HomeMy WebLinkAbout2016-01182 - windows CITY OF ORONO * 2 0 1 6 - PJ 1 1 8 z *
2750 KELLEY PARKWAY DATE ISSUED: 09/28/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 140 GOLDEN VIEW DR
PIN : 33-118-23-43-0023
LEGAL DESC : HALLSON ESTATES 2ND ADDN
: LOT 002 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCT[ON TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 8,506.00
NOTE: REPLACE(5)WINDOWS
APPL[CANT PERMIT FEE SCHEDULE 185.83
PELLA NORTHLAND STATE SURCHARGE(VALUATION) 425
15300 25TH AVE N. -SUiTE# 100 MAIL-IN FEE 2.00
PLYMOUTH, MN 55447- TOTAL 192.08
(952)345-6047 Payment(s)
Minnesota State License#: BUIL-BC645090 CHECK 75989 192.08
OWNER
H[CKOK,CHRIS& ELIZABETH
140 GOLDEN VIEW DR
LONG LAKE, MN 55356
AGREEMEIYT 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�vhich 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 I80 days of the date of issuance,or if construction is
suspended for a period of 1 AO days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requcsted in conformance with the State Building Code.This permit may be ,�
revoked at any time for due cause. ���
� _ /) :___
M(�l,l � (�ll�.� 1�(=%�-=�u�l- / �-,�-�� ��i `�-c� j�
Applicant Permitee Signature Date Issued By Signature Date
� S��P��23/201b/r RI 10� ?8 ?.'��` Elder Jones Bui lding FA� N�, 95? 854 7°C� P, G02
�ity o� �rono
Building Permit Application far Maintenance / Replacemenfi! Remodel �- Residen�pal �NLY
(i.e, wirtdows, doors, siding, re�roof, etc. � NO STRUCTURAL EXPANSlON}
�O A T Mailing Address: � ��/�Q �
�Vr-� PO Box 66
Permit numbsr. v
u Crystel Bay, MN 55323-00$6 Qate recefved: �
Stroet Addres5: Received by:
y 2750 Kelle Parkwa
`� �� Orono, MN 55356 y Pfan revfew fee:
���Fs�o�� i 9a��
Total Fes:
Maln: 952-249-4600 Fax: 952�249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required inforrrtatlon must be submitted.
Incomplete applications wlll b�returned. (Please prini)
G�NERAL INFORMA710N:��� G � ��� n ��
Job Site Address: �) a �,�J
Wfll this be a Parade of Homes, Remodelers Showcase Home or other plsplay Home? Yes No
!f yes,a spsc/a!ovent permlt!s requlred wifh Pofrce Depaiiment and Clty Councll approval 60 days prior to the evsnt. Shutfle bus service w:!!bs
required unless applicant demonstrates sufftclent on-site parking is availabls. Non-psrmlfted events wil!nat be allowsd.
CONTRACTORlAPPL1CANT INFQR,MATION:
Name:
State License# ^ PeI1a Northlaz�d Expiration Date:
Lead certi�ication Numl XS300 25th A,ve N. Ste 200 � �xpiration oate:
{for work on f�om�s f� P�}��aouth, MN 55447 `"—
Phone: (ce Lic#�BC645090 P11. 7G3/7�5-1400 (oTfice)
Mailing Address: zIP'
Contact Person: Applicant • Contractor / Homeowner (Clrcle Onc)
Em�il andlor Fax: n�Sj � �� �
PROPERTY OWNER(NFC?RM,ATION:
Name: �
Phone(day): � 4 . � b
Address: � / l� a t C ,�l City; � On �Q�G zIP: s'�'3 5'L
Email and/or Fax:
PROJECT INFORMATI�N: Overall project descriptic�n:
Type of Project: Any earth movement may also reguire
❑ Door(s} ❑Ramodel Q Fire Damage MCWD review&permits:
❑ Re-roof,asphalt ❑ Repair ❑Storm Damaqe Minnehaha Creek Watershed pistrict(MCWD)
0 Re-roof,cedar 15320 Minnetonka Blvd
� Restoratian ❑Water Damac�e Minnetonka, MN 55345
(�Re-roof,othar{specify} []Siding �� ❑�ther:(speoify) Phone: 952�71-059a
( r5') Fax: 952-47'(-0682
�Window{s�� � www.minnehahacreek.ora
Estimated Construction Valuation of Project (excEuding land) $ O l.
ApPLICANT ACKNOWLEDGEMENT;
• Agrees to provide all information required or requested by the Building Deparfinent;
. Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that fhey are
solely responsible for submitting a complete apnficatlon being awaro that upon failure to do so, the staff has no aiternative But ta
reject[t until it is compl�te;
� 5ome or all of the information tl�at you are asked to providE on this application Is classified by State law as either private or
confidential. Private data is informa4ion whlch generally cannot be given to the public but can be given to the subJect of the data.
Confidential data is information which c�enerally cannot bo given to either the public or the subj�ct of the data. Our purpos� and
(nfended use of this information is to annuafly update our records and records of other governmenta!agencies required by law. If
ou refuse to su I the informatlon,the ap lication ma not be issued.
ApplicanYs Slgnature: �'r�--� bate: '� � / �'
Qwner's SEgnature; C]ate:
�ast Updated:January 2016
� �� ��j . DATE TIME
CITY ONO dGrL�ED IN y
(NS TION N TIC SCHEDULED --�!��,�[r� �
PERMIT NO. � ����OMPLETED
ADDRESS I �T� ��(�;�l',�/� �f�.� I
OWNER TELEP�O O. ���� ��i9-y���
CONTRACTOR l
� DESCRIPTION /"� /f��-/ ��� /��S
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL /
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
r INAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
J ❑ DEMO-SITE ❑ �S TIC INSTALL
2 O'MINFN/CONTRACTOR TO MEET Y�OU:�YES_NO
y COMMENTS: �_
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W ❑WORK SATISFACTORY:PROCEED �OJECT COMPLEfE
� ❑CORRECT WORK 3 PROCEED O ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑CORRECT VYORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CdVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (g52) 249-48��
OwnerlContractor on site:
Inspector: � "�
White Copyllnspector's File Canary CopylSM�Notice