HomeMy WebLinkAbout2012-00858 - windows � � - CITY OF ORONO * z 0 1 2 - 0 0 8 5 8 *
2750 KELLEY PARKWAY �ATE �SSUED: 08/30/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2465 FRENCH LAKE RD
PIN : 09-117-23-11-0010
LEGAL DESC : JOHNSTONS FRENCH LAKE 2ND ADDN
: LOT 000 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING- UNDEFINED
VALUATION : $ 11,573.00
NOTE: RI?PLnCE(9)WINDOWS INTO GXISTING OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 221.25
HARMONY HOMES INC. STATE SURCHARGE(VALUATION) 5.79
1120 WINTER ST. NE
MINNEAPOLIS, MN 55413- MAIL-IN FEE 2.00
(763)413-1 I 00 TOTAL 229.04
Minnesota State License#: 20501883 PAID WITH CC# 6157
OWNER
DAYTON, ROBERT&JOAN
1 FRENCH LAKE RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issucd shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State[3uilding 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 specitied herein.This permit will
expire and become nuli and void if construction au[horized is not
commenced within 130 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 confonnance witii the State Building Code.This permit may bc
revoked at any time for due cause.
C�7ti�(:Gt.t,��d � �l�O / l� �1'U�i� 8/�� l l�
Applicant Pcrmitee Sign re Date Issuc y Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
AUG. 29, 2012 1 : 02PM SHAW/STEWART LUMBER 6514884791 N0. 079 P, 2
� -
Cifiy o� Orono
Building Permit Applica�ion for Internal Work
(windows, doors, siding, re-roof, etc.)
.�,�,� M�,II PO Box 66, Perrr�it�number:
O O Crystal 6ay,MN 55323-0066 Da'fe received:
� a Stree!Address: Receiv�d b,y:
G� 2750 Kelley Parkway Plan revaew fee:
�,�g�og� Orono,MN 55356 �
Tbtal FOe:
Main: 952-249-4600 Fax: 952-24914616 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: 2y4 S �/�6xk C,A�E eD
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Mome? Yes No
If yes,a speciel event permit Is required with Police Department and Gty Council approve/60 days prior to the event. Shuttle bus servica wlll be
rt�quired unlass applicant demonstrates su�cient on�ite paiking is availsb/e. Non•permitte�d events will not be al/owed.
CONTRACTOR/APPLICANT INFORMATION:
Name: 1-�Ae,Motwt l�� s lN�•
State License# 50�'��3 Expiration Dete: 3��� ?�0►3
Phone: �Lo� y13.1►00 (o�ce) CQ'�Z• 455•SZ3d (cell) _
Mailing Address: t 4Zo w��r�G ST � City; wt�S Z1P= SS'�i i3 _
Contact Person: GH-�aS M�(�2�� Applicant is: Cohtf r� / Homeowner (Clrcic One)
Email and/or Fax: G�c�,w+�rsl�•�+a,.•t +Sl-��-�1�• �'�'�
PROPERN OWNER INFORMA710N:
Name: �ORN ����
Phohe(day): 20-�� $yCv. cov$
Address: z�ic.5 c�McF RD City: �120�+o ZfP: S53°l �
Email and/ot Fax
PROJECT INFORMATfON:
Type of Projert: Any earth movemen't may require
MCVNb review&permits
❑Door(s) �emodel ❑Water Damage
Minneh�ha Creek Watershed District(MCWD)
[�lrindow(s) ❑ Repair ❑ Siorm Damage 18202 Minnetonka Bfvd
Deephaven,MN 55391
❑Siding ❑Restoration ❑Other:(specify) Phone; 952-4,71-0590
Fax: 952-471-0682
❑ Re-roof ❑ Fire Da�mage www.minnehahacr_ ek.orq
Overall ProjeckDescription: �.aS�TwrK q w��bc�s �.+ d�c��T� opc.,qNGs
Estimated Construction Valuation of Project(excluding land) $ � I� S 73.�a
_ �
APPLICANT ACKNOWLEDGEMENT:
. Agrees to provide afl information required or requested by the Building Department;
• CeRifies that the information supplied is true and corred to th� best of his/her knoWledge. The applicapt recogniZes thaY they
are solely resppnsible 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 classified by State law as either private or
con�dentia�. Private data is information which generally eannot be given to the publie but can be given to the subject of 4he
data. Confdential 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 annual update our records and rewrds of other govemmental agencies
re uir`ed b law. If ou refuse to su I the info tion, a lication ma not be issued.
!
Applicant's Signature: Date: ��ZQ/'2
Last Updated: 05-04-2009