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CITY OF ORONO �'
* 2018 - 00300 *
2750 KELLEY PARKWAY DATE ISSUED: 03/15/2018
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 2565 LYDIARD AVE
PIN : 20-117-23-11-0021
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 006 BLOCK 004
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 1,740.00
NOTE: REPLACE WINDOWS INTO EXISTING
APPLICANT PERMIT FEE SCHEDULE 70.58
STATE SURCHARGE(VALUATION) 0.87
WINDOW CONCEPTS OF MN MAIL-IN FEE 2.00
291 EVA STREET
ST PAUL,MN 55107- TOTAL 73.45
(651)090-5010 5 Payment(s)
Minnesota State License#:BUIL-20163493 CHECK 23619 73.45
OWNER
WILSON,JAMES
2565 LYDIARD AVE
EXCELSIOR,MN 55331-
E
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 Signature Date Issue By ignature Date
City of Orono
Building Permit Application for Maintenance / Replacement/ Remodel - Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
OMailing Address. Permit number: �OI —t-0
1V
RECEIVPO ES
y Box 66 3�� /�
stal Ba , MN 55323-0066 Date received:
MAR 1 5Sj( Address: Received by:
�"tiii:eikEs
"'2750 Kelley Parkway Plan review fee:
Orono, MN 55356
H O� CITY OF ORONO 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: 2.3(4 3 j_4 8i arc-- ANI c.
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/AP LICANT INFORMATION:
Name: inclo W C _ k, c� r
Cx�GC;
State License# 1(0A s-1 (%3 Expiration Date: ,....5.31. I .1
Lead Certification er: N 2._, -t 1 p_,_ Expiration Date: '-I . .LO
(for work on homes that were constructed prior to 1978
Phone: (cell) (office) coni_ 9a -010.5
Mailing Address: Z9 1 wa -. Ci • 1 ZIP: 5,51 07
Contact Person: 3anc_.1 1 Applicant is. Contractor Homeowner (Circle One)
Email and/or Fax •
: ( anc11e. .rime,A �I Q dvtr,�o�nrc.c,,,,c. Pbol r,• c r*--,
PROPERTY OWNER INFORMATIO- .^Nr• I
Name: ( )arvie VV Anon
Phone (day): c152_ -4-171 -G54r
Address: parr,G a > �,} City:I'�(c�.51 r r ZIP: .5
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel IDFire Damage MCWD review&permits:
CI Reroof,asphalt CI Repair CI Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof, other(specify) ❑ iding CI Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 74-10
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 applica.•• •--• not-be-issued.
Applicant's Signature. LI., Date: .3' 12. ' 1 8
Owner's Signature: Date:
Last Updated:January 016