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CITY OF ORONO PERMIT NO.: 2011-01565
-- - 2750 KELLEY PARKWAY
` ORONO,MN 55356- DATE IssuEn: 12/23/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2160 SIXTH AVE N
PIN : 27-118-23-31-0017
LEGAL DESC : PHILLIPS WOODLAND TERRACE
: LOT 003 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 11,395.00
NOTE: REPLACE(5)WINDOWS WITHIN EXISTING OPENINGS.
APPLICANT pERMIT FEE SCHEDULE 221.25
RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 5.70
1920 COUNTY RD C.WEST
ROSEVILLE,MN 55113 MAIL-IN FEE 2.00
(612)502-4777 TOTAL 228.95
Minnesota State License#: BC130983
OWNER
SCHERER,KEVIN
2160 SIXTH AVE N
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 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 pertnit 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 commeaced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for dae cause. n
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Applicant Permitee Signature Date Issued By Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
Dac-18-2011 12:28pn From-CITY OF ORONO +A5224A4616 T-344 P.002/002 F-A73
�r��� v� v�v��v
. � Building Pe�mit Application for Internal Work
(windows, doors, sidin , re-roof, etc.�
� �enrn�Aadrees:
Po 9ox Bs Pernwt n�mber.
O p cryBeai a�,MN 66323-0088 oats rocaved:
� '� � Sfroet Ad�sa� ReGYIvAd Dy:
� 2�60 Kelley Pa�ltw�y
� od' Orono, MN b5356 p�e^���
Maln: 652-24�-4600 Fax: 852•24g•qB TO�F�': '/ p�
16 ° �O, ��
This applicatldn fnrm must be comple�ed in full and ail�equired informatJon muet be avbmitted.
Ineanpfot�applicaUona yWll be returnsd. (P/aese pnrry
GENERAL INFORMATION:�I�O �., '
Job Site Address: N
Win this be e Parade of i-iom�, Remodelers Shawr.ase Home cr othe�Display Home? Yes Wo
I/J^�s.e spsGN�wntOe►mlt Is bpui�sd w/tt►PbUa�C�paefmsnt snd Ci�y COuncN.pProw/60 daya Wto/10 tl�a a�erM, ShuMM bus aavbs wDl b�
nQui�sd uM�st sP�lkAnt deirioP►6trAlss euNFasnf on-sila parkMp is svolla4l�. Na►l�e�n�led�venh wIN no1 Ee aaowsd.
CON7'RACTOR I APPLICANT tNFORMATIQN:
Name: Kenewa�tiy Andersen
3tete License# ` 1gz0 County Road "C"West Expiraaon �ate:
Phone: �' �o�vi2�e,MN 55113
Med�g A�d�e. License#BC130983 Ct : Z�P; ceu
CoMaCt Per�pn: —" t is: Contractor / Homeowner
Email andlor Fax: � 651-264-4777 �C�ero o�n
. . .. _ .. .�........�..
PROPERTY OWNEFi INFORMA O :
Neme: �,r
P�lOf16(d8y�: .. r
Address: � ,
Emalf end/or Fax . z�P:
._.... ...._
PROJECT INFORMATION: � - � �• .
Type of Pro�s�t:
, �. M!I Mrlft mov�ement may�quiro
f]boor�s) p Remode► ❑Wafer Damege �WO rrvle�r d pannits... -
'�I1Mndow(e).,.,. . . ❑RePair p Sronn oamage Minneheha 8�alc�neeonka 8 d��MCVW)
[]Siding p Reatoretion ( ��) DeeDhpven,MN '55991
.. . . ❑Othe�: e Phone: 952-471-05QD... . .
0 Ra-roof ❑Fire Damege Fax: 952�71-0882
Owrall Pro eae Deseri tbn: 1A l�� W ;� �� •
Esti�nat�d Con�tructlon Valuation of cct exaludin lu�d � � ` � a
rJ.
APPI.JCANT ACKNOWLEDGEMENT:
• AOrees to provide all Ulbrmatbn requked or raqueslod by the Buildinp Department;
• CeRHisa thet Ihe informetlon suppfed ia true end corree.t to the best of hfe/har knowAeQpe. 't'ho app�caM raeajnb�as that thsy
are solely respanelbk ipr eubrYlqn�a complete applic��tion belr�8 aware lhot upon faRure ro do so, the st�ff has�o akemetive
but to reJeq i1 uNil it is complete;
• Sorne or aU o!1Me iniormsticn that you are aeked to provide on this apptiC�tion i9 dasoNied Dy Slste 18w az sither(XIVBte Or
oonbdenflal. PMvete tlat� Is ir�fonftaRiori which genera�ly�„�ba given to ths public but can bo gIVM �0 111E sUbJL�Q/�
data. Confidenliel da� Is Inbnrtnatlon which generelly cannot be piven to ailhe�the public or�e subjsct at Me cleta. Our
purpote e�nd Irllended us�of this inforRlafbn ie t0 annually updale our raeprds and raoorda of other pp��mmernal �genci�
wrod �a�n+• If u reiuee to s �e IMormatlon thf e ' iom m �ot be issiagd.
►pplicant's Signature: �y
Dete: �` /
sa uoa�ed: cs-a�-2oos
Z'd 06I9�L9TS9 3�IA213S .LIW213d Q 9 S I� Lb=6 T i0Z 6T �aQ
��R'"� '" DATE TIME V
CITY OF ORONO CALLED IN ���
INSPECTION NOTICE SCHEDULED ���-�� �
PERMIT NO. 1���-D �565 COMPLETED
ADDRESS ��� �'��� ��� ��/
OWNER TELEPHONE NO. ����� ���
CONTRACTOR /����'�-� � �la'c
,Qpzv i n
�: DESCRIPTION ���� ���C`"l ` 3 d�`'�-- -
�
ly ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
�
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z � INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPIAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW ❑WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CQRRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETItRN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46��
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary Copy/Site Notice