HomeMy WebLinkAbout2012-00972 - siding . - . � CITY OF ORONO * z 0 1 2 - 0 0 9 7 2 *
2750 KELLEY PARKWAY DATE ISSUED: 09/28/2012
ORONO, MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 1795 SHADYWOOD RD
PIN : 17-117-23-21-0008
LEGAL DESC : REG. LAND SURVEY NO.0702
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 9,600.00
NOTE: RESIDING-SOFFIT-FASCIA-TRIM
APPLICANT pERMIT FEE SCHEDULE 191.75
BETZ BUILDERS INC. STATE SURCHARGE(VALUATION) 4.80
300 CRESTVIEW AVE. TOTAL 196.55
LONG LAKE,MN 55356
(612)221-2963
Minnesota State License#:BC3515
OWNER
DIERCKS,MICHAELA
1795 SHADYWOOD RD
P.O.BOX 81(NAVARRE
WAYZATA,MN
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 the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming 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 applica responsible for assuring all required inspections are
requeste ' c formance with the State Building Code.This permit may be
revok at an time for due c�use.
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Applicant Permitee Signature Date Is d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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i� M,arlrng Aaaress: I Permit number. ���� -�d �'
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�� Q Crystai Bay, MN 55323-O�ci6 Date received: —Z � �.'
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' ��� ��'�-�'` a. Sfreet Address: ' Received by: ��
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, \�'����y�,�y,�'�,�;� �� 2750 Kelley Parkway Plan.reviewr'ee. ��
y:� `�.rrEs�o�w Orono, MN 55356 � �� �
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To�al;Fe�: ��'/ � �s<
Main: 952-249-4000 �ax: 952-249-4616 www.ci.orono.mn.us Y�' _ y€;�
' � This applicaiion rorm must be completed in full and all required inforrration must be submitted. �
' incompfete appficaiions will be returnecl. (Please prrnt) ��
���� �ENERA� INFORNEATIOf�: � t;
'� Job Site Address: � � 1, �
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Will this be a Parade of Fiomes, Remodeiers Snowcase Home or other Disp�ay Fiome? ❑ Yes P�o 'f
�{x lf yes, a specral event permif is reouired with Police Deparrmenf and City Council ap,proval 60 Cays orior to the event. 5huifie bus se ice will be �
� required unless applicant demonsirates su(iicient or-site parking is avairabte. Non-permitted events wil/not be allowed. ��
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� . CONTRACTOR!APPLICANT INrORMA�l01�: � _) ��
� ; fvame: ��"Z.-- �� Lf ,�L.�t �'�.� ,���.. �
�<. S�aie License # �� �� 3��—� Expiration Date: " �
F'` Lead Certificafion Number. � � Expiration Qate: �
� �
: (ror work on homes fhaf were constructed prior "o ?978
�� Phone: /a `- a, 1 " C�� GL/� ��f71C?� �C���} �.
Maiiing Address � J�,�J�V� City: ZIP: ��
�=j; Contact Person: Applicant is: Contracior / Homeowner �c���ie Une)
cmail andlor Fax: — �-
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rt � PROP�R�'Y OWN�R INFORM TIOt�: �
Name: � !,� � j�'j-��.�r � �'e- � �� �
Phone(day): .
Address: / �G�` �/�j�u ��� Ci'ty:�`��'�� ZlP�
�.�� Email and/or Fax �.�
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Pr2E3J�GT IN=ORMEeTIOn: �%�
� � Type of Project: � I �
� � Any eartn movement tr,ay require
� ❑ Door(s) ❑ Remodel I MCWD review�.permits: ��
❑ Fire Qamage � Ninnehaha Creek VVatershed District(MCW D) �'
�� ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage � 18202 Ninnetonka Bivd '��
��t ❑ Re-roof, ce�ar ❑ Restoration ❑VVaier Damage I Deephaven, MN 55391 :�.
Z - Phone: 952-471-Q590
Y ❑ Re-roof, other(specify) �Siding ❑ Other: (speci"ry) j rar,: °52-47"�-Oo62 �
°': ❑Window(s) i www.minnehahacreek.orq i
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.�-r Ove�al! Froject DescripfierR:
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��-'. __=siirratecE Cor.s�rucfion �'afuaiion o� ?roject (excfuciing �and� � � (c � �
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��� �4PPLI��I�T �Ci�i�EaV19L�Q��M�i�i: �
� Agrees to provide all inTormafior required or requested by the Building Depariment;
• CerfiTies tnat the information suppiied is true and corre�t to the best or' nis/ner knowledge. Tne appficant recognizes that they I
are sofely responsibfe for submitiing a compfete apoiicafion beinq aware that upon �ailure to de so, tne staff has no alternafive
but to rejec't it unfil i:is�ompieie;
� Some or all of the informafion t'r�at you are asked to provide on tnis appiication is ciassified by S;ate iaw as eitner private or i �'�
confioeni�af. Private da'ta is inTormation wnich gene;ally cannot be given to tne pubiic but can be given to the subject of the
cta.a. Confideniia! data is informa n which generaliy cannot be given to eitner the pubiic o: tne suoject of tne da;a. Our �
purpQse and intended use of th' i formafion is to ann�ally update our records and records of other qovemmen,al agencies I
reauired by law. If vou reruse s pi the informatio tne piic on mav not be issued. ;��
��: kppii�anf's Signature: �-- �,,.J Date: '-''� #
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�s� '_ast Updated: 08-09-2D11 °�
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DATE TIME �/ /
CITY OF ORONO CALLED IN I /ti—�2
INSPECTIO NOTICE SCHEDULED /,/=���
PERMIT NO�c���� 4D���- COMPLETED
ADDRESS 7
OWNER TELE HONE NO.��2-�z�—Z'��'�j
CONTRACTOR �
� DESCRIPTION �
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FIILING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC F�NAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION REQUIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-46�0
Owner/Contractor on site:
Inspector. ,I 11 _ �
White Copyll�spector's File Ca�ary CopylSite Notice