HomeMy WebLinkAbout2017-00195 - windows t- tR. CITY OF ORONO 1 ( 11 lit 111 [II 1 1 1111111111
2750 KELLEY PARKWAY * 2 1 - 0 0 1 5
DATE ISS - 001
03/02/22 017
ORONO,:MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 4545 WATERTOWN RD
PIN : 31-118-23-24-0004
LEGAL DESC : UNPLATTED 31 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 1,620.00
NOTE: WINDOW REPLACEMENT
APPLICANT PERMIT FEE SCHEDULE 67.17
SCHERER BROS LUMBER STATE SURCHARGE(VALUATION) 0.81
10751 EXCELSIOR BLVD MAIL-IN FEE 2.00
HOPKINS,MN 55343 TOTAL 69.98
(952)277-1600 Payment(s)
Minnesota State License#:BUIL-BC239369 CREDIT CARD 3281 69.98
OWNER
BROLL,MR&MRS JEFF
4545 WATERTOWN RD
MAPLE PLAIN,MN 55359
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 with the State Building Code.This permit may be
revoked at any time for due cause.
Cru ??. • , i 7
Applicant Permitee Signature Date Issued B gnature Date
Mar. 2. 2017 2: 53PMNo. 3386 P. 1/2
* Pte.
City of Orono
Building Permit Application for Maintenance I Replacement/ Remodel-itiodoitioNts
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
Mailing Address: ?Oth tg .iy
Sax 66 d
Crystal Bay, MN 55323-0066 eagAgeNedi . �
e1v.11 �lG
Street Address:
2750 Kelley Parkway lahrt,11 4%,§'
k8i'l(IJ
Orono,MN 55356oTst0..11:0? x = •
Mnai : 952-249-4600 Fax: 952-249-4616 www.cl,orano.mn,
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERALINFORMATION:
Job Site Address: ^, t-1 (A) / C0-00Y\ i0/
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 he
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: 5 A "r'e_Ar- To gat
State License# + - Expiration Date: .6 Mann
Lead Certification Num>`1 •\ , 1 _ Expiration Date. _
(for work on homes that were c.n.tructod prior to 19 ; 6 �] `_ `�
Phone: (cell) (office) 7 ) / // O `
Mailing Address: J City. _5K ) AAS ZIP' SSW
Contact Person: �i L/�,. • Applicant is: -ontracto' I Homeowner (circle on"
Email and/or Fax: , �a.Y • /l V)------.
PROPERTY OWNER INFORM•TION:
OP
Name: - _
el Phone(day)' _ - r
Address: H �� /, . . .gym ..0 *j_ City: r YZi ZIP: S
Email and/or Fax:
PROJECT INFORMATION: Overall project description:_
Type of Project: Any earth movement may also require
MCWD review&permits:
❑Door(s) 0 Remodel ❑Fire Damage
Minnehaha Creek Watershed District(MOND)
❑ Re-roof,asphalt ❑ Repair ❑Storm Damage 15320 Minnetonka Blvd
❑Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka,MN 55345
Phone: 952-471-0590
El Re-roof, other(specily) LiSiding ❑Other: (specify) Fax: 952-471-0682
• dow(s) _ yfyrw.mihnehahacreek.gfq
Estimated Construction aluation of Project(excluding land) $ `(,aD
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Departme ,
• 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:lhe 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'.1 the Information the .'ilicatlon ma not be issued.
Js /
Applicant's Signature: A —71:-; i 1 F
. rt' i Date.
Owner's Signature: _ Date:
Last Updated:January 2016