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Home My WebLink About2017-01475 - windows �ry �� CITY OF ORONO * 2 0 1 7 - 0 1 4 7 5 * 2750 KELLEY PARKWAY DATE ISSUED: iUi3/2017 ORONO,MN 5535Cr 952)249-4600 FAX: (952)249-4616 ADDRESS : 2160 SIXTH AVE N PIN : 27-118-23-31-0017 LEGAL DESC : PHILLIPS WOODLAND TERRACE : LOT 003 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOWS ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 16,209.00 NOTE: REPLACE(4)WINDOWS INTO EXISTING OPENINGS APPLICANT PERMIT FEE SCHEDULE 309.75 HOME DEPOT USA STATE SURCHARGE(VALUATION) 8.10 2455 PACES FERRY ROAD MAIL-IN FEE 2.00 ATLANTA,GA 30339- TOTAL 319.85 (860)952-4112 Payment(s) Minnesota State License#:BUIL-BC147263 CHECK 6070 319.85 OWNER TYLER,WILLIAM 2160 SIXTH AVE N LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this perrr►it 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 separate permits. All provisions of Iaws 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 suthorized is not 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 State Building Code.1'his pertnit may be revoked at any time for due cause. � . �.�� 1 ��,/ �, /� Applicant Permitee Signature Date Issued B ignature Date � , � ' City of Orono Building Permit Application for Maintenance / Replacement/ Remodel - Residential ONLY (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) A, Mailing Address: Permit number: (�/7'— �� ' 4-�l VO PO Box 66 Crystal Bay, MN 55323-0066 Date received: l�g'� � � Street Address: Received by: iY� ti� � 2750 Kelley Parkway Plan review fee: �' Orono, MN 55356 ��kFs H o�'�` Total Fee: �/ ' Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 6 This application form must be completed in full and all required information must be submitted. Incomplete applications will be retumed. (Please prinf) GENERAL INFORMATION: Job Site Address: a�� `�- Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a specia/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 sufl`'rcient on-site paricing is available. Non-pe�nitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATlON: Name: �CO�!2 �PAO� U�J� State License# _ �,t�-��,�03 Expiration Date: ,3 -3 l�- I$ Lead Certification Number: N p�T-3 l�lo�y-a Expiration Date: 5 ^(.p -ad (for work on homes that were constructed prior to 1978 Phone: (cell) �(,�D - '�f�01 -Li I I�r�. (office) � Mailing Address: � �_:� +�-�c�,S f--e_.�r-� � City: , . „�,,, ZIP: 3� 303 Contact Person: �- Applicant is: onfractor ! Homeowner �c��o�� Email and/or Fax: C � _ G, PROPERTY OWNER INFORMATION: Name: �Q; � � Phone(day): - -7 S O Address: a��p �� (�_ � . City: Q�rip ziP: 535 b Email and/or Fax: � '� PROJECT INFORMATION: Overall project description: :�:, - � - _ y ► 5 . SA-�--S�z-�, Type of Project: ny earth movement may also require 1'�O ❑ Door(s) ❑Remodel ❑ Fire Damage MCWD review 8 permits: ❑ Re-roof,asphalt ❑Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑Re-roof, other(specity) ❑Siding ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 �Nindow(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(exctuding land) S 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 rec�ognizes that they are solely responsible for submitting a complete 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 dassified 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 govemmental agencies required by law. If ou refuse to su the� formation,the a � tion ma not be issued. _ _ _._.. - .-- ApplicanYs Signature: � Date: 1 ` 3 '- � � Owner's Signature: Date: Last Updated:January 2016