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CITY OF ORONO * 2014 - 00097 *
2750 KELLEY PARKWAY DATE ISSUED: 01/30/2014
ORONO, MN 55356-
952 249-4600 FAX: (952) 249-4616
ADDRESS 1120 TONKAWA RD
PIN 08-117-23-13-0009
LEGAL DESC AUDITOR'S SUBD.NO.217
LOT 009 BLOCK 000
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE WINDOWS
ACTIVITY O/S BUILDING-UNDEFINED
VALUATION $ 1,916.00
NOTE: REPLACE(1)WINDOW INTO EXISTING OPENING.
APPLICANT PERMIT FEE SCHEDULE 73.75
SCHERER BROS LUMBER STATE SURCHARGE(VALUATION) 0.96
10751 EXCELSIOR BLVD MAIL-IN FEE 2.00
HOPKINS,MN 55343 TOTAL 76.71
(952)277-1600 Payment(s)
Minnesota State License#: BUIL-BC239369 CREDIT CARD 3989 76.71
OWNER
BENDT,JOHN&ANNE
1120 TONKAWA RD
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 does
not grant permission for additional or related work which requires 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 the State Building Code.This permit may be
revoked at any time for du cau
Applicant Permitee Signature Date Signature Date
City of Orono
Building Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
Mailing Address: permit number: /
�t�nT PO Box 66
Crystal Bay,MN 55323-0066 Date received:
Street Address: Received by:
y /c� 2750 Kelley Parkway Plan review fee
Orono,MN 55356
FsNOa�' Total Fee: ,t!o, -71Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mnAm
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: A 0 71�nk-a wcc- le0 a of
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 0 Yes 0 No
N 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 available. Non-permitted events will not be allowed.
CONTRACTOR/APP CANT INFORMATION:
Name: 175ros U
State License# 1-2__3 q_3&9 Expiration Date: 3/ ¢
Lead Certification Number: L1AC-,26'30S-/ Expiration Date: /
(for work on horns that were constructed prior to 1978
Phone: (cell) (office)
Mailing Address: 70757 t5ecefstOP- 1—vCRY D h$ ZIP:
Contact Person: Cal"OLLIA vi S Applicant is: ontra / Homeowner (Circle one)
Email and/or Fax:
PROPERTY OWNER INFORMATION,
Name: 30V1 i A[AV _P_-Ay 9k+ -
Phone(day): 175a-471 -
Address: 1120 7Z)`1 a K/G� d- City: 6-,Ona ZIP: a p)39e
Email and/or Fax:
PROJECT INFORMATION: Overall project description: R� Gf I?Q 1 Wi`iG�O u1. NO S (,ccfGW-( t
Type of Project: Any earth movement may also require
❑Door(s) ❑Remodel ❑Fire Damage MCWD review&permits:
❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55391
❑Re-roof,other tspecify) ❑Siding ❑Other.(specify) Phone: 952-471-0590
Fax: 952-471-0682
VWindow(s) www.minnehahacreek.ora
Estimated Construction Valuation of Project(excluding land) S
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
you refuse to supply the'nformation the gepIj!_ptiQn may not be issued.
Applicant's Signature: Date: O 1
Owner's Signature: Date:
Last Updated:03/06/2013
DATE TIME
CITY OF ORONO CALLED IN65
-Z
INSPECTION N TICE �� SCHEDULED
PERMIT NO. 7 COMPLETED
ADDRESS 44,
OWNER LEPHONEO.4� 1— f471
CONTRACTOR owv_e�
DESCRIPTION
tau ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ 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 ❑ COMPLAINT
❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP
❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
Z OWNERICONTRACTOR O MEET YOU:_YES_NO
COMMENTS: �LGiKJ
� /'10 tJ �t t�- ✓4in a S/2 i.,
cc - AdvA flair& s 4 e@
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W
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Q S 441or D_if G�i�tL
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Uj ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE
W ❑CORRECT WORK S PROCEED ❑ NUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector.
White Copyflnspector's File Canary Copyfte Notice