HomeMy WebLinkAbout2016-01285 - windows �� ' CITY OF ORONO * 2 0 1 6 - 0 1 Z 8 5 *
2750 KELLEY PARKWAY DATE ISSUED: 10/1U2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1055 FERNDALE RD W
PIN : 02-117-23-43-0029
LEGAL DESC : N/A
: LOT MB BLOCK MB
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 28,699.00
NOTE: REPLACE 5 WINDOWS IN EXISTING OPENINGS
APPL[CANT PERMIT EEE SCHEDULE 478.83
STATE SURCHARGE(VALUATION) 14.35
SCHERER BROS LUMBER MAIL-IN FEE 2.00
10751 EXCELSIOR BLVD
HOPKINS,MN 55343 TOTAL 495.18
(952)277-1600 Payment(s)
Minnesota State License#: BUIL-BC239369 CREDIT CARD 3281 495.18
OWNER
MCCOURTNEY,GERALD&KAREN
1055 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 Building Code. This permit is for only the work described 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 of the date of issuance,or if construction is
suspended 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[3uilding Code.This permiC may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Sign ture Date
Oci, 6, 2016 4; O1PM �c, 3086 P. 1
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Ci�y of Orono c-� � n�
Buildin g P��mit A p plication for IIlfaintenance/ Re placement/ Remodel —Resid�ntial QN�Y
�i,�. wir�dows, duors, siding, re-raof, etc.—N�STRUC7URAL EXPAfdSIOP�)
Mailing Addr�ess: �� � � ,�...a „ /��
���� Permct n1�mb r
PO Box 66
Crystal Bay,MN 55323-0066 D.�ie:i'eceive�d � �p
Strsef Address: Received py :
�� ti 2750 Kelley Parkway P��n:,rev�eW f�a
�
� G Orono, MN 55356 . �
�Ksst�o�`�' T�C21 Fee
Msin: 952-249-4600 Fax; 952-2ag-4616 www.ci.orono.mn.us -'x
. . .,,,. ._,. . ..
This app[ication form must be completed in full and all required information must be submittad.
Incomplete applications will be returned. (f'Iease print)
GENERAL INFORMATION: J
Job Site Address: y�� T 1� '`� �
Will this be a parade of Homes,Remodelers ShoWCase Home or other Display Home7 ❑Yes No
If yes,a special event permrt is raqulrvd with Police Depedment and Clty Council approval fi0 days pnor to the event. Shuttle bus service wi0 be
required unless applicant demonstrates sufficlenC on-s,Ye parking rs avaifable. /Von-permitted events wlll not be allowed.
CONTRACTOR/APPLICAN7 INFORMA7 ON:
Name: � -e�. ��
State License# � Expiration Date:
Lead Certificatfon Number� '2 � �- Expiration Date:
(for work on homes that were construcfed prlor to 1978 � _��^ ^� ��c7
Phone: (ca11) (office� �J 1 i�
Mailing Address: City:� � ZIP�
Contact Person: Y' y-�� Applicant is: ontractvr / Homeownec �c�r��aono�
Email and/or Fax: r'
PROP�RTY OWN INFORMATION:
Name: ((` ��
Phone(day): Q �
Address:. • City: Zlp:
Email and/or Fax�
PROJECT INFORMATION; overall ydect descri tlon: � � � (,�' �� ( � ��� Z-
Type of ProJect: Any earth movement may also requlre � �/1,�
❑Door(s) �Remodel ❑Fire Damag� MGWp revlew&permits: �
❑Re-roof,asphalt ❑aepair ❑Storm Damage Minnehaha Creek Watelshed Dlstrict(MCWD)
15320 Minnetohka Blvd
❑Re-rooF,cedar [J Restoralion ❑Water Damage Minnetonka, MN 55345
[]Re-roof,other(spec�sy) ❑Siding ❑Qther:(specify) Phona; 952-471-0590
Fax; 952-471-0682
❑Wlndow(s) .minnehahacreek.or
Estlmated Construction Valuation of f'roject(eXcluding land) $ �
APPLICANT ACKNOWL�AG�M�NT:
• Agrees to provide afl information required or requested by the Buflding Depattment;
• Gartifes that fhe informa�ion supplied Is true and correCt to the best oF hislher knowledge. The app{icant recognizes that they are
solely responsible for submitting a comple(e application being aware that upon failure to do so,the staff has no alternatEve bul to
reject it until it is complete;
• 5ome or al1 of the inFormation that you are asked to provfde on this applicatian is classified by State law as either private or
confdential. Prlvale data is information which generally cannot be piven to the public but can be given to the subject of the data.
Confidential data is information which generally cannot be glven t0 eilher the public or the subject of the data. OuP purpose and ,
� intended use of thls Information is to annually update our r�cords and records of other governmentai agencies required by law. IF ,
ou refuse to su 1 the information th a lication ma not be Issued. . I
Applicant's Signature: i � bate� �
I
Owner's Signature; �ate� �I
Last UptlaCed�January 2018