HomeMy WebLinkAbout2013-00951 - windows CITY OF ORONO * 2 0 1 3 - 0 PJ 9 5 1 *
2750 KELLEY PARKWAY DATE ISSUED: 09/13/2013
' ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 600 BIG ISLAND
PTN : 22-117-23-31-0034
LEGAL DESC : ISLAND POINTE
: LOT 003 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS ��,�<; �,.%,.s`k`�,
VALUATION : $ 10,780.00
NOTG: REPLACE 8 WINDOWS IN EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 206.50
RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 5.39
1920 COUNTY RD C. WEST
ROSEVILLE, MN 551 13 MAIL-IN FEE 2.00
(612)502-4777 TOTAL 213.89
Minnesota State License#: BC130983 PAID WITH CC# 8788
OWNER
ADAMS, DONNA L
203 MILL ST#202
EXCELSIOR, MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
Sta[e Building Code. This permit is for only the work describcd 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 not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days oY 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�he State Building Code.This permit may be
revoked a[any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued Si ture Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
, `��'►�� �3� 1�
� City of Orono �
Buitding Permit Application for Maintenance I Renovation
(window�, dQors, siding, re-roof, etc.}
�O �` Mailing Address:
��r PQ 9ox 66 Permit number: q�b I 3 — 0 0 g J�
Q �. Q Crysial 8ay� MN 55323-0066 Date received: 9- �
� _� � StreefAddress,- Reoeived by:
� ' �'` 275Q Kelley Parkway
�g�o$� Orona, MN 55356 Plan review fee;
` 'Main: 952-249-4600 Fayc: 952-249�616 Total Fee: a j �. �G �G ,
www.ci.orono.mn us �
This application form must be cainpleted in full and all required information must be submitted_
Incomplete ap,plications will be returned. (Please priRt)
GENERpL INFORMATIQN:
Job Site Address: �pQQ � 0.
Wil�this be a Parade of Homes, Remodeler� owcase Home or other Display Home? Yes No
yes,a special event pennit is raq�l�d with Police Deparfinenf and City Council approval 6p days prior to the evenf Shuftle bus sarvice wr(1 be
iequired unless applicanf demonstrates su!/Iciern on-site parking is available. Non-permittetl evenfs wi!!not be aJ/owed,
CONTRACTOR!AP,�R{LICANT IMFORMATION:
Name: a.1 'Av��rSe�
State License# �G130q g'3 Expiration Date:
Lead Gertification Number. '✓�' 131
� �� a �'�$� " Expiration Date: Y
(for wwk on homes that were consiructed priqr to 7978
Phone: (05�— a(p�.�—�O$�Q. � (office)
Mailing Address: ,� „ �"� (cell)
�9 a C . � c wes�t- c�ty:�osc.v;� e Z1p: ss i
Contact Person: Applicant is: ntractor / Nomeowner
Emaii andlor Fax: �c����eo►�e)
PROPERTY OWNER �NFORMATIQN:
Name: ��,�� �L���
Phone(day):
Address:
Ernail and/or Fax � C�ty� ZIP:
PROJECT INFORMATION:
Type of Project:
Any earth movement may require
❑ Door(s) ❑ Remodel Q Fire Damage MCWD review 8 permits:
❑ Re-roof, as halt Minnehaha Creek Watershed District{MCWD)
P ❑ Repair d Storm Damage 18202 Minnetonka B1vd
❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven, MN 5539i
❑ Re-roof,other(specify) ❑Sidin Phone: 952-477-0590
9 ❑ Oiher: (specify) Fax: 952-471-0682
❑Window(s) www.minnehahacreek orq
Overall Project Description: � _ ,
Estimated Construction Valuation of Pro'ect ��'�
� (iexc(uding land) � �d �,p
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide aU informalion required or requested by the Building Deparhnent;
• Cert�es that the information supplied is true and correct to the best of his/her knowledge. The appfica►�t recognizes that they
If are solety responsible for subrnitting a complete applica6on being aware that upon failure to do so, the staff has no altemative
but to reject it until it is complete;
� • Some or ail of the information that you are asked t� provide on this application is classified by State faw as either private or
confidential, Private data is intarmation which generally cannot be given to ihe public but can be given to the subject of the
data. Confidential data is information which generalty can�ot be given to either the public or the subject of the data. Our
� purpose and intended use of this informatiorr is to annually update our records and records of other governmental agencies
required bv law If u refuse to supply the in{��rm2tion,the a lication ma not be issued.
Ao�licant's Sianature: � �] � � /
Date: �p�� 3
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