HomeMy WebLinkAbout2010-00985 - windows � CITY OF ORONO PERMIT NO.: 2010-00985
! 2750 KELLEY PARKWAY
ORONO, MN SS3SG- DATE ISSUED: 10/14/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2475 DUNWOODY AVE
PIN : 20-117-23-22-0014
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 006 BLOCK 008
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O!S BUILDING - UNDEFINED
VALUATION : $ 5,095.00
NO'1'E: (9)WINDOW REYLACEMENTS IN GXISTING OYENINGS
APPLICANT PERMIT FEE SCHEDULE 132.75
THE HOME DEPOT A.H.S. STATE SURCHARGE(VALUATION) 5.00
2690 CUMBERLAND PKWY, STE 300
30339- TOTAL 137.75
(763)542-8826
Minnesota State License#: 20268257
OWNER
VICKERMAN, DAVID&V[CKI
2475 DUNWOODY AVE
WAYZATA, MN 55391
AGREEMENT AND SWORN STATEMEIVT
Thc�cork for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and thc
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which rcquires separatc
permi[s. All provisions ol�laws and ordinances governing this type of work
shali be compied with whether or not specitied 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.
I'he applicant is responsible for assuring all required inspections are
requcsted in conformance with the State Building Code.This permit may bc
revoked at any time fol due cause.
���ZLL�-� `�'l. / / </�"�(Q?� / /
Applicant Permilee Signature Date Issued By Sig ture e
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
� �
City of Orono
Building Permit Application for Internai Work
(windows, doors, siding, re-roof, etc.)
---- Mailing Address: Permit number:
�:¢,0,�.� , PO Box 66
O :, O `, Crystal Bay, MN 55323-0066 Date received:
a '�I��`�✓� ,' �, Street Address: Received by:
'$',F, ,���' I,��,� �ti 2750 Kelley Parkway Plan review fee:
��.ykE�;Hog,� Orono, MN 55356
_ = Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete apnlications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: o�� 7 S �(//� GJ O D(t�� �v(,
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required un/ess applicant demonstrates sutficient on-site parking is available. Non-permitted events wil/not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: THD At- Home Seivices, Inc. JDO�r D� ��cl�tJ� ,J0/1a�
State �icense# �690 Cumberland Pkwy, Ste 300 Q$'' 3�S • � o Y7
Phone: ` (cel�)
Mailing Address: Cumberland Office Park ZIP:
Contact Person: Atlanta, GA 30339-3913 iomeowner (Circle One)
Email and/or Fax: Lic#20268257 Ph. 763/ 542-8826
PROPERTY OWNER NFORMATION:
Name: AV( /`�6 n
Phone (day): L (� 3 2 5' ' � L S a
Address: �4'i S U/I w e oC �V �v� City: ���Z Q � ZIP: �S'��/ �
Email and/or Fax
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.or
Overall Project Description: W� n�0 W rt Q U � /) S �'/,S (' ('� .!/� 1 � �S'
Estimated Construction Valuation of Project (excluding land) $ 5 0 q
.
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
required b law. If ou refuse to suppl the information,the ap lication ma not be issued.
ApplicanYs Signature: � Date: y` �` t� �� U
Last Updated: 05-04-2009