HomeMy WebLinkAbout2015-00274 - addn/remodel/repair CITY OF ORONO * 2 0 1 5 - 0 0 2 7 4 *
2750 KELLEY PARKWAY DATE ISSUED: 03/06/2015
ORONO,MN 55356-
4 952 249-4600 FAX: 952 249-4616
ADDRESS� : 2745 SHADYWOOD RD
PIN : 21-117-23-31-0003
LEGAL DESC : REG.LAND SURVEY NO.0500
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 46,777.63
NOTE: THIS WAS WATER DAMAGE,THIS IS REPLACING DECKING ON AN EXISTING DECK IN KIND AND A ROOF REPLACEMENT.
APPROVED ON THE SPOT BY LYLE.
APPLICANT PERMIT FEE SCHEDULE 682.03
STATE SURCHARGE(VALUATION) 23.39
UNGERMAN CONSTRUCTION INC. TOTAL 705.42
4450 NICOLLET AVE S Payment(s)
MINNEAPOLIS,MN 55419- CREDIT CARD 4280 705.42
(612)825-2800
Minnesota State License#:BUIL-BC001239
OWNER
ZIMMERMAN,JAMES
2745 SHADYWOOD RD
EXCELSIOR,MN 55331-
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 requires separate �
permiu. A1l 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.
1'he applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be �
revoked at any � e fo ue cause. �/
/
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Applic t Permitee Signat ate Issued By Signature Date
City of Orono
Builc'.�ng Permit Application for Maintenance / Replacement / Remodel
��i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
�O� Mailing Address: Permit number: �� S–OU Z"-7�
O PO Box 66
Crystal Bay, MN 55323-0066 Date received: '3 — �n—��S
� � ) ,�y�-�-
Street Address: Received by: � �—�
:� G� 2750 Kelley Parkway Plan reviewfee: �-� ` �h /'""'
`qKfSH��� Orono, MN 55356 �-.lU S � �
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 vwvw.ci.orono.mn.us p� �C � �t"s-,�t� .U
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION: „ ,
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Job Site Address: ���� J ���,�t-�/C.L);,Y�i,^ � C�'� � � < ! �r.� ��.4J ��� �
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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 su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
�
Name: U r , ,-U .v�i r2 " � r .� ' .�-l/���
State License# �� �J�z�� Expiration Date: ? {3� Z,c�;S�
Lead Certification Number. �(��r ��`"�� �_� Expiration Date: �;,� 2��,�r
(for work on homes that were constructed prior to 1978
Phone: (cell) -,/�- ,�.�%� - �7�ik (office) ��z- 6 2 '�"=-2��lrc�/
Mailing Address: � t� � �/, 1,���;--r- �� � �,� City: ��-� ZIP: ,*'� ��" ��
Contact Person: �'�.,� tj(t,�;��Z�,�, �Applicant is: ontra �r / Homeowner (CircleOne)
Email and/or Fax: �i (,� g L�� 2`��� �
PROPERTY OWNER INFORMATION:
Name: �iv� ���^/!�t?r�i�"./ai�4�
Phone(day): CS�- �7 C� - ��'3�� '�T ���,
Address ��.�� �j�- <U�,iy� City:�,�:�,�;, >�_ ZIP: `; �y'
� Email and/or Fax: - N ��
PROJECT INFORMATION: Overall project description: �
Type of Project: ny eart movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage
MCWD review&permits:
❑ Re-roof,asphalt ❑ Repair ,�Storm Damage Minnehaha Creek Watershed District(MCW D)
18202 Minnetonka Blvd
c�� ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Deephaven,MN 55391
�Re-roof,other(specify) ❑ Siding ❑ Other:(specify) Phone: 952-471-0590
� <������;�.�� Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
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 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 i nually update our records and records of other governmental agencies required by law. If
ou refuse to su I the i atio �cation ma not�e issued.
ApplicanYs Signature:..- :_ � � � /' ;, Date: �E'` ��%�
f
/
Owner's Signature: � � Date:
Last Updated:January 2015
A�sa�D�epartment ot 1a6or and industr�t kisaeRsin�a�nd�allon Servi��
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Sra�nt Fau1,lAli i615b Webse�e: rrww..dfi,rt►n�ovlcc4�f.asp
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DATE TIME V
CITY OF ORONO CALLED IN �� N--� ��'' �
SPECTION OTIC � SCHEDULED Y Y�1 ��■L
� PERMR NO. �� �COMPLETED
ADDRESS S O O C� D�
OWNER TELEP ONE NO. —�
CONTRACTOR r✓�Qh
� DESCRIPTION �`�'� �� ''"''�
W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
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Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 ONfNERICONTRACTOR TO MEET YOU:_YES_NO
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V BEFORECdYERING PERMANENT
❑CORRECTUNSAFECONDITIONWRHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call br the next inspection 24 hours in advanoe. (952) 249-46��
OwnerlContractor on site: ��
Inspector: `
Whita Copydnspecto�'s File Canary CopylSite Notice
� DATE TIME �
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED 3��o `/� /v�
PERMIT NO.�Osb 'G�7S� COMPLETED
ADDRESS a 7�� ���w� �'
OWNER TELEPHONE NO.
CONTRACTOR
� DESCRIPTION T��- d��
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Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
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Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPIACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
4� ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
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V BEFORECOVERING PERMANEN7
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor on site:
Inspector.
White Copyflnspector's File Canary CopylSite Notice
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DATE TIME _
CITY OF ORONO CALLED IN '' �
INSPECTION N TICE , ,�cHEDULED � Z .5 l D :3�
PERMR NO. ?f�COMPLETED
ADDRESS '/
OWNER TELEP ONE NO �� 'T�3 -��7
CONTRACTO
a DESCRIPTION
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W ❑ FOOTING DEMO-FINAL S TIC FINAL
� ❑ POURED WALL ❑ PLUMBING RI EX AV/GRADING/FILLING
O ❑ FOUNDATION WATERPFOOF ❑ PLUMBING FINAL ❑ E REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
i ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET Y�OU:_YES_NO
c� COMMENTS:
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V BEFORECONERING PERMANENT
❑CORRECT UNSAFE CONDITiON WRHIN HOURS. ❑pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISS D
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection in adva . (952) 249-4600
OwnerlCoMractor on site:
Inspe�tor:
White CopyMnapecto�'s File Ce ry CopylSite Notiee
C� ��v� DATE TIME "
.�ITY OF ORONO CALLED IN
INSPECTION OTICE SCHEDULED � —__i�
PERMIT NO. ��S���� COMPLETED
ADDRESS '�� �-I � ��`lc��U�p`X�Y� I�
OWNER TELEPHONE NO�'rZ���� �'09
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� DESCRIPTION �/-" �`��� � ��f%T
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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 ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
F IA6---�' ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
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V BEFORECWERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 ho in.a nce. 9 2� 249-46��
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary Copy/SRe Notice
� � � � DAT���� TIME �
CITY OF ORONO ALLED IN =�
INSPECTION NOTICE SCHEDULED `-�
PERMIT NO..�L����^'L�n�7�COMPLETED �7—�
ADDRESS �� �� -`"� ���Gtc-�./l.l,'CX�� K�y
OWNER TELEP ONE NO. �a��a�7�
CONTRACTOR � � ��n �G' �
� DESCRIPTIO � ���' ' / �--
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
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 ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
4! ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ PTIC INSTALL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU: YES_NO
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V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR W{LL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-46��
OwnerlCon on site:
Inspector
White Copyllnspector's File Canary CopylSite Notice
�� l,-���� DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED � �
PERMIT NO. 7�%/r�J� ���COMPLEfED
ADDRESS Z�7 i-� ��ll'.�� (_t)C 1'C�?
OWNER TELEPHON��-N�O.�� -��� Z8�
CONTRACTOR ��� �-��
� DESCRIPTION �� , � � ���7`--C��� •
ly ❑ FOOTING ❑ DEMO-FINAL�/�d' ��G� U SEPTIC FINAL ��Q
Q ❑ POURED WALL ❑ PLUMB�NG RI l� ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINALjZG� ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
? ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC I�ALL ❑ FOUNDATION/REMOVAL
2 OWNE�`� N;-T�OR TO MEET YOU:_YES_NO
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�NSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
` �M�PECTION REQUIRED.CALL TO ARRANGE ACCESS.
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Call for the next inspection 24 hours in advance. (952� 249-4600
OwnerlContractor on site;.
Inspector. �^�' �
te CopyAnspector's File Canary CopylSite Notice