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Home My WebLink About2013-01168 - doors iiiiiiiiiiiiiimiiiiiiillillillilI CITY OF ORONO * 2 0 1 3 - 0 1 1 6 8 2750 KELLEY PARKWAY DATE ISSUED: 11/01/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS 1160 WILLOW DR N PIN 27-118-23-32-0004 LEGAL DESC UNPLATTED 27 118 23 LOT 000 BLOCK 000 PERMIT TYPE MINOR ALTERATIONS PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE DOORS ACTIVITY O/S BUILDING-UNDEFINED VALUATION ; $ 1,021.00 NOTE: REPLACE(1)ENTRY DOOR. APPLICANT PERMIT FEE SCHEDULE 44.50 DENNIS SARELL CONSTRUCTION INC STATE SURCHARGE(VALUATION) 0.51 11368 RED FOX DRIVE TOTAL 45.01 MAPLE GROVE,MN 55369- (612)723-2354 Minnesota State License#: IR665951 OWNER HILLSTROM,CLIFFORD 1160 WILLOW DR 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 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'ff nce with the State Building Code.This permit maybe revoked tr due ise. Applicant Permitee Signature Date lssuVfi By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. City of Orono 'Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �0 Mailing Address: Permit number: PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: Received by: 2750 Kelley Parkway Plan review fee: Orono, MN 55356 �gkFSHO��` 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: 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 sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/AP,PYCANT INFORMATION: Name: ft n �' State License# Expiration Date: r � Lead Certification Number: Expiration Date: j�/j� /s- (for work on homes that were constructed prior to 1978 Phone: (cell) 6 /� _ 3 = �j y (office) Mailing Address: J F On c- Ci :/ , „ 4,",4,"4,", ZIP: < j Contact Person: Applicant is: , CefJtcactor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFOWTIQN:1 Name: Phone (day): Address: � -. , � vCity: C1-j^ : ZIP_ . _5 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: ❑ 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(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.or 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 is to annually update our records and records of other governmental agencies required by law. If you refuse to supply ttbre information, the application may not be issued. Applicant's Signature/y �,�. J— Date: Owner's Signature: Date. Last Updated: 03/06/2013 CITY NO CALLED / INSPECTION NOTICE / SCHEDULED TIME V ED PERMIT NO. / COMPLETED ADDRESS 1I(aiQ _( r Al OWNER TELEPHONE NO.&IZ72 Z3 CONTRACTOR Soy r(fj 00n it Is DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z El 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 TO MEET YOU:_YES_NO 2 COMMENTS: W a J O O W cc Q 2 W W cc WJ Z �� ❑WORK SATISFACTORY:PROCEED OAVaDJECT COMPLETE QZ ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C1 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. ,— A—.ll�I R V�t— White Copylinspectoes File Canary Copy/Site Notice