HomeMy WebLinkAbout2010-01147 - windows � ~ CITY OF ORONO PERMIT NO.: 2010-01147
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1U22/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 106 CHEVY CHASE DR
P[N : 36-118-23-41-0033
LEGAL DESC : HILL O'WAY MANOR
: LOT 028 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BU[LDING -UNDEFINED
VALUATION : $ 17,955.00
N01'E: (10)WINDOWS IN7'O EXIS`I�ING OPEN[NGS ONLY
APPLICANT PERMIT FEE SCHEDULE 309.75
THE WINDOW REPLACEMENT COMPANY STATE SURCHARGE(VALUATION) 8.98
5153 CLEAR SPRING DRIVE
MINNETONKA, MN 55345- TOTAL 318.73
(952)934-0005
Minnesota State License#: 201 17686
OWNER
JOHNSON, MR. &MRS.
l06 CHEVY CHASE DR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for���hich this permit is issued shall be performed according to
the approved plans ai�d specitications,applicable City approvals,and the
State Building Code. "Chis permit is for only the work described and does
not grant permission for additional or related work which requires separate
pennits. All provisions of laws and ordinanees governing this type of work
shall bc compied with wheUier 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 ii'construction is
suspended for a period of 180 days at any time after work has commenced.
"I�he applicant is responsible for assuring all required inspections are
� requested in conformance with the State Building Code.This pennit may be
� revok at any time for ue cause.
� l� l ZZ l / � �l �l / LJ
Applicant Permitee ignat Date s e By Signature Date
SEPARATE PERM[TS REQUIRED FOR WORK THER THAN DESCRIBED ABOVE.
� �" City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
�,�,� PO Box 66
O � O 1 Crystal Bay, MN 55323-0066 Date received: r
�.' � Received by:
,� ,'� ,�-��, a StreetAddress:
'$`.�, 6� Gti 2750 Kelley Parkway Plan review fee:
L`9kESHog'� Orono, MN 55356
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:
Job Site Address: � � Co C 1���� �., C �� �Q � :� • ,
Will this be a Parade of Homes, Remodelers Showca e 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 service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �1,.o (,�; „. d�,•--�� 2.�.0 l � w`�� C�-�.n c�,�N
State License# 2�, i�� �,�� Expiration Da e: ,3/�i /i�
Phone: q �'Z� � 3 y- o o � � (office) �c Z - �� 5 - y� 3 � (cell)
Mailing Address: � �-3 ''.� Cit : � � ZIP: �'-S"-3 .i�
Contact Person: `l( Applicant is: on rac o Homeowner (Circle One)
Email and/or Fax: �_-I-e : l� @ �,.��,�� �. . ( ��-e � Q . �-- � . �,�-._._.�
PROPERTY OWNER INFORMATION:
Name: ,(��.. �< < J o I.�.... ��
Phone (day): ��2 � y � 6 - y 1 >,
Address: ��� C�..� , C � � _�'1s . City: �;-�c�s�c ZIP: SS"3� 1
Email and/or Fax �_s A�s �I��<,�1„ 5 �--- �
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: �p �„� � S .- eki s fi ;.,- s � 'l.
Estimated Construction Valuation of Project(exc ding land) $ �'� ,�i S S� , s--�
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.
Applicant's Signature: � � Date: jf �2 Z�/ �
�
Last Updated: 05-04-2009