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Home My WebLink About2012-00308 - doors iiiiiiiiiiiiiiiiiiiiiillillillillillillil CITY OF ORONO * 2012 - 00308 * 2750 KELLEY PARKWAY DATE ISSUED: 04/23/2012 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS 2490 OLD BEACH RD PIN 21-117-23-22-0005 LEGAL DESC SHORE HILLS LOT 004 BLOCK 000 PERMIT TYPE MINOR ALTERATIONS PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE : DOORS ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 9,779.00 NOTE: (2)PATIO DOOR REPLACEMENTS PELLAPPLICANT PERMIT FEE SCHEDULE 191.75 15300 25TH AVE N.-SUITE# 100 NORTHLAND STATE SURCHARGE(VALUATION) 4.89 15300 PLYMOUTH,MN 55447 MAIL-IN FEE 2.00 (952)345-6047 TOTAL 198.64 Minnesota State License#:BC645090 OWNER MCINTEE,SHAWN&JACQUELINE 2490 OLD BEACH 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 four due cause. Applicant Permitee Signature Date Issued By Si tore ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: 0� PO Box 66 Crystal Bay, MN 55323-0066 Date received: O'..r Received by: Street Address: �9 . . � ky, 2750 Kelley Parkway Plan review fee: (W.0 j Orono, MN 55356 1 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: 7 ( 4J 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR 1 APPLICANT INFORMATION: Name- Pella Northland 2 3VV - o V State License# _ Phone: 15300 25th Ave N. Ste 100 — --- - ZIP: (cell) Mailing Address: _ -_ _ Plymouth, MN 55447 Contact Person: — Lic#BC645090 Ph. 763/745-1400 lomeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: / Name: 5 0 Lj /7? Phone (day): S7 J gf 71f • 4`�`5 f Q 1 /Q- ZIP: SS 3_9 Address: 4 p 6/1 City: Q Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review&permits Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWD) ❑Window(s) Repair ❑ Storm Damage 18202 Minnetonka Blvd Deephaven, MN 55391 E]Siding Siding Restoration ❑ Phone: 952-471-0590 Other: (specify) Fax: 952-471-0682 ElRe-roof El Fire Damage www.minnehahacreek.org Overall Project Description: / D do 0 Q Estimated Construction Valuatio of Project(excluding land) $ 99. 7 7 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 required by law. If you refuse to supply the information,the application may not be issued. / Applicant's Signature: Date: Last Updated: 05-04-2009 Minnesota Department of Labor and Industry Licensing and Certification Services Construction Codes and Licensing Division Phone: 651.284.5034 443 Lafayette Road N Email: DLI.License@state.mn.us •Saint�Paul, MN 55155 Website: www.dli.mn.gov/ccld.asp NOTICES NOT TRANSFERABLE CHANGE YOUR BUSINESS STRUCTURE PELLA NORTHLA SUBMIT A NEW APPLICATION FOR NEW ENTITY 153010 -2 AVE STE 100 RENEW OR REPLACE INSURANCE POLICY PLY LITH, MN 55447 SUBMIT NEW CERTIFICATE OF INSURANCE PQ ll G S /112J � G� L NOTIFY THE DE13ARTMENT OF A CHANGE IN YOUR BUSINESS. Failure to do so,subjects you to administrative penalties of up to $10,00 15-Day Notice Requirement—Forms available online at www.dii.m.q.ggv/CC&..Duf/LLLiicUuUpdada ov/CCLD/LicUpdat sp • Change in buslnr.�s'physical address,mailing address,phone number,or email address • Change in control, owners,officers,directors,members,partners • (Hauge n1 Nismoss' locial mune;and/or assumed name • Loss of or clt,nnptr nI QUALIFYING BUILDER • Change in dent+ral linbilily insurance or workers'compensalion insurance,coverag Immediate Notice Requirement—Notification to DLI in writing .ludglnent Dei-Mor. A licensed contractor has 15 days to provide written notice of tho. findinc lh al it is found to be a judgment debtor based upriri Conduct requiring IicenSUre. • Bankruptcy Politipn_F'iled. A licensed contractor has 15 days to provide wrillon notice that it filed a petition for bankruptcy. • Conviction Notice. A licensed contractor has 10 days to provide written notice that it has been found guilty of a felony,gross misdemeanod, misdr_+monnor or any comparable offense related to the license. including convictions of fraud, misrepre sonlation,misll se of funds. theft, criminal sexual conduct, assault, burglarv, conversion of funds, or theft of proceeds Ill this or any olhor state or any other United States jurisdiction. YOUR CERTIFICATE IS 13ELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS. �' vi30 C3r 11P.1"DrUst01-NRESIDENTIAL BLDG CONTRACTOR _ .. Cony;lrurllon;;odes anrd I Icnm,:rent Ihvieaon Licensing and Got fifiration Services -1,11 1 Afaye_lla 130ad N St.Paul,MN 55155 weh"11w w:aw r8i'loo 11�rv!rcJrl,a?SV 1=mnll: tali lice115gfr�gl�In n1n.lrs I'hnne: 651.284.5034 I In. to ccrtll:�•111:11 the crrlllicn(c holder is liccnsetl as a RFSIDIiNTIAI.. BUILDING CONTRACT()R in the:alit,of�4innesola and i%in r,nu+liance Mill Minncsola Stalulrs 326B.905. :Ind may build residonlial real esmte,contract or offer to conlincr :villi an owner to build It'Id(.1111.11 real vstatc,:1111 contract or off Cr to counsel with an owner to improve esisring residential re:11 estale; provided the q•,u1z1171r individual is al ;III Innes a OL1 I,IFY ING BUILDI R and the certificate holder maintains comphrince with ill(-required general '.r 11)1!11v !n+ur:lnrc. and wolt.cr;'rv7nrpcn.alirw laws. License RESIDENTIAL BLDG CONTRACTOR LIc Number t3106,15090 PELLA NORTHLAND L:Ifective Date 0'1127/201.' 15300 25TI-I AVE STE 100 f3 Expiration Date : 0.3/31/;'013 PLYMOUTH, MN 55447 C 1 VERIFY UP-TO-DATE STATUS, BOND, AND INSURANCE INFO ATwww.dli.mn.gov/ccid/LicVerifv_.ast� (ENTER NUMBER). li IN ' I� Ii it II k "1dY 4• .n•....,. Al � � y'f �� .� � M, I .•A•,olP . r V.CL C) .•+oJ• r 'i ron In (ti �R4ulno 1A .. CL I' 'i. CU IN our CID cn til r„ (T� m G LI'd J t7) rI f+ .r •I R'' ,irnN • I I lrr' II i kit .__. DATETIME CY OF ORONO CALLED IN II INSPECTION NOTICE SCHEDULED 1 PERMIT NO. 20/2 -06 COMPLETED ADDRESS (a OWNER TELEPHONE NO. �`� �3 oto CONTRACTOR SCL_ DESCRIPTION �0brS , yc W ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARDCOVER REMOVAL v ❑ PLUMBING RI ❑ SEP FINAL ❑ FOUNDATION/REMOVAL OWNER/CONTRACTOR TO MEET YOU: YES_NO COMMENTS: -D'1 r amr4f 6114 CV 0 a 0 W cc Q W W cc d , 4th ❑WORK SATISFACTORY:PROCEED -5-PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C1 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site- Inspector. ��r White Copyllnspector's File Canary Copy/Site Notice