HomeMy WebLinkAbout2017-01005 - windows CITY OF ORONO * 2 0 1 7 - 8 1 8 0 5
2750 KELLEY PARKWAY DATE ISSUED: 08/28/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 2560 OLD BEACH RD
PIN : 21-117-23-22-0010
LEGAL DESC : SHORE HILLS
LOT 025 BLOCK 000
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE WINDOWS
ACTIVITY O/S BUILDING-UNDEFINED
VALUATION $ 6,198.00
NOTE: REPLACE WINDOWS INTO EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 154.85
PELLA NORTHLAND STATE SURCHARGE(VALUATION) 3.10
15300 25TH AVE N.-SUITE# 100 TOTAL 157.95
PLYMOUTH,MN 55447- Payment(s)
(952)345-6047 CHECK 78756 157.95
Minnesota State License#:BUIL-BC645090
OWNER
KREY,JAMES
2560 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 for due cause.
Applicant Permitee Signature Date Issued By 61griature Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
�Ol VO Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-00A6I6' Date received:
Street Address:
AUG 2 S Z01_1 Received by:
ti 2750 Kelley Parkway Plan review fee:
elt L Orono, MN 55356 CITY OF ORON
'fkes►io�� 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: �S�D� ��� ���� �� •
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
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTP•..�..., , ..,... .,...•r ,.,�,.�...T,.. .
Name: Pella Northland
State L 1530025 1h Ave N Ste.100 Expiration Date:
Lead C Plymouth MN 55447 1S 17 g 2' 1 Expiration Date: cf-7—a-p
(for i 763-745-1400 1978
Phone: BC645090 expires 3/31/19 (office)
Mailing Address: City: ZIP:
Contact Person: 2 3'(S_(d017 Applicant is: ontractor Homeowner (circle one)
Email and/or Fax:�O
PROPERTY OWNER INFORMATION:
Name: -3GmtES kl/w
Phone (day): 01S2,g771 473._
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
Window(s) www.minnehahacreek.org
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 information is to annually update our records and records of other governmental agencies required by law. If
you refuse to supply t information,the application may not be issued. —7
Applicant's Signature/X-- y Date:
Owner's Signature: Date:
Last Updated:January 2016