HomeMy WebLinkAbout2017-00521 - windows CITY OF ORONO * 2 0 1 7 - 0 0 5 2 1 *
• 2750 KELLEY PARKWAY DATE ISSUED: OS/18/2017
ORONO,MN 55356-
(952 249-4600 FAX: (952) 249-4616
ADDRESS : 3695 LYRIC AVE
PIN : 17-117-23-34-0038
LEGAL DESC : NAVARRO
: LOT 002 BLOCK 003
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 4,943.00
NOTE: REPLACE:6 WMDOWS IN EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 123.87
STATE SURCHARGE(VALUATION) 2.47
BRAGER REMODELING MAIL-IN FEE 2.00
150 W. 88TH ST
#205 TOTAL 128.34
BLOOMINGTON,MN 55420- Payment(s)
(612)866-2888 CREDIT CARD 3084 12834
Minnesota State License#: BUIL-BC635019
OWNER
TURKOWSKY,ROBERT
3695 LYRIC AVE
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed acwrding to
the approved plans and specifications,applicable Ciry approvals,and the
State Building Code. This pertnit 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 hereia This permit will
expire and become null and void if construction authoriaed is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of l80 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. r✓Yr/
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Applicant Permitee Signa re Date Issued By Signature Date
� � City of Orono � �
Building PeRnit Application for Maintenance/ Replacement/Remodel-Residential ONLY
� (i.e. windows, doors, siding, re-roof, etc. -NO STRUCTURAL EXPANSION)
' �O�O Mailing Addiass: �_
PO Box 68 Permit number. �_('`�� ��� �__ )
f Crystal Bay,MN 55323-0066 Date received: �=� -�7
'� � �, � Street Addiess: Received by_ �
' ''� `: 2750 Kelley Pa�tcway Plan review fee:
l�kfSH00.E Orono,MN 55356
Main: 952-249-4600 Fax 952-249-4616 www.ci.orono.mn.us TotalFee: /� (� 3L/
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This application form must be completed in full and all required irNormation must be submitted.
Incomplete appllcations will be retumed. (Please print)
GENERAL INFORMATION:
Job Site Address: �� 5� ` ,E'/ L' �(/�� �(/ s��y�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
11 yea,a speda!eve�n permlt!s�equrred wlth Police Departrr�ent and Crty Council approva�60 da
required untess applicant demonstrates sul�icient on-site parking is available. Non �����e evenL Shuttle Dus seMce wd!be
�ermifted events wil!not be adowed.
CONTRACTOR/APPLICANT INFOg�ATION:
Name: ,gR�}�c/� /�'Er?lc��/EG//1! � �
State License# � ��r p Expiration Date: 3 �j �{jj
Lead Certification Number. -�
_ /I'�%�T— 3� i y� '.� Expiration Date: .�/a�/�o a O
(for work on homes tfrat were constructed prior to l978 �T
Phone: _(�}----------..�.._,_ (office) ( ��)��ib '�02��'�
Mailing Address: / !J �,�/, � ,�.�.�; #a0.5� City; $1nc/run -ti�N ZIP: �� 2D
Contact Person: j-;� ,�pW�/ • Applicant is: Contracior Homeowner �d�ae o�,e�
Email and/or Fax: �,Lr�d�u�i a��nr�;�is"a/t�vi �l✓����Ptr Co/Yl • /.2����"3��.�
PROPERTY OWNER INFORMATION:
Name: O,f3C�T G!/�kO���sfC/
Phone(day): �' /�l �d � ��_
Address: �Qy �!/�i C �f/G /v CitY� (J/e0/�O ZIP: ,�.�39�
Email and/or Fax:
PROJECT INFORMATION: Overall ro"ect description: � LA�iN �v l�ljNdp�d t� `c�c,��j^/� pPPN�/Y9S
Type of Project: �y e�mo�����u�
❑ Door(s) ❑Remodel ❑Fire Damage MC�����Pa+n'��:
❑ Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(M(,yyp)
❑ Re-roof,cedar ❑Restoration ���Minnetonka Blvd
❑Water Damage Minnetonka,MN 55345
❑ Re-roof,other(specif� ❑Siding ❑Other.(specify) PhOne: 952-d71-0590
IJ Window(s) Fa�c 952�71-0682
www.minnehahaaeelc orv
Estimated Construction Valuation of Project(excluding land) ; ,OCJ
APPLICANT ACKNOWLEOGEMENT: �
• Agrees to provide all information required or requested by the Buifding pepartrnent;
' • Certifies that the information supplfed is true and correct to the best of his/her knovuiedge, The app�i�nt recp9�f�s�t�y are
i solely responsible for submitting a complete application being aware that upo�failure to do so,the staff has rro altunabve but to
i rejecf it until it is complete;
� • Some or all of the informatlon that you are asked to provide on this appliption is dassified by gts�e Iaw as eilher�� a
� ., confiden6al. Private data is information which generally cannot be given to the p�Wic but can be 9iven������the date.
Confidential data is information which generally cannot be given to Nther the public a the subjed ot fhe data Our purpa�e and
intended use of this informa6on is to annually update our records and records of ofher govemmental ayencies tc�quitcd by�aw_ If
ou refuse to su I the i a o the lication ma not be issued.
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ApplicanYs Signature: Date: � �v
Owner's Signature: Date:
Last Updated:January 2016
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