HomeMy WebLinkAbout2011-00204 - doors CITY OF ORONO PERMIT NO.: 2011-00204
2750 KELLEY PARKWAY
E ORONO, MN 55356- DATE ISSUED: 04/08/2011
(952) 249-4600 FAX: (952) 249-4616
ADDRESS 3085 WATERTOWN RD
PIN 04-117-23-22-0032
LEGAL DESC WALNUT CREEK
LOT 001 BLOCK 001
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE DOORS
ACTIVITY O/S BUILDING-UNDEFINED
VALUATION $ 750.00
NOTE: REPLACE FRONT DOOR WITHIN EXISTING OPENING
APPLICANT PERMIT FEE SCHEDULE 34.75
GERHART,RICHARD&JANICE STATE SURCHARGE(VALUATION) 5.00
3085 WATERTOWN RD TOTAL 39.75
LONG LAKE,MN 55356-
OWNER
GERHART,RICHARD&JANICE
3085 WATERTOWN RD
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 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 ith the,State Building Code.This permit maybe
revoked at an a for a caus�
V
`I(j tiv 1 �l l
A hcant ertnttee Signature Date Issued By Si ture - Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER MAN DESCRIBED ABOV .
. City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: rDate
it number:
oV.O O PO Box 66Crystal Bay, MN 55323-0066 received:
i + s Street Address: Received by:
2750 Kelley Parkway Plan review fee:
L�kZS140 Orono, MN 55356
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 Q s 6- " r ����-roc` 1 i r
Job Site Address: W /v L�,
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o
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 t� /:D INFORMATION:
Name: 19 i
1 C 'r r4/:D6 _15-K #-A-(e-T
State License# 6 rn.E 060IV6lZ Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructedprior to 1978
Phone: 3 3— ( (- �� b (office) (cell)
Mailing Address: 3 0 8'-'cf- L.) 4T6X TOW City: (.9 p P-3 lJ ZIP: S3s-rZ,
Contact Person: � /Z45'4t-- /LT Applicant is: Contractor / omeown (circle one)
Email and/or Fax:
PROPERTY OWNER INFOR ATIQN:
Name: l � �Z V �j EfZA 1�T
Phone (day): 0
Address: 0 � (,U 4-F67Z 7au;�J ( City: 6X9_ZA10 ZIP:
Email and/or Fax
PROJECT INFORMATION:
0ooType f Project: Any earth movement may require
r(s) emodeI ❑ Water Damage MCWD review& permits:
Minnehaha Creek Watershed District(MCWD)
❑ Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391
Phone: 952-471-0590
❑ Re-roof ❑ Fire Damage Fax: 952-471-0682
www.minnehahacreek.org
Overall Project Description: ax-p- Do
Estimated Construction Valuation of Pro ect (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 you refuse to su' ly the information,
� e alic tion may not be issued.
Applicant's Signature: `� � Date:
Last Updated: 03-01-2011