HomeMy WebLinkAbout2017-00512 - window / door replacement CITY OF ORONO * z 0 1 7 - 0 0 5 1 z *
' 2750 KELLEY PARKWAY DATE ISSUED: OS/18/2017
. ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3051 FARVIEW LA
PIN : 04-117-23-33-0009
LEGAL DESC : FARVIEW
: LOT 007 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATIOIY : $ 29,000.00
NOTE: WINDOW&DOORS REPLACEMENT
APPLICANT PERMIT FEE SCHEDULE 478.83
STATE SURCHARGE(VALUATION) 14.50
CITIES HOME REMODELERS INC TOTAL 493.33
5395 BAYWOOD SHORES DR
MOUND, MN 55364- Payment(s)
(612)386-7600 CHECK 14898 493.33
Minnesota State License#: cont-BC638869
OWNER
DELANEY, DAVID&FRANCINE
3051 FARViEW LA
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according ro
the approved plans and specifications,applicable Ciry 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 separate
pennits. 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 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer work has commenced.
'rhe applicant is responsible for assuring all required inspections are
requested in conformance with th�State Building Code.This permit may be n�
revoked at any time'for due cause. ,� I l t�;l/
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Applicant Permite � ignature� Date Issued By Signa ure Date
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��ty o� ��on�
��ilcleng Perrt�it A►pp6ic�ti�r� for �aontenance 1 ReplaCement / Remode� — Residential ONLY
' ��.�. �er������, d�s�c�, �f�e��, ��-����9 �f�e � �� �`���C�'fJ�e�;,� �3���,E�������
��� Mailing Address: Permit number: 2(�� � ���2
� PO Box 66
Crystal Bay, MN 55323-0066 Date received: �"� 1' ��
,� � Street Address: Received by: SP
ti�, G� 2750 Kelley Parkway Plan review fee: '—
�qK�SHO��, Orono, MN 55356
Total Fee: 3
Main: 952-249-4600 Fax: 952-249-4616 wU,�v�.ci_oror�o.mn.us .3, 3
This application form must be completed in full and all required information rnust be submitted.
6ncornplete applications will be returned. (P/ease print)
GEIVERAL INFORIVIATION: /
Job Site Address: �C/�) �fV ��' � L�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Fiome? ❑ Yes �;IVo
If yes, a special event permit is required with Police Department a,nd City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. IVon-permitted events will not be allowed.
CONTRACTQR/AFPLICAI�T INFORN{i4TION: /
Name: �� t�t� �b� Vw �"�.( Z��� �`^C
State License# �' '2� � Expiration Date: �
3 - � / Zc`��
Leac! Certification Number: �)�..�- —.�"'<a�r,�� �7_ � Expiration Date: 9 _ � 3 ._... � �-'
(for work on homes that were construcfed prior fo 1978 ��'—
Phone: (cell) ��/2_ ��(p - 7(d �C.� (office)
Mailing Address: " L � 4,,�. �J c � ���� � , City: : .� � ZIP: �- �
Contact Person: p< <r �- � �v Applicant is: Cont�rac_ tor: / Homeowner (Circle One)
Email and/or Fax: � �_ ' � �/ aL, •d
PROPERTY OWNER INFORIVIATIOt�:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORNiA►TION: Overall project description:
Type of Project: Any earth movement may also require
�oor(s) ❑ Remodel ❑ Fire Damage �CWD review 8�permits:
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,cedar 15320 Minnetonka Blvd
❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
Window(s) wvvvv.minnehahacreek orq
Estimated Construction Valuation of Project (excluding land) $ P-�"
APPLICANT ACKNOWLEDGEIVIENT:
• 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 a nually update our records and records of other governmental agencies required by law. If
ou refuse to su I th nfo tion,t lication ma not be issued.
ApplicanYs Signature: Date: ��� � /r Z���
Owner's Signature: Date:
Last Updated:January 2016