HomeMy WebLinkAbout2012-00410 - windows CITY OF ORONO * 2 0 1 2 - 0 0 4 1 0 *
• 2750 KELLEY PARKWAY DATE ISSUED: OS/15/2012
� � ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2585 LYDIARD AVE
PIN : 20-117-23-11-0003
LEGAL DESC : APPLE HILL
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 5,000.00
NOTE: SIDING AND 9 WINDOWS-2 WINDOWS HAVE STRUCTURAL CHANGE
APPLICANT pERMIT FEE SCHEDULE 118.00
BORISOV,TROFIM&NADIA STATE SURCHARGE(VALUATION) 2.50
4932 NORTHERN ROAD TOTAL 120.50
MOUND,MN 55364
OWNER
BORISOV,TROFIM&NADIA
4932 NORTHERN ROAD
MOUND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which[his 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 which requires separate
pertnits. All provisions of laws and ordinances goveming 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 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 ti for due c e.
� �,�.� , �a , ,
pplic t Permitee Signature Date Issue gnature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
� . � ' City of Orono
Building Permit Application for Maintenance / Renovation
(windows, doors, siding, re-roo�, etc.)
Mailing Address: Permit number:
Og,�,�0 PO Box 66
Crystal Bay, MN 55323-0066 Date received:
a �, Street Address: Received by:
�'� • � GtiF 2750 Kelley Parkway Plan review fee:
r'�gESHo�''� Orono, MN 55356
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 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: Z5$5 �yai�-2d �vE �p/IXIX� �'1/lJ ,$5,33/
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus se ice will be
required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFO MATION:
Name: —t-n,0��r►�t�Nf}'P/i'�' ��OYL[fib✓
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes thaf were construcfed prior t 1978
Phone: � -�j� -?��f (office) (cell)
Mailing Address: LYi�//hQ�d Ciry: / pNo � ',�33
Contact Person: Applicant is: Contractor / meowner �c�►�ie o�e�
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: ���� ����/
Phone(day): �12—702.•58�
Address: ZS'BS �-Y�/A�R.D /��/� c�ry: (�o�v ziP: SS��/
Email and/or Fax N�/A�.7'+t�G-�.vt"� I7orina�L. (�n.,
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits:
Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,asphalt ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd
❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
Phone: 952-471-0590
❑ Re-roof,other(specify) �Siding ❑Other:(specify) Fax: 952-471-0682
Window(s) www.minnehahacreek.orq
Overall Project Description:
Estimated Construction Valuation of Project(excluding land) $ �Ov .Oo
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 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 annually update our records and records of other governmental agencies
re uired b law. If ou refuse to su I the information,the a lication ma not be issued.
ApplicanYs Signature: �� ��1� Date: �����p�D/�
Last Updated: 08-09-2011