HomeMy WebLinkAbout2017-00399 - windows CITY OF ORONO * z 0 1 7 - 0 0 3 9 9 *
, 2750 KELLEY PARKWAY DATE ISSUED: 04/20/2017
ORONO, MN 55356-
� (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1065 FERNDALE RD W
PIN : 02-117-23-43-0021
LEGAL DESC : REG. LAND SURVEY NO. 1372
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 26,158.00
NOTE: REPLACE 7 WINDOVI'S&2 ENTRY DOORS IN EXISTING WINDOWS
APPLICANT PERMIT FEE SCHEDULE 456.25
RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 13.08
1920 COUNTY RD C. WEST MAIL-IN FEE 2.00
ROSEVILLE, MN 55113 TOTAL 471.33
(612)502-4777 Payment(s)
Minnesota State License#: BUIL-BC130983 CREDIT CARD 8788 471.33
OWIYER
DETOR, ELIZABETH&LUCAS
1065 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
S[ate 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 I 80 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 aIl required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. -
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Applicant Permitee Signature Date Issued By Signature Date
�.
. X�,
. Cr� af arona ��,
. Bu�lding Permit Application for Mainten nce`I ��nova#ian
� (windows, door�, sidin , re-ro ,,, etc.)
MaUing Address: '�"� ' �' ,. i�G
��,� PO Sox 66 ��,; Perrnit number: �- �� � � � `
Q Q Crys#al Bay,MN 5�323-OOSB �k+i Date received: �� �
�� �, Sfreet Address: ��4 Recelved by. , '
�, G�' 2750 Keliey ParkwaY ';'E: Plan revfevrr fee_
-��s�dg� Orona, MN 55356 �i''� �.: >
,°,,. To#al�ee: '�;_ ` l� '"i�i
Main: 952-249-4500 Fax= 952-249�B1$ www.Ci.orono.mn.us ,� -
This appGcation form rr;ust be compl�ted in ful[and alf requireci in 'tmation must be submitted. � • ?� �
Incomplete applications wi[i be retu�ed. (P;��ase print) � 1 j�% i ,
G�N�RAL IN�ORMA1'ION: r � , _ 1 ,, F','
Job Site Address: ----- � (�v�Cj ��+(Y��c ��ri �-�.��
Will this be� P�r�de af Homes, Remodelers Showcase Home or other pis ay Home? Yes No
!i yrs,a specia/event permit is required wfth Pol)ce Departmant and Clty Cauncll a�proval BO d�ys pdor fo the evenf. Shutfle 6us senrice wil/be
requfrsad unless appllCant d�monatrxfea acJfPfcient on�ife perlcin�is eVsilable. Non;�e,n,►rrBa�v�m$W;a no�be anowed.
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CONTRACTOR/APPLICANT lNfORMA71dN: :�
Name: 1��@'r���o.\ � 'A`nc�tCSeiN '��i.
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State License# �,��-�oq g� ;�xpiration Date: �j��
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Lead Certifrcation Num6er� �"�� �'�.a$� �� �xpiration Date: �j f�,r
(fnr wnrlr on homgs#/aat were canstruci�ed prlor to 9978 :' '
Phone: (o��-' �(¢C{..t1,0�qn (office) :i;; (cell)
Mailing Addre&s: l�a� CO.��, �•G•� W�S�}' C���Sevt11� ZIP: SSl��
Contact�'erson: Applicant is: � bntra / Homeowner (CfrcSe One)
�ma9i and/or Fax: ,.��, !
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pROP�R'rY ownfER 1NFORMATION: ��!
Name: ��ob��'�' —'--- - :€'
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Pftone(day): "
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Address: � Ci�iar: ZIP:
�mail and/ar Fax ': �
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PRQJECT !N�'ORMATION:
Type of Project: My earth mQvemant may require
'�:
� MCWD re�ew&permits:
❑Door(s) 0 Remodel ❑Fire Damage ''''�,�haha Creek Vllate�shed qistrict(MCWD)
0 Re-rQof,asphalt �] Repair ❑ Storrn Damage �" 18202 Minnetonka Blvd
�Re-rodf,�edar [� Restoration �Water Damsge F;, �eeph�ven, MN 55391
.� Phane: 952-471-D59�
❑Re-�oo�, other(specify) �s�d�n� 0 Other:(specify) •;;;', F�x: 952-471-o6sz
�a� � �(� ;,"� www.minnehshacreek.arq
'�Window(s) u%� :�;,.
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Overall Projec# Description: � o'�? �,�}{ G{p�c� l�', `QJX�S � �
Estimated Ccnstruct9on Valuation of Pro ect exctudln land $ �; �
F,:
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APPLICANT ACKNOWLEDGEMENT: �'I
�;.
. Agrees to provlde all Inform�tlon required or requested by th�Building Dep�rtrrt�nt;
. Certffles that the Informatfon supplied is true ancl correct to the best of h9s/herv�nowledge. The applicant �ecognizes that#hey
are solely resppnslble for submitting a Compfete 2ppf9C�tiort being aware that�r�on faiiure to do sa, the staff has no alfemativ�
buf#o r�ject it untii�t is complets;
���;
• Some or a!I o��he in#orma#ion that you are asked to provide on thfs appllcati''� fs ciasslfled by Steie law as elther prfvate or
confident9al, Privgte data is ini�rmation vvhich generaliy cannot be glven tv t. pubfic but can be given to the subject of the
dafa. Confidentia! dats is infiormaUon which ganerally cannot be given ta e' er the public or the subject of tfie data. bur
purpase �nd intended us� of#his information is to annually update our recoc�$ and records of ather govemmental egencies
re uired b iaw, If ou rofuse to su I the information,the a fication ma na�'�e issued.
AAnfican#'s 5ianature: ��� ;;.''. D2te: �U���� ��
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