HomeMy WebLinkAbout2018-00377 - windows CITY OF ORONO
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2750 KELLEY PARKWAY * 2 1 8 - 0 0 3 7
DATE ISSUED: 03/29/22 018
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 1890 CONCORDIA ST
PIN : 17-117-23-23-0022
LEGAL DESC : MAPLEGATE INLET
: LOT 005 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 649-ALL OTHER BUILDING&STRUCTURES
VALUATION : $ 6,500.00
NOTE: REPLACE EXISTING WINDOWS,USING SAME SIZE(10)
APPLICANT PERMIT FEE SCHEDULE 154.85
STATE SURCHARGE(VALUATION) 3.25
BETZ BUILDERS INC.
300 CRESTVIEW AVE. TOTAL 158.10
LONG LAKE,MN 55356 Payment(s)
(612)221-2963 CHECK 20324 158.10
Minnesota State License#:BUIL-BC3515
OWNER
KROLL,CHARLES
1890 CONCORDIA ST
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.
e9(46(4 3 21 IT
Applicant Permitee Signature Date Issued By Stg)ure Date
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel —111006#040- lLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
V.,01V Mailing Address:PO Box 66 IPermit number:
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
ti LAt. 2750 Kelley Parkway Plan review fee:
Orono, MN 55356 /�
IKESHO�� / �'. I
Total Fee: V666
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)
INFORMATION:
Job Sito Address: /5 `o ,.
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/APPLICANT INFORM ON: _
Name: s/ _
State License# 1! 11110 •- Expiration Date: /vl a D 2
Lead Certification Number: A)19---/--- Oj i(..)f -2- Expiration Date: _ •
(for work on homes that were constructed prior to 1978
Phone: (cell) 6./a- -2/- Z 3 S j (office) 9 '- /-73 . zf2S-7
Mailing Address: 34,2z7 City: /-0/1 4/we ZIP: 'ic33Z
Contact Person: Applicant is: Contractor/ I Homeowner (Circle One)
Email and/or Fax: ,6.s o, pit 00 I mo_
PROPERTY OWNER INFORMATION:
Name: C,t"1 611.1-e-5 /lie.& I/
Phone (day):
Address: / lO CoG 9t i7/y9- 31. City: O,1..07A..0 ZIP: 3--)--3 /
Email and/or Fax: 4,iQ.4-ce
PROJECT INFORMATION: Overall project description: ��ti 7*11ivJ>rd0C)3 i�y�i SS 1 .- /2.
Type of Project: -Any earth movement m y also require
❑ Door(s) 111 Remodel 1:1 Fire Damage MCWD review&permits:
ID Re-roof,asphalt ❑ Repair 111 Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑Re-roof,other(specify) ❑ Siding ElOther: (specify) Phone: 952-471-0590
Fax: 952-471-0682
,Window(s) www.minnehahacreek.org
Estimated Construction Valuation of Project(excluding land) $ b�( / i
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: - 2. _ I"
Owner's Signature: L h t'�-. ) Date: yl 2J• 2"-
Last Updated:January 2016