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CITY OF ORONO * 2 0 1 6 — 0 0 0 4 � * <br /> ,. 2750 KELLEY PARKWAY DATE ISSUED: OU26/2016 <br /> . ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3640 JACOBS MILL RD <br /> PIN : 32-118-23-24-0010 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 110,000.00 <br /> NOTE: SEPARATE PERM[TS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) <br /> BASEMENT FINISH <br /> APPLICANT PERMIT FEE SCHEDULE 1,172.92 <br /> STATE SURCHARGE(VALUATION) 55.00 <br /> WOODDALE BUILDERS INC. TOTAL 1,227.92 <br /> 6117 BLUE CR DR <br /> MINNETONKA, MN 55343- Payment(s) <br /> (952)345-0543 CHECK 84513 1,227.92 <br /> Minnesota State License#: BUIL-BC002926 <br /> OWNER <br /> HOPFMAN,KEITH&MARY <br /> 3640 JACOBS MILL RD <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are ��n <br /> requested in conformance with the State Building Code.This permit may be � ��J <br /> revoked at any time for due cause. ^ <br /> I� ! <br /> i.^�1 �� I_�- � � � � �v��� ( / � / <br /> � f•,,/�` J l � L� � L <br /> Applicant Permitee Signature Date Issued By Signatu Date <br />