HomeMy WebLinkAbout2014-00477 - windows ' � CITY OF ORONO * 2 B 1 4 - 0 0 4 7 7 *
2750 KELLEY PARKWAY DATE ISSUED: OS/27/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 740 BROWN RD N
PIN : 34-118-23-12-0002
LEGAL DESC : UNPLATTED 34 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ 7,488.00
NOTE: RL;PLACE 9 WINDOWS IN EXIS"1'ING OPL;NINGS
APPLICANT PERMIT FEE SCHEDULE 162.25
STATE SURCHARGE(VALUATION) 3.74
THE HOME DEPOT A.H.S. MAIL-IN FEE 2.00
2690 CUMBERLAND PKWY, STE 300
30339- TOTAL 167.99
(763)542-8826 Payment(s)
Minnesota State License#: BUIL-20268257 CHECK 681 13 167.99
OWNER
MABUSTH, SCOTT
740 BROWN RD N
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
I'he work for which this permit is issued shall be perfonned accordin�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
permi[s. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specifled 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 requircd inspections are
requested in conformance with the State Building Code.'I�his permit may be
revoked at any time for due cause.
' s , a�, ��
Applicant Permitee Signa w�e D e [ss d E3y Signature Date
MF:Y/,1E!2014/FRi 04; 24 AM Elder Jones Building rA� No, 952 854 �909 P, 002
City of Orono
�ui�d�ng �ermEit Application for lnterna[ Work
(windows, doors, siding, re-roof, etc.)
MaililtgAddress: permit number: �DI �
O-�,�,�Q PO Box fi6 _
Crystal Bay, MN 55323-Op66 Date rBCeived: �-
�' ' - Received b
,� �p��,�.��. � StraetAddress: Y�
� .��,.'`i1.� Gti 2750 Kelley P�rkway P3an reviewfee:
'�� '�:�, "�•�.w Orono. MN 55356
��sfY�
Main: 952-249�4600 Fax: 952-249-4616 www.ci.orono.mn.us � Total F2e' I ��./}
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This application form must be comple�ed in full and all required infdrmation must be submitted.
Incomplete appEications will bQ retumed- (P18ase prinf)
GENERAL 1NFORMATION: �,�� ��Q w � G]� a � � /
J�b Sife Acldress: �'� l V
Will this be� P�r�de of Homes, Remodelers Showcase Home pr otl�er DiSplay Home? 0 Yes ❑ No
!f yes,a spec/a/evant perm;t;s required with Pollce Department and City Counci!approval 6o days prior to the event. Shutfle bus service will be
fequiled unless�pplitarlt d6mon3trJtes 5uiiicienf on�site parking is available. Non-peYmitted evenfs wi!!not be�a1/o�✓9d.
CONTRACTOR/APPLfCANT INFQRMATIQN�
Name� ,� ��'� 31/S"• � a�7
8tate License# '�HD At-Hpz711e SeT'Vi.Ce� �c, n�y,
Phone: x 2690 Cu�nberland�kwy, S�e 300 (cell)
Maifing Address� Atlanta, CrA 30339-3913 ZIP:
Contact Person� �,lc#GR2.6gZ�7 Pl�,. 763/542-$$26 �omeowner �c�����o„��
E��ail and/or Fax:
;
PROP�RTY�WN�R INFO MATjqN: M Q L U S��}
Name: ('4 ff" � '� U
Phone(day): QS� Y7G - �S7
Address: 7 0 /` 0 W /Z n Q � Ci : L on �Ct �� ZIP: �� �a 5 L
Email and/or Fax
PROJECT IN�ORMAT[ON:
, Type of Project �—� � Any earth mo�ement may require
MCWD review&permits
�Door(s) ❑ Remodel ❑Wat6r Damage
Minnehaha Creek Watershed District(MCWD)
"�IQ(indow(s) Repair ❑Storm Damage '18202 Minnetonka Blvd
Deephaven, MN 5539'E
❑Siding ❑ Restoration ❑Other:(specify) Phone: 952-471-0590
Fax: 952-47'E�0682
[] Re-roof ❑ Fire Damaga www.minnehahaCreek.or
O�erall Pro�ect Descript�on: (,.� �/'� � � /� (,�, Q,� S l�} � �J O t� Ct'S
�stimated Construction Va[uation of Project(excfi�di g land) $ � �l � Q�
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide 211 inform�tion required or requested by the Building Department;
. Certifi�s that th0 information Supplied is true and correct to the best of his/her knowledge. The applicant recognizgs that th6y
are�Solely fesponsible for submi�ting a compEete appiication being aware that upon failure to do So, the Staff has no alternative
but to reject it untif it is compfete;
• ' Spmg pr all of the informaUon thaf you are asked to provide on this application is classified by State law�s efther pnvate or
confidentiaf. Private data is information which generally cannot be given to the public but can be given to the subject.of the
data. Confider�tial data is informafion which gener�Ily cannot be yiven to either the public or the subject of tFte data. Our
purpose and intended use of this information is to annually update our records an� records of other govemmental ag�ncieS
re uired b faw. If ou refuse to suppl thg fnformation,the a IiCaYion m2 nUt be issued.
Applicant's Signature: � Date= � l� L ( �y
Last Updated: OS-04-2009
✓
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO..�Gf�7`' ��``» COMPLETED ,����/�
ADDRESS ��i'D i�,�[�:�1 �l'� .1S/:
OWNER TELEPHONE NO.
CONTRACTOR �lo�� ���✓OL�
�: DESCRIPTION W`V��w '��� �•
W ❑ FOOTING ❑ PLUMBING FINAL Q EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
�
O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
���NAL ❑ SEWER HOOK-UP � COMPLAINT
��❑ DEMO-SITE ❑ SEPTIC MAINT. LLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HA D COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNERfCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED �P DJECT COMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WFLL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (952) 249-4f)00
OwnerfContractor on site:
Inspector. ��'�—
White Copyllnspector's File Canary CopylSfte Notice