HomeMy WebLinkAbout2017-00398 - windows CITY OF ORONO * 2 0 1 7 - 0 0 3 9 8 *
, , 2750 KELLEY PARKWAY DATE ISSUED: 04/20/2017
� ORONO, MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 825 FOREST ARMS LA
PIIV : 07-117-23-12-0011
LEGAL DESC : FOREST ARMS
: LOT 003 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 10,000.00
NOTE: REPLACE(1)WINDOWS INTO EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 20132
STATE SURCHARGE(VALUATION) 5.00
NIEMELA CONSTRUCTION INC.
5765 QUAM AVE NE TOTAL 206.32
OTSEGO,MN 55330- Payment(s)
(612)532-7956 CREDIT CARD 7996 20632
Minnesota State License#: BUIL-BC602194
OWNER
BRANDENBURG,NATHAN&BETH
825 FOREST ARMS LA
MOiJND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additionai 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 witl
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 Building Code.This permit may be
revoked at any time for due cause.
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App�c Pe Date Issued B ignature Date
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�uifcling �errnit Appiication for I�lGaintenance / Replacerv�ent / Remode! — Resident��l OFVLV
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�o� Mailing Address: Permit number: �/7�� �j
O PO Box 66
Crystal Bay, MN 55323-0066 Date received: ! 20 �
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Street Address: Received by:
ti� � 2750 Kelley Parkway Plan review fee:
t L Orono, MN 55356
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Total Fee: a��i��
Main: 952-249-4600 Fax: 952-249-4616 vvv,��.^:.ci.oronc.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications wrill be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: ��5 �rC�� ��.M L�,,.r e � /✓�c,✓ni 4'
Will this be a Parade of Homes, Remocfelers Showcase Home or other Display Home? ❑Yes �No
lf yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATIOIV:
Name: ; e(� Cc�„i , � ' 1ivC
State License# � �,�p a (� � Expiration Date: 3 3 a0
Lead Certification Number: Expiration Date:
(for work on homes fhat were constructed prior to 1978
Phone: (cell) (�„Z 53a 7q,5� (office)
Mailing Address 5�6 v ,� - City: � �f./v� c�„k� � ZIP: ,S5 j 7�
Contact Person: .�Q rt,� �-.� d Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax: �r�� (�-��{:� M� c� CB v,51'luC��oN . �7.�
PROPERTY OWNER INFORMATION:
Name: /�l�`�a,�, U �.r P..I c,�r
Phone (day): 9(� (�(5 3
Address: �, ,� �•,�,� ,� City:� ��, � ZIP: ,5�,5 J��
Email and/or Fax: ,Ja �a,� ru N e,� , �r' r` �
PROJECT INFORIVIATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits:
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other:(specify) Phone: 952-471-0590
Fax: 952-471-0682
�� �Window(s) www.minnehahacreek.OPQ
Estimated Construction Valuation of Project(excluding land) $ 0 D
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 app►icant 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 update our records and records of other governmental agencies required by law. If
ou refuse to su I the information,the a lication ma not be issued.
Applicant's Signature: Date: ��o�d/oZ���
Owner's Signature: Date:
Last Updated:January 2016