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Home My WebLink About2016-00649 - addn/remodel/repair � . , . CITY OF ORONO * 2 0 1 6 - 0 0 6 4 9 * 2750 KELLEY PARKWAY DATE ISSUED: 06/06/2016 ORONO,MN 5535Cr (952)249-4600 FAX: (952)249-4616 ADDRESS : 2195 SHADYWOOD RD PIN : 17-117-23-43-0135 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 007 BLOCK 002 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 3,700.00 NOTE: REPAIR CHIMNEY CROWN APPLICANT PERMIT FEE SCHEDULE 108.38 PATRICK D DONAHUE STATE SURCHARGE(VALUATION) 1.85 505 FIRST AVE NE TOTAL 110.23 MINNEAPOLIS,MN 55413- Payment(s) (612)763-1803 CASH 110.23 OWNER ANDERSON,JOHN 2195 SHADYWOOD RD WAYZATA,MN 55391- 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 dces not grant permission for additional or related work which requ'ves 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 th tate Building Code.This permit may be revoked at any time ue cau e. � � ' �(/ / (l/ / 6 Applicant Permitee Signature Date Issue ignature Date � -. City of Orono Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �O�O MailingAddress: Permitnumber: ad�� —�x7C� PO Box 66 Crystal Bay, MN 55323-0066 Date received: � — � —� � � a Street Address: Received by: y�, G� 2750 Kelley Parkway Plan review fee: t �, Orono, MN 55356 �K�S"°� l�0 � � 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. (Please print) GENERAL INFORMATION: —� Job Site Address: ,-- � J �. �''� � �` Will this be a Parade of Homes, Remodelers Showc e 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 availab/e. Non-permitted events will not be allowed. CONTRACTOR/APPL NTINFORM ; Name: ��'�, ,�,:�,� �� State License# Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that we �nstructed prbr t 1 78 Phone: (cell) �� -� � (office) .' / Mailing Address: � �' City,: ZIP:, � Contact Person: Applicant is: Contractor / Homeowner �c�«ie o�e� Email and/or Fax: ��, �, , - �,, ��`�� a PROPERTY OWNER INFORMATION: Name: � Phone (day): Address: l City: �� ZIP: IGe Email and/or Fax: PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑ Re-roof,asphalt �Repair ❑ Storm Damage 15320 Minnetonka Blvd ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof,other(specify) ❑ Siding ❑ Other: ( pecify) Phone: 952-471-0590 ` �,� Fax: 952-471-0682 ❑Window(s) k'� www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ i 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 our records and records of other governmental agencies required by law. If ou refuse to su I the inf rmatio ,t 'on ma no be issued. Applicant's Signature: .r� Date: Owner's Signature: Date: Last Updated:January 2016 C�t � r pATE/� TIME / CITY OF ORONO CALLED IN � - So � INSPECTION NOTICE q SCHEDULED �o- �D -! !o //� PERMIT NO. D -UD / COMPLETED ADDRESS � S �c� OWNER PHON NO.��7�3�$� CONTRACTOR � DESCRIPTION ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FI AL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q�� ❑ WATER HOOK-UP ❑ FOLLOW-UP i" U AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERfCONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: o� r- , a � Cau, � a-f b•�c r� !� - o ,� o� �2 .. o� G/��i,�1 i�To��c�-- a � o � � aoa 4s�i a i r�53�✓5 0� si�Q - Q 1�/aCt A�r��toi� d �Q� .�s.,...� ,�,�,el�v � 2 W � W � � J � ❑WORKSATISFACTORY:PROCEED � OJECT COMPLEfE w ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952� 249-46�� OwnerlContractor on site: Inspector. � White Copyllnspector's File Canary CopylSite Notice