HomeMy WebLinkAbout2010 - 001192 - windows .� .. CITY OF ORONO PERMIT NO.: 2010-01192
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 12/17/2010
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4700 WEST BRANCH RD
PIN : 06-117-23-33-0004
LEGAL DESC : UNPLATTED 06 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 2,500.00
NOTE: REPLACE BAY WINDOW
APPLICANT PERMIT FEE SCHEDULE 88.50
GREAT LAKES WINDOW&SIDING STATE SURCHARGE(VALUATION) 5.00
14650 GLENDA DRIVE
APPLE VALLEY, MN 55124- MAIL IN FEE 2.00
(952)891-3400 TOTAL 95.50
Minnesota State License#: 20060427
OWNER
PETERSON, RONALD
4700 WEST BRANCH RD
MOUND, MN 55364
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.
6'14/(//.10 //O / abc.44,t_. /al/ 7
/7//ApplicantPermgnature Date Issue/Cy Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
1s • 50
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
�t0 Mailing Address: REPO Box 66
E Permit number: 070/0i 01/ 9Y
0 y_ .4Mailing
,, Crystal Bay, MN 55323 QDc6Date received: 1 Z//7//D
i��a ) rte ?•,/,'' Street Address: DEC 1 7 1010 Received by: �( t
ti
`.�tn cf// 2750 Kelley Parkway Plan review fee:
s�h X '__,_`� Orono, MN 5535Cy�i OF ORONO
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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: 4/706 west- &cowl
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Will 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 be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: 6 tetti5 to ndoxi f. d,t.q
State License# ZOO 0/127 •J Expiration Date: 3.31. 2e!2
Phone: 152.81/.3'00 (office) (cell)
Mailing Address: /'f(5t 641,m lam_ ae. Cit : u, vaKe ZIP: 5512 y
Contact Person: 4415 Applicant is: contractor Homeowner (Circle One)
Email and/or Fax: V
abbNUeadlit,eSegi";/•Cbl
PROPERTY OWNER INFORMATION: v
Name: aeon P{,kLsiv!
Phone (day): 152. 172. CO
Address: ypaU rtxsf-8/larc , ltd City: p'bvn61. ZIP: 553(1�
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel MCWD review&permits
❑ Water Damage
Minnehaha Creek Watershed District(MCWD)
�$Window(s) Repair ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
f❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-roof
0 Fire Damage www.minnehahacreek.orq
Overall Project Description: _ faze- cu:nS0•o
Estimated Construction Valuati n of Proj c (excluding land) $ 2.8500
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 supply the information,the application may not be issued.
Applicant's Signature: ` / Date: 6/
/Last Updated: 05-04-2009