HomeMy WebLinkAbout2012-00707 - windows �' CITY OF ORONO
* 2 0 1 2 - 0 0 7 B 7 *
� 2750 KELLEY PARKWAY DATE ISSUED: 07/24/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2912 CASCO PO[NT RD
PI N : 20-117-23-31-0072
LEGAL DESC : REG. LAND SURVEY NO. 0461
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ 3,029.00
NOTE: REPLACE 2 WINDOWS
APPLICANT PERMIT FEE SCHEDULE 103.25
SCHERER BROS LUMBER STATE SURCHARGE(VALUATION) 1.51
]0751 EXCELSIOR BLVD
HOPKINS,MN 55343 MAIL-IN FEE 2.00
(952)277-1600 TOTAL 106.76
Minnesota State License#: BC239369 PAID W[TH CC# 3989
OWNER
BARRETT, MICHEAL
2912 CASCO PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,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 no[specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within]80 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer 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.
\_�r�-�".,� Lt�--
/ / / /
Applicant Permitee Signature Date Issued By S' ature , a e
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
Jul. 24. 2012 11 : 54AM No, 9335 P, 1
.
City of Orono ,
Building Permit Application for Maintenance / Renovation
(windows, doors, siding, re-roof, etc.)
Mai/ing Address: Permit number:
O.g,O�O P�Box BB
Crystal Bay, MN 55323-0066 Date received:
r
' ;r ,, Streel Add�ss: Received by:
�� �� G�' 2750 Kelley Parkway Plan review fee;
i � Orono, MN 55356
���H�¢' Total Fee:
Main: 952-249�600 Fax: 852-249�d616 www.ci.orono.mn.�
This application form must be completed in full and all required information must be submitted.
Incomplete epplfcatfons will be returned. (Please printJ
GENERAL INFORMATION:
Job Site Add�ess: q?� � C C��P � ��-� � �
Will thls be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No
Nyss,a specia�event permit is required wirh Police pepartment and City Counc;l approva160 deys prio�to the event. ShutNe bus servioe will be
required unless applicanf demonstrates sufficient on-srte parla�ng is available. Nony�ermitted events will not be ellowed.
CONTRACTOR/APPLICANT INF�RMATION:
Name; �' �h e� ` �3 .�.�.
State LiCense# � C � 3 y 3 �, � _ Expiration Date; — _
Lead Certification Number:�y A� a (p '3 a5—I F�cpiration Date: r-(-a 3 r�s
(for worJc on homas that were construct�d pNor tn 1978
Phone: - (office) (Cel l)
Mailing Address: o�s 1� , ��ty: ZIP: 3
Contact Person: y3 c.�� Applicant is: nNact / Homeowner �ci►�ia o�o►
Email andlor Fax: Cy S �—�� _(�, �
PROPERTY OWNER INFORMATION:
Name: � � � rt2.z-t�'
Phone(day); �- � '
Address: �La C__ _c,�.y�w p-t , 1�•� Clty' p�t_s_,,J � ZIP: S $3�
Email end/or�ax •
PROJECT INFORMATION: , . .,
Type of Project Any earth movement may require
MCWD revlew g permits:
❑Door(s) ❑Remodel ❑Fire Damage Minnehaha Greek Watershed District(MCWD)
❑Re-roof, asphalt ❑Repair ❑Scorm Qamage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑Re-roof, cedar ❑Restoration ❑Water Damage Phone: 952-471-0580
❑Re-roof,other(apecl(y) �Siding ❑Other;(specify) Fax: 9521171-0662
www.minnehahacr �k.om
indaw(s)
Overall ProJect Descriptlon' � ��cA a � � �� o..�5
Estlmated Constructlon Valuation of Project(excluding land) $ '3 0 � q o�
APPLICANT ACKNOWLEDGEMENT:
. Agrees to provide all infortnation required or requested by the Building Department;
• Certifles 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 rejeot It until it is complete;
• Some or all of the information that you are asked to provide on this application is dassified by State law as either private or
confidential. Private data is information which generally cannot be given to the public but can be given �o the subjecl of the
data. Confidential data is information which generally cannot be given to either ihe public or the subject of the data. Our
purpose and intended use of this information is to annually update our tecords 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.
Applicant's Signature: ,f�,1 � �- Ci-..�.a.�,� Date: �/ �'��'I 2___ _