HomeMy WebLinkAbout2010-01154 - windows ." �,'
CITY OF ORONO PERMIT NO.: 2010-01154
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �ssUEn: 11/23/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 142 CHEVY CHASE DR
PIN : 36-118-23-41-0044
LEGAL DESC : HILL O'WAY MANOR
: LOT 000 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACT[VITY : O/S BUILDING - UNDEFINED
VALUATION : $ 17,269.00
NOTE:
(12)WINDOW REPLACFMENTS INTO F_XISTING OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 309.75
PELLA WINDOWS& DOORS STATE SURCHARGE(VALUATION) 8.63
1�300 25TH AVE N. -SUITE# 100
PLYMOUTH, MN �5447 TOTAL 318.38
(952)345-6047 PAID WITH CC# 0166
Minnesota State License#: 20165884
OWNER
SIMPSON, MICHAEL
142 CHEVY CHASE DRIVE
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The���ork for���hich this permit is issued shal�be performed according to
the approved plans and specifications,applicable City approvals,and the
State[�uilding Code. 'fhis permit is for only the work described and does
not grant permission for additional or related work���hich requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or nol specified hercin.This permi[will
expire and become null and void if construction autliorized is no[
commenced within 180 days of U�e date of issuance,or if 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 conlormance with the SLale Building Code.This permit may be
rev d at any time for due •ause.
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Applicant crmitee Sig ture Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NOVr'23/2C�?0/TUE 01 � 26 PM P. �02
j Cifiy af Orono .
� Building PermNt Application for tnternal Work . . .. �
; � (wir�dows, doors, siding, re-roof, efc.) � �
, . Mailing Address; Permit nUmber: '�U �� �
.¢,Q�, PO Box.�6 .
O � �Crystal Qay, MN 55323-0066 Date re�eived: ID
��'. � �. ' Received by: .
� �,, Streef Addross: .
` ,r��• 2750 Kallcy Parkway Plan�revlew fe :
�`t���s���'�,�� . Orono.MN 55356 • . ,
Total Fee: �i � �� 3 R
Main: 952-249-4600 �ax; 952-249-4618 www.cl.orono.mn.us U
This application form must be completed in full and all required Information musc be submitted. . .� � . . ,
. � Incomplete applications will be returned. (Plesse print) ' . . .
G�N� AL INFORMATION: � � .�. �
J.ob Si�e Address: � � � � ��0 V L� C�Q ,�,C. �/�/ �.L. . . �
Will this be a Parade of Horr�es Remodel�rs Showcase Home or other D�splay Nome7 � Yes.. O�No . �
r,. _ .. . .. : . . _ . � � .
..
!f yes,a special evan(permlf is requ r��ollce�itment a�tli -CllyCimrreU�approval-8�-day��pYlo�ta-�ne-�ver�t�MaFUe-pu,s�servi�e-wil�b„ •• •
fequllBd unless appliCenr tlemonstrateS SU117Clenf on�ite parlcing ia evallebla. Non-pormlusd'event8 wlll nof be P!lowpd- ' . :
CONTRACTOR/APPLICANT INFCfRMAT10N: � • � ,
Name: � ' . . , ' OC�� Q� � !/� 0/)XS
State �icense# � _Pe��a WiiZdovvs &T�ooXs , q' � y s - d �� � � � " .
Phone: 15300 25t1�Ave N. Ste 100 . � (c�'0)
Mailing ddress� ; �p�ya�outh,MI�55�4�4� • ZIP; � , '
Gont�ct erson: .lomeowner �ci�aa o�e�
�m�i� a /or Fax� Lxc#201658841'11. 763/745�1400 , � � � � - � . .
PR�P��TY OWN�R,iA�ORM 710N: ' . - :
Naine: _ / �!l l' �4-L � S1M 5 0 � . ,
Phone (�ay): 1 y o • S L .
Address: / v 4 S�L �!' ci : � zIP:
Email and/or Fax ` � . � � ��
PR0.IECT INFORMATION: qn �eartn'movemene ma re ulre
Type of ProJect: y y 9
MCWD review S permlts .
❑ Doof(s) ❑Rmmodel � ❑Water Demago . .
Minnehaha C�eek Watershed District(MCWD)
Window(s) Repalr ❑Storm Damape . 18202 Mlnnetonka Blvd
Desphaven, MN 55391
❑ Slding ❑ Restoration ❑ Other:(specify) � �• �Phone: 952-471-0590� . ..
Fax: 95Z-471-0662 -
❑ R8-foof ❑ Fire Damage wvwv.min ahacr ek.o
Overall Pro'ect Description: L�) � 0�l.�f /'( �/-l''1e f � � �. k�� �.�1
�sYimated Construction Vsluation of Pro'ect eXcludin la d $ � ' " ' � ' �' � " � -,'
� ( g ) � / 7',: �'. b �:
App�ICANT ACKNOWLEDGEMENT: � • �
� Agrees to provlde al!inforrnation requlred or requested by the Bulldf�g Department; . . � � � � �
.. • C.1ertifies Ihat tha inforrnatlon supplled is true 2nd correct to the best of his�her knowledAe. The applicant recognizes ihat th6y
are sorely responsibi�for aubrn�tting a complete aDPIICation�being awafe that upon failure to do So, the sts�F�hes no alternative
b�ut to reject it until it IS COmplete; , �
. Some or aJ( oi the information that you are asked to provlde on this appllcation is classlfied by State law as either private or
cvnfidcntial. Private data Is informatlon whiah genewally cannOt b� given to the public but cen be given to the subject of the
data. Contidential data is information whlch generally cannot be glven to either the public or the subject of the data. Our ��
pNrpose and iniended use of this Information Is to annually update our records and records of other governmental agencles
f6qulred b 18W. If ou refuse t0 su I the inforrnatlon,the a Iic�Slon ma not be issuea. ,
' �- � �� �� � t� o .
ApplicanY Signature: � Dst�:
Lasc Update : 05•04-2009 �
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