HomeMy WebLinkAbout2014-00224 - windows ` � CITY OF ORONO
2750 KELLEY PARKWAY * z 0 1 4 - PJ 0 2 2 4 *
DATE ISSUED: 03/20/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 980 FERNDALE RD W
PIN : 02-117-23-44-0019
LEGAL DESC : COUNTRY CLUB ESTATES
: LO'I� 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ 23,467.00
NOTE: WINDOW REPLACF.MLN"1
APPLICANT PERMIT FEE SCHEDULE 39825
STATE SURCHARGE(VALUATION) 1 1.73
APEX ENERGY SOLUTIONS MAIL-IN FEE 2.00
8400 NORMANDALE LAKE BLVD#920
BLOOMINGTON, MN 55431- TOTAL 411.98
(651)688-2739 Payment(s)
CRGDIT CARD 5542 411.98
OWNER
SAFAR, JACK& PAMELA
980 FERNDALE RD W
WAYZATA, MN 55391-
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
State E3uilding Code. This permit is tbr only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specitied herein."I�his permit will
expire and become null and void it�construction authorized is not
commenced within 180 days ot�the date of issuance,or if construction is
suspendcd for a period of 180 days at any time after work has commenced_
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
' � � � /� � � � 7"
C � �
Applicant Permitee Signature Date Issued y Signature Date
To�. Paye 3 oT 3 Z0�4-03-20 '1�1:0'I:'10(GMT) From: Apex Ener'JY Solutlons
Gity of Qrono
Building Permit Application for Maintenance / Repiacement / Renovation
(No structural expansion. �nly windows, doors, siding, re-roof, etc.)
j%",�� �'� Mailing Address: permit number: o�� -�p�.
� ��\ PO Box 66
� � Crystal Bay, MN 55323-OQ66 Date received: � '" —
� �,
� ,, ! Streef Address: Received by:
�'. 1 `% 2750 Kelley Parkway Pfan review fee:
�`��q a`�'1� t.`' ' Orono, MN 55356 � �
�FSHVF,� Total Fee: ��� �O
Main: 952-249-4600 Fax: 952-249-4616 v�n,;�ci.orono.r�;7.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please prrnt)
GENERAL tNFORMATION• �1 ..�-
Job Site Address: ��t-f � S'�-�nc�{G��'e-,
WiH this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No
If yes,a special event permit is requimd with Police Department and City Council approval 60 days prior to the event. Shuttle bus service Unll be
required unless applicant demonstrates su�cienf on-site parking rs availabJe. Non-permitted events wiN not be allowed.
CONTRACTOR!APPLICANT INFORMATION:
Name: �1-Fu-x �i���Gi t,� ..s�f�i�`rL,S
State License# ��r����(,}.� �� �'x��¢>� Expiration Date: ---
Lead Certification IVumber: /.!f}T' - �j ��i 3�-1_. Expiration Date� yn�,,.T t� ��t�
(for work on homes that were constructed prior fo 1978 �—
Phone: (cel�) /�,Si -SG�� --��/ :3`i (affice)
MailingAddress: ,�'�fpU /�lr��'m4��:Zccl� c �j1V� Sui'� �f,2;; City ,,,�'3Jo,;rr�i�y�'f�'�- Z1P� �ti,:37
Contaet Person: ��zY-�{ (ic J��r- Applicant is: Contractor / Homeowner (CirdeOnej
Emai!and/or Fax: C��tE'�()�v`�C i�rti3�� ���t'r}
_. � �___._._____._._.__.
PROPERTY OWIVER INFORMATIOIV:
Name: f CR h'� .Si2-f�Y'
( Y)= 1� �:3S'L^"_��`�__�_ ,
Phone da ��
Address: G' C� \!�) �f c+r"f'�G�QM� � ��'tY= (�"�L�C ZIP: "J`�J.�f�
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
- ._
Type of Project: Any earth movement may also require
❑Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof,asphalt ❑Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWDj
18202 Minnetanka Blvd
❑Re-roof,cedar ❑Restoration ❑Water Damage � Deephaven,MN 55391
❑Re-roof,other(specify) ❑Siding ❑ Other(specify) Phone: 952-471-0590
Fax: 952-471-0682
[�Window(s) , wwed minnehal�a�reek orr,
Estimated Construction Valuation of Project(excluding land} $ _:,,�3� c�, '�,Gt�
APPLICANT AGKNOWLEDGEMENT:
__...
• Agrees to provide all information required or requested by the Building Department;
• Certifies that the informa8on supplied is true and correc:t to the best of hisJher knowledge. The applicant recognizes that they are ;
solely responsible for submitting a complete application being aware that upon faiture 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 �
confidentiaf. Private data is information which generally cannot be given to the public but can be given to the subject of the data.
Confidentia(data is information which generally cannot be given to either the public or the subject of the data. Our purpose and i
intended use of this information is to annually update our records and records of other govemmental agencies required by law. ff
ou refuse to su pl he informati the a n ma not be issued.
,, , � ;: , - �7
ApplicanYs Signat�r'e:,- .."<, '_.:�. `- ��::,� , r -' / -----�.,�__ �ate: , r�. J,
�....�.,_ `
/_
Owner's Signature� Date:
Last Updated:03J06l2013