HomeMy WebLinkAbout2011-00298 - windows ` CITY OF ORONO PERMIT NO.: 2011-00298
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE �ssuE�: OS/04/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 744 DICKEY LAKE DR
PIIY : 27-1 18-23-33-0007
LEGAL DESC : RINGERSWOOD
: LOT 004 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
COIYSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ 14,000.00
NO"1'E: REMOVE AND REPLt�CG(14)STORM DAMAGGD WINDOWS
APPLICANT PERMIT FEE SCI-IEDULE 250.75
COMPANION CONSTRUCTION STATE SURCHARGE(VALUATION) 7.00
3305 HARBORLANE N
PLYMOUTH, MN 55447- TOTAL 257.75
(952) 836-4806
Minnesota State License#: 20638527
OWNER
PETTIS, GERALD& ALICE
744 DICKEY LAKE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for�vhich this permit is issued shall be pertormed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is Cor onl��the work described and docs
not grant permission for additional or related work which requires separate
pennits. All provisions ot�la��s and ordinances�overning this type o��work
shall be compied with whether or not specilied hercin.This permit will
cxpire and become null and void if construction authorized is not
commenced within I 80 days of the date of issuance,or if construction is
suspended ibr a period of I 80 days at any time after�vork has commenced.
The applicant is responsible for assuring all required inspcctions are
requested in conformance with the Slate l3uilding Code.This permit may be
revoked at ry.ti ne for due cause.
�--' a,--4'�� s � �' �.�,�,� �'�� �-� _1�(�c�` .J'`� � � �
Appli nt ermitce Signature / Date �
� � 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: Permit number. �Q L
��%%g►�,j��,,� PO Box 66
rf 0 . Q�, Crystal Bay, MN 55323-0066 Date received: /
�r,: -
a '''�?3�� .:.. a. StreetAddress: Received by:
�, % {�`����'•�, G�� 2750 Kelley Parkway Plan review fee:
l��ys%�?��4,,*v� Orono, MN 55356
�,..,�sx_,i .
--- Total F ��"��f �L-j
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.
Incomple�e applications will be returned. (Please print)
GENERAL INFORMATION: /�
Job Site Address: � �' l,C� /J j!'� � yty �, �Q �'I'I/V ss3 �j
Will this be a Parade of Homes�Remodelers Sho case Home or other Display Idbme? Yes No
tf yes,a specia!event permit is required with Police DepaRment and Giry Council approva/60 days pr'�or to the event. Shuttle bus service will be
required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be al/owed.
CONTRACTOR/APPL CANT INFORMATION:
Name: } � LLC,
State License# (0 3 g sa� Expiration Date: G3 �3/� �,lj/d
Lead Certification Number: Expiration Date:
(for work on homes that were consirucied prior fo 1978
Phone: ,3 -. �a -�6 (office) 7G 3�S9v�-' 9 cell)
Mailing Address: �js City: J mG f� ZIP: S"
Contact Person: �, Applicant is: Contrac o / Homeowner �a���one�
Email and/or Fax: , �
PROPERTY OWNER INFORMATION:
Name: G��SIoI ��i s !!Jf�'r�e, ��I�GP
Phone(day): 5'a- - (p�—
Address j,� City: � ZIP: s,s3 �i
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
;�Window(s) ❑ Repair ,�Storm Damage 18202 Minnetonka Blvd
g � Restoration ❑Other: (specify) Deephaven, MN 55391
❑Sidin Phone: 952-471-0590
❑ Re-roof ❑ Fire Damage Fax: 952-471-0682
www.minnehahacreek.or
Overall Project Description: / / y ,S-
Estimated Construction Valuation of Project(excluding land) $ / p
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 altemative
but to reject it until it is complete;
Some or all of the information that you are asked to provide on this application is Gassified 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 govemmental agencies
re uired b law. If ou refuse to su t the information the a lication ma not be issued.
ApplicanYs Signature: Date: US ���'��1/
Last Updated: 03-01-2011