HomeMy WebLinkAbout2015-01040 - windows CITY OF ORONO * 2 0 1 5 - 0 1 0 4 0 *
_ 2750 KELLEY PARKWAY DATE ISSUED: 08/17/2015
� � ORONO, MN 55356-
(952 249-4600 FAX: (952 249-4616
AD�DRES� : 3115 SUSSEX RD
PIN : 04-117-23-32-0015
LEGAL DESC : FOX BEND
: LOT 004 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION T PE : WINDOWS
ACTNITY : O/S BUILDING-UNDEFINED
VALUATION : $ 5,020.00
NOTE: REPLACE 4 W[ DOWS IN EXISTING OPENINGS
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PPLICANT PERMIT FEE SCHEDULE 139.40
STATE SURCHARGE(VALUATION) 2.51
MINNESOTA EXTER ORS INC. TOTAL 141.91
8600 JEFFERSON HI HWAiY Payment(s)
OSSEO,MN 55369 CHECK 202414 141.91
(763)391-5508
Minnesota State Licens #: BUIL-BC002877
OWNER
MARY RASKOB,DA IEL pELMORE&
3115 SUSSEX RD
LONG LAKE,MN 553 6-
AGREEMENT ND SWORN STATEMENT
The work for which this pe it is issued shall be performed according to
the approved plans and spec �cations,applicable City approvals,and the
State Building Code. This p rmit is for only the work described and does
not grant permission for add tional qr related work which requires separate
permi[s. All provisions of la s and prdinances goveming this type of work
shall be compied with whet r or n specified herein.This permit will
expire and become null and oid if struction authorized is not
commenced within 180 days of the ate of issuance,or if construction is
suspended for a period of 18 days any time after work has commenced.
The applicant is responsible or ass ing all required inspections are
requested in conformance w h the ate Building Code.This permit may be ' �
revoked at any time for due ause.
` .� 0 / '--�-�'�� � / / �
Applicant Permitee Sign ur Date Issued By Signature Date
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! ` City of Urono
Bu Iding Permit Application for Maintenance 1 Renovation
(windows, doors, siding, re-roof, ete.}
Mailin Address: �� _ Q� �
;�0,�.� PO Box 66 Permit number:
�/ i Crystal Bay,MN 55323-0066 Date received: ��
��o ��!?� r- ' Received by:
y,z,�, �, i� Street Address:
�'�c, �;,�.�.���„�'�` � 2750 Kelley Parkway Plan review fee: �
�-s}g"�`•�����w arono,MN 55356
�EsBo
-- Total Fee: '
Mai : 952-249-4600 Fax: 952-249-4616 wvv�v_ci.orono.mn.us
Thi applicafion form musk be compfeted in fulf and all required informatian must be submitted.
Incomplete appl'rcations will be returned. (Please prinf)
GENERAL !P[F MATION:
Job Site Addre s: ��1����(� � �,,� �,��
WiEI this be a P rade Of Homes, Rernodelers Showcase Home or ather Dispfay Home? ❑Yes „�-l�Fo
If yes,a special vent pqrmit rs required wifh Police Deparfinent and Cr(y Councrl approva!60 days prior to fhe event. Shutfle bus service will be
requ ed un!.gs applrcanf demonstrafes suffirient on-site parkrng rs available. Non-permifted events wi!!nof be a/lowed
CONTRACTOR APP�ICANT INFORMAT[ON:
Name: �
State License# -7 " Expiration Date: 21.��
Lead Certificatio Number. ���-���S^� Expiration Date: �-:_��p
(for work on h mes tlhat were consfructed prior to 1978
Phane: G -�l 7 . 790 {office) 7e '.3`j/•S�.6 (eeffp
Mailing Address; � �. � � City:�S�� ZIP: C`
�?�—.— ���
Contact Person: �����`��rh U-� Applicant i�--E-�rttrac o { Homeowner (Cirde One)
Email and/or Fax f'��r..�SC�-i �'��>/� P_,��Lv/� 76��t jj• �"'�1��
PROPERTY OW ER I FORMAT ON:
Name: � ��
Phone(day}:
Address: � «/ City�'�-�C�y�p ZIP: S.�S�+
Email and/or Fax
PROJECT iNF RMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Fire Damage MCWD review&permits:
fvlinnehaha Creek Watershed District(MCWD}
❑Re-roof,asphal ❑ Repair ❑5torm Damage 18202 Minnetonka Blvd
❑ Re-roof,cedar ❑Restoration ❑Water Damage Deephaven, MN 55391
Phone: 952-471-0590
❑ Re-roof,other( pecify) ❑Siding ❑Other:(specify} Fax: 952-471-0682
�indow(s) www-minnehahacreek.orq
Overal{ Praject escrip#ion: .� � � L J� �7� �,� ,�Z-
Estimated Cons ruction Va uati n of Project{excEuding land) $ �'��;�: (�
APPLICANT A KNOWLEDGEMENT:
• Agrees to rovide all information required or requested by the Building Department;
• Certifies t at the information supplied is trve and correct to the best of his/her knowledge. The applicant recognizes that fhey
are solely esponsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative
but to reje t it untll it is complete;
• Some or I o#the information that you are asked to provide on this application is classified by State law as either private or
confidenti I. Pri te data is informaYion which generally cannat be given to the public but can be given to the subject of the
data. Co fidenti I data is information which generally cannot be given to either the public or the subject of the data. Our
purpose a d inte ded use of this information is to annually update our records and records of ather governmental agencies
re uired b law. f ou refuse to suppEy the' ,rma' n,the a lication ma not be issued.
Applicant's Signa re: . � � Date: c� •��°%�'
Last Updated: 08-09- 011
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DATE TIME �
CITY OF ORO O CALLED IN
INSPECTION OTI E SCHEDULED
PERMIT NO. � b COMPLETED ��
ADDRESS 5 ��-
OWNER TELEPHONE NO.
CONTRACTO - � � �o�
� DESCRIPTION � � f-
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
"j ❑ FOUNDATION WA ERPR �F ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q �1dAL ❑ WATER HOOK-UP (�OLLOW-UP
_ ❑ AS BUILT-SURVE ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERlCONITRACTO TO MEET YiOU:_YES_NO
y COMMENTS: r ��C l vr ./ a0 G /l �
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W ❑WORK SATISFACTO Y:PROGEED �OJECT COMPLEfE
� ❑CORRECT WORK 6 E ❑ISSUE CERTIFICATE OF OCCUPANCY
W
O O CORRECT WORK,C L FO REINSPECTION TEMPORARY
V BEFORECONERING PERMANENT
❑CORRECT UNSAFE NDIT N WITHIN HOURS. O PHOTO TAKEN
INSPECTOR WIL RET
❑STOP ORDER POSTE .CAL MISPECTOR O CITATION ISSUED
❑INSPECTION REQUI D.CA l TO ARRANGE ACCESS.
Ca11 br nextlinspection 24 hours in advaru�. (g52) 249-4600
OwnerlContractor n si :
Inspector:
White C yAnsp tor'a File Canary CopylSit�Notice