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CITY OF ORONO * 2 0 1 7 — 0 1 0 4 9 *
2750 KELLEY PARKWAY DATE ISSUED: 09/OS/2017
ORONO,MN 55356-
(952 249-4600 FAX: (952 249-4616
ADDRESS : 765 SPRING HILL RD
PIN : 36-118-23-22-0002
LEGAL DESC : UNPLATTED 36 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-LTNDEFINED
VALUATION : $ 155,000.00
NOTE: 33 WINDOWS AND 4 PATIO DOOR REPLACEMENTS
APPLICANT PERMIT FEE SCHEDULE 1,456.42
PELLA NORTHLAND STATE SURCHARGE(VALUATION) 77.50
15300 25TH AVE N.-SUITE# 100 TOTAL 1,533.92
PLYMOUTH,MN 55447- Payment(s)
(952)345-6047 CHECK '78818 1,533.92
Minnesota State License#:BUIL-BC645090
OWNER
WINSTON,FREDERICK&ELANOR '
765 SPRING HILL RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this pern►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 does
not grant permission for additional or related work which requires separate
permits. All provisions of Iaws 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 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.This permit may be
revoked at any time for due cause.
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C, 7-�, 9 , � ,/ �
Applicant Permitee Signature Date Issued B Signature Date
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City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
Op, ��� � �. Mailing Address: ��7_ �!�
� !y � � �� PO Box 66 Permit number:
� Crystal Bay, MN 55323-0066 Date received: ! /f
� �
�L` o� �01� StreetAddress: Received by:
ti�, G� �RON� 2750 Kelley Parkway Plan review fee: �
t �� C'-n/ QF Orono, MN 55356
qkf.SHn 1 � ��� �� �
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 print)
GENERAL INFORMATION: � �� , , , ��
Job Site Address: 7�Os s )''I '�
Will this be a Parade of Homes, Remo elers S owcase 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:
Narr,e: Pella Northland
State LicE 15300 25th Ave N Ste.100 Expiration Date:
�ead Cer Plymouth MN 55447 F IS►7 S 2—I Expiration Date: �(-7�zp
(forwo 763-745-1400 �8 ( ) �(S2'3�5�5 7
Pnor,e: gC645090 expires 3/31/19 office
Mailing A� City: ZIP:
Contact Person: ���. . Applicant i : Contractor , Homeowner (Circle One)
Email and/or Fax: '��`�,�.F-�.P�{P�✓-�(MLoS•CUVy�� �
PROPERTY OWNER INFORMATION:
Name: �Y�'Gd �( �i��V�Cl� �1�15'f"dl�'�,
Phone (day): �i5'Z-- c{�]3 r,721 �
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Overall project description:�J?' (N Yl Gi.@?.1��
Type of Project: Any eart movement may also re uire
�poor(s) ❑ Remodel ❑ Fire Damage MCWD review&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(specify) ❑Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
�Window(s) www.minnehahacreek.orp
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 responsib�e 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 s I the� formation,the a lication ma not be issued.
Applicant's Signature: � Date: �3���?
�' SEP U 5 ZU�I
Owner's Signature: Date:
Last Updated:January 2016 CITY OF ORONO