� (� Crystal Bay, MN 55323-0066 Date received: �-t �'��v —��J
M��""'� Received by: �I�
� `' a, Street Address:
�,�,��''`�SE oti'`' 2750 Kelle Parkwa —J'
Y Y Pfan reviewfee:
'���p� Orono, MN 55356 �
Total Fee: ' a 2 -�
Main: 952-249-4600 Fax: 952-249-4816 uvwuv.ci.orono.mn.us
This application form must be cornpleted in full and afE required information must be submitted.
Incomplete applications will be refurned_ (Please prinf)
GENERAL INFORMATIOI�(;,� ` Q � � L Q � b� _ O C}
Job Site Address: a! ll
Wilf this be a Parade of Homes, Remodefers Showcase Home ar other Display Horne? ❑Yes No
If yes,a specla/event perm/t/s requlred wlth Pollce Depariment and City Counc;l approva!60 days prior to the event ShutHe bus sa►vice wi4 be
requlrsd unfsss appllcant demonstrates sufflclent on-sfta parking is avalfab/a. Non-paimiYted avents wi0 not be a!lowed.
CON1"RACTOR/APPLlCANT INFORMATION: ������S ,G �y�
Name: THD At-Hpzxae Service, Lac,
State l.icense#
Phone: 2690 Cw�berland P�wy, Ste 30Q (cell)
Mailing Address: A,t�.anta, GA,30339-39X3 zE�'
Contact Person: Lic#CR268257 ph. 763/542-$826 Iomeflwner (Clrcle One)
Email and/or Fax:
PROPERTY OWNER I OR�IA Ti01�:�Q v � �
Name: �� T
Phone(day): fl . 8 q
Address: � v � Ci �d'�ti l"�/o C z�p_ S S 3 �
Email and/or Fax
PROJECT INfORMATION:�- *
Type of Project Ally earth movement may Yequire
� ' MCWD review&permits
boor(5) ❑Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
[]Wndow(s) ❑ Repalr ❑Storm DBmage 18202 Minnetonka 81vd
Deaphaven,M N 55391
❑Siding . Q Restoration ❑Other:(SpeCify) . Phone: 952-471-0590
Fax: 952-471-06$2
❑ Re-roof ❑ Fire Damage www.minnehahacreek.orp
Overafl Project Description: i !'i ! Q �! � //1
�stimated Construction Valuati n of Project(exclud ng iand) � g ,rj S O
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all'informa'tion required or requested by the Building Departmerl#;
• Certifies that the informatipn SUpplied IS tn,le and COt�eCt to the best of his/her knowledge. The applicant recognizes that thay
. are solely respOnsible for submitting a complete application being aware that upon failure to do so, the staff haS no altemativs
but to reJect it until it is complefe;
• Some or all of the information that you are asked to provide on fhis application is cfassified by State faw as either private or
confidentisl. Private data is information which genera�ly c2nnot be glven to the public but can be given to the subject of the
data. Confidential dat2 is information whioh generally cannot be giyen fo either the public or the subject of the daCa, Our
purpose and intended use of this in{Orm&tion is to annually update our records and record5 of othel'gOvel'nmental agencies
required b law. ff ou refuse fo su I the information the a lica'on ma not be issued.
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ApplicanYs Signature: � Date; ��� �
Last Updated: 05-0a2009