HomeMy WebLinkAbout2018-00400 - windows CITY OF ORONO I11 I 1' t r ��
2750 KELLEY PARKWAY * 21 8 - 0 0 4 0
DATE ISSUED: 04/04/2018
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 3080 FARVIEW LA
PIN : 04-117-23-34-0012
LEGAL DESC : FARVIEW
: LOT 002 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 5,680.00
NOTE: REPLACE(2)WINDOWS WITHIN EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 139.36
STATE SURCHARGE(VALUATION) 2.84
RENEWAL BY ANDERSON MAIL-IN FEE 2.00
1920 COUNTY RD C.WEST TOTAL 144.20
ROSEVILLE,MN 55113
(612)502-4777 Payment(s)
Minnesota State License#:BUIL-BC130983 CREDIT CARD 8788 144.20
OWNER
LIPS,DANIEL&MARTHA
3080 FARVIEW LA
LONG LAKE,MN 55356-
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.
(C io
Applicant Permitee Signature Date Issued By Sign re Date
City of Orono
Building Permit Application for Maintenance I Renovation
(windows, doors, siding, rer000f, etc.)
hh__ Mail PO Box f3$ Permit number: --2 eV - �-
o1. Y6 Crystal Bay,MN 55323-0066 Date received: x/34 T.
ts Sheet Address: Received by:
'ii ...11,- 2750 Kelley Parkway Plan review fee: '
i�, Orono, MN 55356
Total fee: l(71-V,-,0140
Main: 952-249-4600 Fax: 952-249.4616 www.ci.oroup.mn.us
This application form must be completed in full and ail required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: 3 (CC 0 •( v` c Lcu\-t
Job Site Address: o
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? NI Yes M No
it yes,a special event permit is required with Police Department and City CounCA approval 60 days puerto the event- Shuffle bus service will be
required unless applicant demonstrates sufficient onsite parking is available. Non-permitted events will not be allowed.
CONTRACTOR l APPLICANT INFORMATION:
Name: r lel.. ..‘ .- flasbuser,
State License# C.1349$3 Expiration Date: 3 i Si
Lead Certification Number: ik„)' ` -- a c $3 -t Expiration Date: 4/IC
(for work on homes that were constructed prior to 1978
Phone: (& l— a • -4.0 s'$- ; , (office) (cell
Mailing Address: • . . C•. 1 . " _ •. W eCity: ,. ; t ZIP: 551 3
Contact Person: Applicant Is: .antra. / Homeowner (ctrrieone)
Email and/or Fax: .
PROPERTY OWNER INFORMATION
Name: ir 4. l.%0
Phone(day): t tart -- 'lb— I •
Address: City: ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Protect: Any earth movement may require
❑Door(s) ❑Remodel 0 Fire Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑Re-roof,asphalt 0 Repair 0 Storm Damage 18202 Minnetonka Blvd
Deephaven,MN 55381
❑ Re-roof,cedar 0 Restoration ❑Water Damage Phone: 952-471-0590
❑Re-roof,other(specify) 0 Siding ❑Other_(specify) Fax: 952-471-0682
❑Window(s) www.minnehahacreek.ort
Overall Project Descri• +on: ' ',• • ii 11J+ a C� LAJ) A -'5ire- r"
Estimated Construction Valuatlo of Project(excluding land) $ r '>9./
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 oan 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 •u refuse to su,•I the informatiokthe application manot be issued.
•QcI )
Applicant's Signature: / I 1 r✓�--
- / Date: 3 t