HomeMy WebLinkAbout2017-00781 - windoes CITY OF ORONO JIjI1I �I I0 Il �� �HIe 11111
2750 KELLEY PARKWAY DATE ISSUED: 07/07/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 40 ORONO ORCHARD RD N
PIN : 35-118-23-34-0005
LEGAL DESC : ORONO OAKS
: LOT 009 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : 0/S BUILDING-UNDE?INED
VALUATION : $ 5,000.00
NOTE: REMOVE(1)WIDE PICTURE WINDOW
INSTALL(1)3 WIDE DOUBLE HUNG
SAME SIZE OPENING
APPLICANT PERMIT FEE SCHEDULE 123.87
STATE SURCHARGE(VALUATION) 2.50
HAMEL BUILDING CENTER TOTAL 126.37
18710 HIGHWAY 55 Payment(s)
PLYMOUTH,MN 55446- CHECK 44307 126.37
(763)478-6601
Minnesota State License#:BUIL-20631040
OWNER
KLEMA&JULIA SHAVER,DAVID
40 ORONO ORCHARD RD N
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according o
the approved plans and specifications,applicable City approvals,and e
State Building Code. This permit is for only the work described and d es
not grant permission for additional or related work which requires sep ate
permits. All provisions of laws and ordinances governing this type of ork
shall be compied with whether or not specified herein.This permit wi
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if constructio is
suspended for a period of 180 days at any time after work has comme ced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit ay be
revoked at any time for due cause. r
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7 //> / 7 //7
Applicant Perm' tgnatur Date Issued Signature Date
i .
City of Orono
Building Permit Application for Mainte ance / Replacement/ Remodel - Residential ONLY
(i.e. windows, doors, siding, re4roof, etc. — NO STRUCTURAL EXPANSION)
O� Mailing Address: Permit number: p742/7— 7�/
� 0 PO Box 66
Crystal Bay, MN 55323-0066 Date received: 7-7-SCO /7
Street Address: Received by:
1.<0 11 .. 2750 Kelley Parkway Plan review fee
e A,L Orono, MN 55356
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Total Fee: /v2\!�• 37
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: /de5 4.--a7 l'77-C-V-,lijel n ,,,e � Q✓ -�v� m-,--- SST 7/
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 INFORMATION:
Name: M. -7 f2 4' .'''‘ /--i--.6". �g---97. --, -.0:-----'7-47' GilGc/7.l7. - - /
State License# ���3/G y.0 Expiration Date: y ,
Lead Certification Number: ......270 7 , -2 Expiration Date: y )-9`
(for work on homes that were constructed prior to 1978
Phone: (cell) (2 ) ‘/6-- ic- o' (office) (563) 7., _,‘-4,„ ,
Mailing Address: /f 77/e, ,,"1-'7 ss City: ,e,y7„ 7/ ZIP: r:c /E
Contact Person: z,...,,,7- isC��t/�i f,✓ Applicant is: Cd-ontract Homeowner (Circle One)
Email and/or Fax: ,-4,44-x, v,e-� C2/�;,-.,,,,r, �o,.,,--2 ,.-,,2,-r , cam-`
PROPERTY OWNER INFORMATION:
Name: 47 ,s' Tv��.„4 „..C--"Atr-- /a-
Phone(day): 6./7-- Ve/- a7 9 f
Address: yU Gas<.--aijraX, -e, , /ate City: ."/2c�4:7 ZIP: f3-79
Email and/or Fax:
PROJECT INFORMATION: Overall pro.ect description:
Type of Project: Any earth movement may also require
❑ Door(s) IDRemodel ❑ Fire Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑ Re-roof,asphalt 0 Repair ElStorm Damage 15320 Minnetonka Blvd
0 Re-roof,cedar 0 Restoration 0 Water Damage Minnetonka, MN 55345
El Re-roof,other(specify) IDSiding ❑Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
//( lindow(s) lit Zia psi -!^^r Tial 9o,.,.....-- 6 www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ SoU0
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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 ur records and records of other governmental agencies required by law. If
you refuse to supply the information,the application m y not be issued.
Applicant's Signature: /eel- ,, G%X - Date: 7/‘//-2
Owner's Signature: Date:
Last Updated:January 2016
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