HomeMy WebLinkAbout2010-00981 (doors) CITY OF ORONO PERMIT NO.: 2010-00981
� 2750 KELLEY PARKWAY
• ORONO, MN 55356- DATE 1SSUED: 10/1U2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1416 BALDUR PARK RD
PIN : 08-117-23-34-0015
LEGAL DESC : BALDUR PARK
: LOT O11 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIU�\PE : DOORS
ACTIVITY : O/S BUILDING -UNDEFINED
VALUATION : $ 3,276.00
NOTE: RFPLACE 1 PATIO DOOR IN EXISTING OPENING
APPLICANT PERMIT FEE SCHEDULE 103.25
SEARS HOME IMPROVEMENT STATE SURCHARGE(VALUATION) 5.00
2700 WINTER STREET NE
SUITE 1 MISC FEE 0.00
MINNEAPOLIS, MN 55413- MAIL-IN FEE 2.00
(651)341-3732 TOTAL ll0.25
Minnesota State License#: 20090017
OWNER
MARCIA PETERSON,JEFFREY ULKU/
1416 BALDUR PARK RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The�cork for which this permit is issued shall be performed according to
thc 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. Ali 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[he date of issuance,or if construction is
suspended for a period of 180 days at any time atter 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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Applicant P rmitee Signature Date Issued By gnature te
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB .
.
' City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
_�, Mailing Address: Permit number:
%�,�,�. PO Box 66
��Q � Crystal Bay, MN 55323-0066 Date received:
i ��, :
Received b
,�� r��� ,� StreetAddress: y�
,�, .�����'�� �ti�' 2750 Kelley Parkway Plan review fee:
t�v '���'r�` � Orono, MN 55356
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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: � ` C
Job Site Address: (4-( � C�(dU✓ �G(Y�L (Z.� � Wq y Za� Mr� J�J��I�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No
If yes,a special event permii 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 evenis will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: Se 0.1'S �OIMe T►M CJ 1''bVG m G ''�+
State License# 00�[00 (,"� � Expiration Date: 3--3(—� �
Phone: _ (os�—34�_ 3732 (office) (cell)
Mailing Address: 2100 ►v1 e+'' Sr{- — 5V► I Ci : e L'S ZIP: Srj
Contact Person: Applicant is: ontractor Homeowner (Circle One)
Email and/or Fax: Gt e � ( (05 — �
PROPERTY OWNER INFORMATION•
Name: MGI.YGI GI ���'��SO�
Phone (day): � 2— y 7 1— F�2 G!9 L,.
Address: ( • (2` r- aylL �c� . City: WGIu�GI,'lc,( ZIP: S�j3�'] f
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review&permits
(�Door(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑ Siding [�Restoration ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq
Overall Project Description: �(CG G( 'O QaY' � ' Vl D Chlv�
Estimated Construction Valuation o Project (excluding land) $ ?�2'��,p
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
re uired b law. If ou refuse to su I the information,the a lication ma not be issued.
ApplicanYs Signature: ���w�.��i�G{�UX� Date: ��j "'��-'�a
Last Updated: 05-04-2009