HomeMy WebLinkAbout2014-00810 - windows CITY OF ORONO * z 0 1 4 - 0 0 8 1 v� *
�.. 27_50 KELLEY PARKWAY DATE [SSUED: 07/29/2014
, ORONO, MN _55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2245 FRENCH LAKE RD
PIN : 10-117-23-22-0004
LEGAL DESC : JOHNSTONS FRENCH LAKE
: LOT 001 BLOCK 001
PERMIT TYPF, : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING - UNDF,FINED
VALUATION : � 5,000.00
APPLICANT PERMIT FEE SCHEDULE 118.00
STATE SURCHARGE(VALUATION) 2.50
SELA ROOFING& REMODELING, INC. TOTAL 120.50
4100 EXCESIOR BLVD
ST. LOUIS PARK, MN 55416- Payment(s)
(952)915-7227 CHECK 34700 120.50
Minnesota State License#: BUIL-BC 1050
OWNER
KLAMMER,JOHN& SARAH
2245 FRENCH LAKE RD
WAY7.ATA, MN 55391
AGREEMENT AND SWORN STATEMENT
I�he work for which this pennit is issued shall bc perfonned according to
the approved plans and specitications,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 separale
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specificd herein.This permit will
expire and become null and void if construction authorized is not
commenced�vithin 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any timc after work has commenced.
The applicant is responsible for assuring all rcquired inspections are
requested in conformance with the State Building Code.This permit may be
rcvokcd at any tin �for du�_�tuSe.
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Applica rm�tee Signature Date lssued By Sign u c � j�7 Date
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, • City of Orono
Building Permit Application for Maintenance 1 Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
Q Mailing Address: Permit number:
PO Box 66
� � Crystal Bay, MN 55323-0066 Date received:
Received by:
Street Address:
2750 Kelley Parkway Plan review fee:
�� C� Orono,MN 55356
1"�kcsHo`��` 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 applications will be returned. (Please print)
GENERAL INFORMATION: �
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes o
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus rvice will be
repuired unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR 1 AP�LICANT INFORMATION:
Name: V Expiration Date: `j
State License# Expiration Date:
Lead Certification Number: � • "�
(for work on homes that were constructed prior to 1978 (offiCe) • ' � ����
Phone: �ce11) s pK„ ZIP: �j
� City:
Mailing Address: �
Contact Person: Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax: '
PROPERTY OWNER INFORMATION: �
Name:
Phone (day): • City: �� ZIP:
Address: _�
Email and/or Fax:
PROJECT INFORMATION: Overall pro'ect description: v `^"'
Any earth movement may also require
Type of Project: MCWD review&permits:
❑Door(s) ❑Remodel ❑ Fire Damage
Minnehaha Creek Watershed District(MCWD)
❑Re-roof,asphalt ❑Repair ❑Storm Damage 18202 Minnetonka Blvd
Water Dama e Deephaven, MN 55391
❑Re-roof,cedar ❑Restoration ❑ g Phone: 952-471-0590
❑Re-roof,other(specify) ❑Siding ❑Other: (specify) Fax: 952-471-0682
�ndow(s)
www. innehahacreek.or
Estimated Construction Valuation of Project(excluding land) $
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 u date our records and records of other governmental agencies required by law. If
ou refuse to su I e�i ation,th '�" 1ic 'on a not be issued.
Applicant's Signature:
Date:
Owner's Signature:
Date:
Last Updated:03/06/2013