HomeMy WebLinkAbout2017-00622 - windows CITY OF ORONO * Z 0 1 7 - 0 0 6 2 2 *
- 2750 KELLEY PARKWAY DATE ISSUED: 06/08/2017
• ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1261 BRIAR ST
PIN : 10-117-23-31-0042
LEGAL DESC : CRYSTAL BAY MINNETONKA
: LOT 000 BLOCK 003
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-LINDEFINED
VALUATIOIY : $ 5,270.00
NOTE: REPLACE:2 WINDOWS& 1 PATIO DOOR
APPLICANT PERMIT FEE SCHEDULE 13936
STATE SURCHARGE(VALUATION) 2.64
HOME DEPOT USA,INC. MAIL-IN FEE 2.00
2455 PACES FERRY RD
ATLANTA,GA 30339- TOTAL 144.00
(763)542-8826 Payment(s)
Minnesota State License#: BUIL-BC147263 CREDIT CARD 0182 144.00
OWNER
PRINTUP,GARY&LINDA
P.O. BOX 104
CRYSTAL BAY,MN 55323-
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
State 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 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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Applicant Permitee ignature Date Issued By Signa ure Date
JUN/08/2017/THU 09: 45 AM Elder Jones Building FAX No, 952 854 4909 P, 002/002
.
� City of Orano
Building Permit Application for 1111aintenance / Replacement I Remodel — Residential ONLY
(i.e.windows, doors, siding, re-roof, etic. � NO STRUCTURAI� �XPANSION)
�O�a Mailing Address: Permit number: .Z
PO Box 66
Crystal Bay, MN 55323-OQ66 Dafe received_
Streai Address: Racefved by:
� � 2750 K�lie Parkwa ._.---
��, G� Y Y Plan revfew fee:
� Orona,MN 55356
�xFSHo � Total Fee: � ��. ��
Main: 952-249�4600 Fax: 952-24�4616 www.ci.orono.mn.us
This applicatlon form must be completed In full and all required information must be submitted_
Incomplete applications will ba returned. (Please print)
GENEFtAL INFORIIAATION: �
Job Site Address: 0�.(�� �{r`((,(� S`f".
Will this be a Parade of Homes, Remodelers Showcase Home or other tiisplay Home? Yes No
!f yes,a specia/even��A�mJ+�R�an�are�i wirn p�lir:A Deaertment end Citv Council approvaf fi0 days prlor to the�v�nt. Shutfle bus ae�vice will be
raquin9 Home Depot USA, InC. �9 rs avallable. Non-permftted ev�nts w111 notbe allowed.
CONTRACTOR l� 2455 Paces Ferry Road
Name: Atlanta, GA 30339
State License# Phone 763-542-$826 Expiration Date;
Lead Certification f �ic # BC 147263 Exp.3/31/2018 �0�a7(�y a Expiration l7ate� -j ..�j
(for work on homes fhat were constructed prior fo i978 ,
Phone: (cell) (office) �jsZ,',�j�J�,v� 7 �'L�,�,��
Mailing Address: City: ZIP:
Contact Person: Applicant is: ontracto / Homeowner (Clrcle One)
�mail and/or Fax: ��,;�.���d��cnrn,�t �G(IVY�
PROPERTY OWNER INFORIVIATION: �
Name: � � U
Phone(day): Gj�'2-� �'l�7-��87�
Address� City: ZIP�
Email and/or�ax�
PROJECTINFORMATI�N; Qverall r�ectdescription:
Type of project: Any eaCth movement may also requlre
❑Door(s} �Remodel �Flre Damage
MCWD review&permits:
�Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creelc Watershed Dlstrlot(MCWD)
15320 Mlnnetonka glvd
❑Re-roof,cedar ❑Restoration ❑Water Damage Minnetpnka,MN 55345
❑Re-roo#,other(spec[fy) ❑Siding ❑Other:(specity)
Phone: 952-47�-0590
Fax: 952-471-0682
�Nindow(s) a�(N� � � ,�vw�,�Cr�ghahacresk.orQ
Estlmated Constructton Valuation of Project(excluding fand) $ -'
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provfde all information required or requested by the Building Department;
. cartifies that the informatlon supplied is frue and correet to the best of his/her knowledge. The applicant recogni�es that they are
solely responsible for su6mitting a compl�te applicatlOn being aware that Upon falEure to do S0, th9 Staff has no alternative but to
reject it until it is complete;
• Some or all of the Inform8tlon that you ere esked to provide on this application is classified by State law as either private or
confd�ntial. Privat�data is infarmation which generally cannot be given to the publle fout ean be glven to the subject of the da1a.
ConfldentEal data is information which generally cannot be given to eithmr th� public pr the subjeCt of the data. Our purpose and
intended use of this information is to annually update our rBCOrds and recoPds oF other goverrlmental agencies required by law. If
ou refuse to s I th ' formation the a ication ma not be issued.
Appficant's Signature� l"r"�� Qate: ���f r /
OWner's Signatur . Date�
Last Updated:January 2016