HomeMy WebLinkAbout2009-00784 - replace windows CITY OF ORONO PERMIT NO.: 2009-00784
• 2750 KELLEY PARKWAY
� ORONO, MN 55356- DATE ISSUEn: 1U04/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 4760 BAYSIDE RD
PIN : 31-118-23-33-0012
LEGAL DESC : BAYSIDE HILLS
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 48,000.00
NOTE: REPLACE WINDOWS AND REROOF SMALL FLAT ROOF
APPLICANT pERMIT FEE SCHEDULE 660.25
EXCEL CONSTRUCTION LLC STATE SURCHARGE(VALUATION) 24.00
17723 227TH AVE
BIG LAKE, MN 55309- TOTAL 684.25
(651)895-9003
Minnesota State License#: 20391158
OWNER
BARNUM, MARCIA&GREGORY
4760 BAYSIDE RD
MAPLE PLAIN, MN 55359-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifica[ions,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 wficther 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.
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Applicant Permitee Signature ate Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
, Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: �� 8j
g,�,� PO Box 66
Permit number:
0,^ O Crystal Bay, MN 55323-0066 Date received: f� � �
�
� � � � Received b
� ��'��4;;;;� s,�! Street Address: y�
�'.�, �� 4 � Gti 2750 Kelley Parkway Plan review e:
L�kESH04'� Orono, MN 55356
Total Fee. /„Q„1/ �
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us {%O ��`"
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: �l�n �A s�� �r.Q
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic wil e
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION: U' l
Name: �x�-EL_ C�rv s1� v L-ha�v LLC� �1��F r l E��N F,v
State License# 2 039 t 1 S� Expiration Date: 3 z� �a
Phone: ��� - �q 5 -qao3 (office) l,s i - 3 30� `��� (cell)
Mailing Address: 1`1-7 Z3 'Z-'z'1-� Y1v� � Cit : r3; L�►<F ZIP: SS�v
Contact Person: w��•��E }-��;,�,E.� Applicant is: ontrac or / Homeowner (Circle One)
Email and/or Fax: mL��,'.yia,�p f��,�\ Gov�r{'�,�c,�-:�,-� b S
PROPERTY OWNER INFORMATION:
Name: _� -� �M�,n,c.;b �t��.U�w.
Phone (day): !� - �52- `�1�2 - ''? qq�1,. c.al t - (��z _ S�8 - q31�
Address: y't l,b �n�<;�.Q,� �.�. City: ZIP:
Email and/or Fax �bu��,,,,,,,, Q�,�}G�;,,�,, G�,,,,�
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review 8�permits
❑ Door(s) ❑ Remodel �Water Damage
Minnehaha Creek Watershed District(MCWD)
�e]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:
Estimated Construction Valuation of Project(excluding land) $ Q�,00c� • °b
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: _ Date: <<1 yl2�o�
LastUpdated: 05-04-2009