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Home My WebLink About2012-01216 - addn/remodel/repair CITY OF ORONO * 2 0 1 2 - 0 1 z 1 6 * � 2750 KELLEY PARKWAY llATE ISSUED: 12/03/2012 , ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 25 BROWN RD S PIN : 03-117-23-21-0001 LEGAL DESC : UNPLATTED 03 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION /REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 4,000.00 NOTE: SEPERATE PERMITS MAY BE REQUIRED: PLUMBING,MECHANICAL, FIREPLACG,ELECTRICAL(STATE) RE-SHEETROCK AND RE-INSULATE FAMILY ROOM-WATER DAMAGE APPLICANT PERMIT FEE SCHEDULE 10325 ASSET MANAGEMENT AND RESTORATION STATE SURCHARGE(VALUATION) 2.00 161 1 PULASKI ROAD TOTAL 10525 BUFFALO, MN 55313- (612)685-8005 OWNER POWERS, SUSAN 25 BROWN RD S 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 no[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 due cause. /� �� _�/V l ��l�vL� App nt Permitee Signat e Date � � � � � �" ssue y Signature Date SEPA TE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. �� c�� t ��c��r�� E�� ,�� - f�a�r��r�a�c� � ��c�� r (v�i�cio�p�, �iaa€-�, siaic��, ��-ra�f, ��c.} M,ai/ing Adar-ess: ;�� PO Box oo j Permit numb�r: p2��p2—d/2/ �� Crystal Bay, MN 55323-0066 ' -Date received: � ��O,�'�� ' �r.�. �� ,-.rY � � Received oy: ��,� ��t��;y Srreet Address: � � � � `\'��M�'�{�f�`'."��,�� / 2750 Keliey Parkvray � ��rr4w Orono, MN 55356 � Pianrreviewfee: ��Esxo � Main: �52-249-4000 �ax: °52-249-4016 www.ci.orono.mn.us i Total:Fe�: �0�,p� This application form must be compl�ted in full and all required information must be submitted. fn�ompiete appiicaiiorts wil! be returnea. (Please prrnt) ��h'=r.A! INr=ORMATlO�: Job Site Address: '� �� ,^�I,J�'` 1�� Will tn:s be a Parade or Eiomes, P.emodefers Showcase Fiome or other Disp{ay Fiome? I� Yes �fo /fyes, a specral event permif is required with Fofice Gepartment and Cit}��ouncil approva!60 days prior to the event. 5nuttie bus se rce wil!be required unless appiicanf aemonstrates sufiicient on-site parking rs availabls. N'or-permitted events will nof be aliowed. CONTRACTOR/;a,PPLICANT INrOP.MATIOf�: r Name: :� - State License # ' �(�' � � cxoiration Cate: '�' '� ' � Lead Certirication Number. U -'-� Expirafion Cate: �-� (ror work on i�omes thaf were.,onstructed prior to 1978 Phone: ' — � (ofiice) (cell) Naiiing Address � City: ZIP: 1—• Con;act Person: ' � Appiicant is: Contrac / Homeowner (Circfe ne) Ernail and/or Fax: - PROP�R i Y OWN=R INrO �ID�t: � _ Name: � V�J�'. J � � Phone�(day): - . Address: �>� �'�'�'� �" � �D c t�� City��..�a�'�1�-ZfP� j�l��. Email andior Fax .�, n� Z� � PROJ�CT IN�ORM,�t,TlOt�; ' Type of Project: � � � Any earth movement rr,ay require ❑ Door(s) ❑ Remodel I ❑ �ire Camage MCWD review&permits: I Ninnehana Creek V1.'atershed District(MCW D} ❑ Re-roo?, aspNalt i (�Repair I ❑ Storm Damage 15202 Ninnetonka Blvd ❑ Re-roof, cecar � o A Deephaven, MN ��391 ❑ R„sto�aiion V��at„r Gamage � � Pnone: 952-471-Q590 ❑ Re-roof, other(speci"ry) � ❑ Siding ❑ Other: (specify) i �ax: 952-47"�-OoE2 I ❑Window(s) www.minnehahacreek.orq I Overall Froject DescripfiaR: v �, 9„ " � - =siirr,atecE Cor.s"truciion ��aivaiion o; Proiect (�xciuciing ;and) � � � ,?� �4P�LI�At�T �CFEi�JV1�L�Q^v�Mc�?i: � Agrees to provide all inrormatior required or requested by the Building Department; , • Ceriifies trat the informafion suppiied is irue and corre�t to the best or' nis/ner knowledge. The appficant recognizes tr�at they are soleiy responsible fa�submitiing a compiete appiicafion being aware that uoon �ailure to do so, the siaff has no alternative I, but to reje�t it until it is complete; i p Some or all of tne inTormatior that you are asked to provide on tnis appii�ation is ciassiTied by State iaw as eitner orivate or ; coniidenual. Private da;a is inrormation wnich pene;ally cannot be given to the pubfic but can be aiven to the suoiect of the � ; data. Conrideniia! da�2 is inrormafion whicn generaliy cannot be given to eitner the pubiic or tne subiect or tne cata. Gur i puroose and intended use of this inrormation is to annualiv updat� our re�ords and records o� other aovernmen;ai aaencies I reauired bv lati�. If vou refuse t0 SUDDIV tf12 IIl70fR18tI0R,tI12 2ppIIC8il0tl IT2\� no:be issued. Hppii�anf's Sigra'ture: Cat�: ��/6�j/�� Las:UQdateC: 0°•-d5-2D1" � � C��` DATE TI E � CITY OF ORONO CALL i , I - —l7i � ��C�` INSPECTION N TIC/E scH�� ' PERMIT N0. Q` �/�� COMPLETED ADDRESS � OWNER T EPHON NO.�/��—� �5�� CONTRACTOR ' >: DESCRIPTION �� G� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Z 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 � OWNERICONTRACTOR TO MEEf YOU:_YES NO � COMMENTS: G G �� W a � J O �. � O � W � Q � Z W � W � � GW �RKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTOARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (J52� 249-4600 OwnerlContractor on si e: Inspector. White Copyllnspector's File Canary CopylSite Notice