HomeMy WebLinkAbout2011-00385 - windows - , CITY OF ORONO PERMIT NO.: 2011-00385
� ' 2750 KELLEY PARKWAY
j ORONO, MN 55356- DATE ISSUED: 05/24/2011
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 865 PARTENWOOD RD
PIN : OS-117-23-43-0002
LEGAL DESC : PARTENWOOD
: LOT 001 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 1,500.00
NOTE: REPLACE 2 WINDOWS WITHIN EXISTING OPENINGS
APPLICANT pERMIT FEE SCHEDULE 57.50
PLEKKENPOL BUILDERS STATE SURCHARGE(VALUATION) 0.75
401 E 78TH ST TOTAL 58.25
BLOOMINGTON,MN 55420-
(952)888-2225 PAID WITH CC# 3447
Minnesota State License#: 1797
OWNER
PICCARD ET AL TRUSTEE,JANE E
865 PARTENWOOD RD
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
permiu. All provisions of laws and ordinances goveming this type of work
-shall be compied with whether or not specified herein.This pertnit will
expire and become null and void if construction authorized is not
•commenced within 180 days of the date of issuance,or if consVuction is
}suspended for a period of 180 days at any time after work has commenced.
,7'he applican[is responsible for assuring all required inspections aze
irequested in conformance with the State Building Code.This permit may be
revoked a[an time for due cause.
' � � Zy � 20� � �
plicant Permitee Signature Date Issued By Si ture
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A .
�k>
. City of Orono
' Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
O�,L,D,�O PO Box 66
Crystal Bay, MN 55323-0066 Date received:
a, �'`� ,4� �, Street Address: Received by:
�'� '' �� �ti�' 2750 Kelley Parkway Plan review fee:
L�E3H04'� Orono, MN 55356 ;�
— 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. (P/ease print)
GENERAL INFORMATION:
Job Site Address: ��5 '�/��►�� c„1 C,?�� �:u��
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 sufi5crent on-site parking is available. Non-permitted events wilf not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: CC I�"-���c. c��� p=�S
State License# j �� �j �7 Expiration Date: C�3 3� Z c�/j
Lead Certification Number: �pT-. 32955- J Expiration Date: '�- 3D- 1S^
(for work on homes that were construcfed prior to 1978
Phone: � 5 "L -�,�',�`- "L"Z L�5 (office) (/Z -3 �. � ' !�3.�'C..,� (cell)
Mailing Address: y p� �� 5� � �' f'` � �-yL��'� City: �pMir�7z��IP: S Z
Contact Person: � c ��
2��ro L��,��Z(_ Applicant is: � Contractor)/ Homeowner (CircleOne)
Email and/or Fax: ���� �� ;��C I�K c=N f CL , ���
PROPERTY OWNER INFORMATION:
Name: yvNT �Qc�=NC H� Jt�N� PiCC. A2j�
Phone (day): `15�. - y 7% � U�'`15
Address: �'�S �Ae.�?�N �-•�vv p ��r��7 CitY� C s�;���c Z�P: S s 3 5�.
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits:
Window s Minnehaha Creek Watershed District(MCWD)
� ( ) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391
❑ Re-roof Phone: 952-471-0590
❑ Fire Damage Fax: 952-471-0682
www.minnehahacreek.orq
Overall Project Description: (?�i� r�� � L,,;Np�,� S ``�
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 appficant 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
re uired b law. If ou refuse to su I the information, the a fication ma not be issued.
ApplicanYs Signature: ��� �--�`J_��---�___ Date: �j��Z y/Z c:�J
Last Updated: 03-01-2011