HomeMy WebLinkAbout2012-01147 - windows � � CITY OF ORONO * 2 0 1 2 - P1 1 1 4 7 *
2750 KELLEY PARKWAY DATE ISSUED: 1U09/2012
' ORONO, MN 55356-
y
(952) 249-4600 FAX: (952) 249-4616
ADDRF.SS : 744 BROWN RD N
PIN : 34-118-23-12-0005
LEGAL DESC : REG. LAND SURVEY NO. 1275
: LOT 000 BLOCK 000
PERMIT TYPE : M[NOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 7,700.00
NOTE: REMOVE AND REPLACE(1) 1-W[DE AND(2)3-WIDE BASEMENTS-ALL SAME SIZE OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 162.25
HAMEL BUILDING CENTER STATE SURCHARGE(VALUATION) 3.85
18710 HIGHWAY 55
PLYMOUTH, MN 55446- TOTAL 166.10
(763)478-6601
Minnesota State License#: 20631040
OWNER
ML STEIL, TM SCHULTZE/
744 BROWN RD N
LONG LAKE, MN 55356-
AGREEMEIVT AIVD SWORN STATEMENT
Thc work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and thc
State E3uilding 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 wi[h whether or not specitied herein.This permit will
expire and become null and void if cons[ruction authorized is not
commenced within l80 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 Sta[e Building Code.This permit may be
revoked at any time for due cause.
��a;'�_..�'�`��-- �' l `� l �.Z
Applicant Pe ' ee Signat e Date / � //Z—
Iss By Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
r .
r�t� of Orono � 3� c�3 �
Building Permit Application for Maintenance / Renovation �
{windows, doors, sidin , re-roof, etc.j `
O Mailr O Box 66 PP.tmi[rulmbef: Q —(7
� �� Crystal Bay,MN 55323-Q066 Date receiveci� ``���_2!- _
��0 -� Q"';�.
a �,�<_ __ �1
.' _ a,�; Streel Address: Recerved by:
\\�'�.t M;�, G.`�/%` 2750 Kepey Parkway Plan review fee:
� Orono,MN 55356
ytLiggp�'4�%'
_—._ �/�
Total Fee: �i'� '� D
Mairt: 952-24g-4600 Fax: 952-249-4616 .�,,i�.+r�i�1rc�r�i�ri���u�,
_ --------
This apptication form must be completed in full and all required information must be submitted.
Incomplete applicati�s will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: 7�// j�i�c-:��r/ �/J• ./!!
WiH this be a Parade of Homes, Remodelers Showcase Home or other Display Home7 Yes o
1l�nes,a speria/event permit is required with Paice departmPnt and Crty Cow�cd appraval 60 days priar to the ewenl. Shuttle bus serv6ce wifl be
required urdess app/icant demonstrates sulfi�ient on-site parktix�is available. Non-permilled eva?+�s wN/nol be a!lowerl.
CONTRACTOR!APPUCANT INFORMATION:
Name: f.r.��f Z /�.< �J,--,.-G �-,.-Tt'�2
State License#� �C�3l v yU Expiration Date: 3 �i ,p;��
Lead Certification Number: y-�7` _ �7p 7u - / Expiration Da[e: , �j ,z�,;5--�
(for w�ork on ltomes tl�at were corrstnicted priar ro 197E
Phone: 7 c 3 - y�g-GG'o � (o�ce) 6�1- -- ��G -�"so� (cell)
Mailing Address: /�7%o j�,,�,� rr- Ci�i y,.,e..�,� ZIP: S�y��
Contact Person: ,�;,,.T y ��«fir�„�,�,� Appticant is�� Contra�/ Homeowner �c.a.a,y
Email and/or Fax: �-�.<<FH�<-�.��c �,�,��.-..c .���-�,�..--��<-��-,z.. . �r-�---
PROPERTY OWNER INFORMATION:
Name: ��'� S�i��'�Tz f
Phone (day}: 7�s -��S� -ry�>S 3
Address: �yy ,�,.�«,,. �,� ,� City: Go.,�.a l,.�-i�f ZIP: s'S3S�
Email and/or Fax
PROJECT INFORMATION:
Type of Project: My earth movement may require
❑Door(s) ❑Remodel ❑Fire Damage ��review&permns:
Minnehaha Creek Watershed Disuict(MCWD)
❑Re-roof,asphalt ❑Repair ❑Storm Damage 18202 Mirnietonka 8ivd
❑Re-root,cedar ❑Restoration ❑Water Damage �P�veri,MN 55391
Phone: 452-471-0590
❑ Re•roof,other(speciry) ❑Si ' ❑Other:(specify) Fax: 952-471-0682
Window(s) www.minneh�h�r.rcc:k.orq
Overali Project Description:���-�•� �;,Q���ir.r r /�l i w;oF �l,z�3w;,�i �µr-�-�T �Cc s-�-�f s�tf
Estimated Consiruction Valuation of Project(excluding land) S '7'�Uv, c�� v � ���f"'"'�a S'
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Certifies that[he informalion supplied is true and correct to ihe besc of his/her knowledge. The applicar►t recognizes that they
are solely responsible for submitting a camplete application being aware thai upon fa�lure to do so, the statf has no altemative
but to reject it until it is complete;
• Some or all of the intarmauon that you are asked to provide on this a�lication is classified by State law as either private or
confidential. Private data is information which generaNy cannot be given to the pubNc but can be given to the wbject of[he
data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our
purpose and irne�ed use of this infomiation is to annuatly update o�x rezords and records of otMer governmental agencies
re ufred b law. If ou refuse[o su I the information the a ication ma not be issued.
ApplicanYs 5ignature: ,,� Date: ��/`� �� Z
� �
�asc updaced: oa-os-zoi�