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Home My WebLink About2015-01080 - windows t . �, CITY OF ORONO * 20 15 - 0 108PJ * 2750 KELLEY PARKWAY DATE ISSUED: 08/25/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 2775 SILVER V[EW DR PIN : 33-118-23-42-0010 LEGAL DESC : MEYER DAIRY ADDN : LOT 001 BLOCK 002 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOWS ACTIVITY : O/S BUILDING-UNDEFINED VALUATIOIV : $ 59,514.00 NOTE: REPLACE(19)WINDOWS AND(2)PATIO DOORS IN F_XISTING OPENINGS APPLICANT PERM[T FEE SCHEDULE 794.64 STATE SURCHARGE(VALUATION) 29.76 FOSS EXTERIORS LLC TOTAL 824.40 1891 SANDBAR CIRCLE WACONIA,MN 55387 Payment(s) (612)229-8619 CHECK 11077 824.40 Minnesota State License#: BUIL-BC 438042 OWNER BRANDENBURG,CRAIG 2775 SILVER VIEW DR LONG LAKE, MN 55356- 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 specitied 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 are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. , �, �-25 -- � �-P�t�� i��,� A / , Applican i Signature Date Issued y ignature Date , ,�, City of Orono Building Permit Application for Maintenance / Replacement / Remodel (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) �O�O Mailing Address: Permit number: '��l S- PO Box 66 �j y�- � Crystal Bay, MN 55323-0066 Date received: �5 Street Address: Received by: y G` 2750 Kelley Parkway Plan review fee: `�t Orono, MN 55356 �� ' /'` �k�SH�� 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. (P/ease print) GENERAL INFORMATION: �?�S Job Site Address: �l �1��2d(/(CLJ�� 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 approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: �SS �k'`C'Fz1LcolL� L.�C� State License# �jC t.�� Expiration Date: 3 •3� • !(� Lead Certification N'umber: `UA� �� 2�/_ ( Expiration Date: /� • �Ll ' �� (for work on homes that were constructed prior to 1978 Phone: (cell) (�j�2 22�t �'(� � �t (office) �{��,�- Mailing Address: City: t�c�,q,�,�� ZIP: '�j Contact Person: —�'�._.�,6�� Applicant is: ontract / Homeowner (Circle One) Email and/or Fax: �N��-,�5 S�X.T�/L/c.�/�S , c�w-�, � PROPERTY OWNER INFORMATION: Name: ��/U�t�,/L� Phone (day): Address: Z'7?S S( �.�,�21//E� /�2 City: ��,�/�, ��1� ZIP: 5 S 3 S� Email and/or Fax: PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require (�] Coor(s) 2 ��AT lc.� ❑ Remodel ❑ Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 „�Window(s) OQ SAl�k� C��N6-- www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ �/�-- 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 required by law. If ou refuse to su I the info ation,the a lication ma not be issued. ApplicanYs Signature: Date: �5' - 2S'� � � Owner's Signature: � Date: Last Updated:January 2015 t �l�ifp� ��I�� 1�t11t�11I�tI1�tL'l�t��t�. �11��t��tiYIT Ll�t� � �� t:� t� f11 ��1'�i�� f��I� s �e� �.� � �� • 0 . �`� �"� �.�"'�� a T�u>. ��\ ��EPA � ��- � - Foss Exteriors, LLC � � '� �,� has fulfilled the requirements of the Toxic Substanc�s Control Act(TSCA)S�ctic�402,antt has received certification to conduct lead- based paint renovation,rcpaix, and painting activities putsuant to 40 CFR Part 745.89 � . .��. j , � ., ,�. � ��, ��. ,�� .r �' � � � Y;,: ,J�t fl��:�� rt��d��t �r�: , �� All EPA Administered States, Tribes, and Territories This certification is valid from the date of issuance and expires Noyember 14, 2016__ ___ NAT-118291-1 ��R"'� __ _._ . ___ __.__----- _----- ----- Certification# - Michelle Price, Chief October 31, 2011 Lead, Heavy_Metals, and Inorganics Branch ------- _ _----- � __ .._ ___. _ _ ---- __ --- -- lssued On ._ = �� ,�� ;��' '�t��rr,�€�'�