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Home My WebLink About2017-01353 - windows f CITY OF ORONO * 2 0 1 7 — 0 1 3 5 3 2750 KELLEY PARKWAY DATE ISSUED: 10/24/2017 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS 581 NORTH STREAM RD PIN 25-118-23-34-0005 LEGAL DESC NORTH STREAM LOT 002 BLOCK 001 PERMIT TYPE MINOR ALTERATIONS PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE : WINDOWS ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 12,753.00 NOTE: REPLACE(4)WINDOWS APPLICANT PERMIT FEE SCHEDULE 247.79 STATE SURCHARGE(VALUATION) 6.38 PELLA NORTHLAND TOTAL 254.17 15300 25TH AVE N.-SUITE# 100 Payment(s) PLYMOUTH,MN 55447- CHECK 79082 254.17 (952)345-6047 Minnesota State License#:BUIL-BC645090 OWNER LARSON,DAVID&JANIS 581 NORTH STREAM RD WAYZATA,MN 55391- 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. �o lO 17 Applicant Petmi a Signature Date Issued By ature Date OCT/17/2017/TUE 03:21 PM Elder Jones Building FAX No, 952 854 4909 P, 002/002 City of Orono Building Permit Application for Maintenance / Replacement/ Remodel — Residential ONLY (i.e.windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) OA, Mailing Address: Permit number: CZU VO PO Box 66 Crystal Bay,MN 55323-0066 ^ Date received: Street Address: Received by: yF 2750 Kelle Parkwa J-I� 4t, C� Y YPlan review fee: �kFSH0�� Orono,MN 55356 10—t -6_t-7 Main: 952249-4600 Fax: 952249-4616 I.Orono.mn.us I Total Fee: 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: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No If 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 req(Jlrey AnV lil•Anf HP—f—f—ff",..,.„r,,,`17 Is available, Non-permitted events will not be allowed. Pella Northland CONTRACTOR/All 15300 25th Ave N Ste.100 Name: State license# Plymouth MN 55447 _763-7451400 Expiration Bate: Lead Certification Ni X t5)—)I� Expiration Date: (for work on homs BC645090 expires 3/31/19 Phone: (cell) y (office) c�s-{� � �t Mailing Address: Cit : ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: (��4 (D,fNt-lrtYlf-S c-ogf fN PROPERTY OWNER INFORI ATION: 1 Name: y �ErtSSC7'✓� Phone(day): (Q(Z ",53 Z—M Z0 Address: City: ZIP. Email and/or Fax: PROJECT INFORMATION. Overall project description: Type of Project: Any earth movement may also require ❑Door(s) ❑Remodel El Fire Damage MCWD revlew&permits: Minnehaha Creek Watershed District(M CW D) El Re-roof,asphalt El Repair El Storm Damage 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 Windows) www_minnehahacreek.ora Estimated Construction Valuation of Project(excluding land) $ 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 info ation is to annually update our records and records of other governmental agencies required by law. If you refuse to su I information the application ma not be issued. Applicant's Signature: Date: /0-17-17 Owner's Signature: pate: Last Updated:January 2016 i City of Orono Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �O `O Mailing Address: Permit number: PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: Received by: y� L� 2750 Kelley Parkway Plan review fee: e kES 1o�� 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: 58/ Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes 0 No If 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 1-1— -- ----7 is available. Non-permitted events will not be allowed. Pella Northland CONTRACTOR/All 15300 25" Ave N Ste.100 Name.- State ame:State License# Plymouth MN 55447 Expiration Date: Lead Certification NI 763-745-1400 Expiration Date: BC645090 expires 3/31/19 ( p V-7-ICU (for work on on ne Ni Phone: (cell) (office) C/�Z Mailing Address: Ci!f.— ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: 'kittz°,- Cd� mneeS .CQYV� PROPERTY OWNER INFORMATION: 1 – Name: �yLa ��_ 11�YIlS I�WScJY� Phone (day): (4(2 �-S'32-af4 yo Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 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 414Window(s) www.minnehahacreek.orci Estimated Construction Valuation of Project(excluding land) $ /2 753 — 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 inforination is to annually update our records and records of other governmental agencies required by law. If you refuse to suoply the�information,the application may not be issued. —7 Applicant's Signature: Date: /0-"'17 Owner's Signature: Date: Last Updated:January 2016