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CITY OF ORONO PERMIT NO.: 20��-oo6g5
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISSUEu: 07/20/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1 120 COX FARM RD
PIN : 27-118-23-31-0021
LEGAL DESC : SHADOWOOD FARM
: LOT 005 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : STUCCO
ACTIVITY : O/S BUILDING -UNDEFINED
VALUATION : $ 5,600.00
NOTG: THIS PGRMIT IS FOR WATER INTRUSION REYAIRS FOR PARTIAL STUCCO.
APPLICANT PERMIT FEE SCHEDULE 132.75
HUNERBERG CONSTRUCTION CO STATE SURCHARGE(VALUATION) 2.80
11102 86TH AVE N TOTAL 135.55
MAPLE GROVE, MN 5531 I-
(763)463-5040 PAID WI7'H CC# 1341
Minnesota State License#: 3243
OWNER
PIPER, WILLIAM& TIFFANEY
1120 COX FARM RD
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The«�ork for�vhich this permit is issucd 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 pennission for additional or related wark 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 datc of issuance,or if construction is
suspended for a period of 180 days at any time atter work has commenced.
The applicant is responsibie for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked a ny time for c
�l �v l �r �r�� �7/ �d l l
Appl ca Permitee Si ature Date Issu�, By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Frdm:HUN�RBERG CONSTRUCTION 763 463 5046 07/20/2011 09 : 14 #456 P.001/001
City of Orono
Building Permit Appfication for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: ' � '
O.��,�0 PO Box 66 Permit num6er: aC�E l—U
Crystal Bay, MN 55323-0066 Date received: ZU . �
� �-�r � StreetAddress: Received 6y:
� ' 2750 Kelley Parkway Plan reviewfee.
iqR��ogrv° Orono, MN 55356 � _
- Total Fee: /�`'` 4-��
Main; 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �..�
This application form must be completed in full and alt required information must be submitted� !� ,55
Incomplete applications wifl be returned. (P/ease print) ��� / 3
GENERAL INFORMATI�N:
Job Site Addresa: �lao Cox f�rm cad
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
lf yes,a special evenf permit is required with Police Departmenf and City Council approva!60 days prior to the evenf. Shuffle bus service will be
required unless applicant demonstrafes su�cient on�site parking is availab/e. Non-�ermitted events wlll not be allowed.
CONTRACTOR 1 APPLICANT INFORMATION:
Name: Hunerbcr� L'Qns�-rucf�on �om�3nu
State License# 3ay� Expiration Date: c,�/,��/,�oi.�t,
Lead Certification Number: Expiration Date:
(foi work on homes that were constructed prfor to 1978
Phone, 74 3-H4�-SoH� (office) ��a-g�a-y s�L� (cell)
MailingAddress: lll02 ��� PruG IVor' City: a )c C-rcv� Z�P: 5�3L�)
Contact Person: JeF� �hcv�n Applicant is: Contractor / Homeowner (CircleOna)
Email and/or Fax: ;e�F� t' �un rh rn. ��rrt
PROPERTY OWNER INFORMATION:
Name: 1�l�ll�am L ��pCr
Phone(day):
Address: llaa L'cu farm Ruad City: �;ony ��1�� ZIP: 553.5�
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑Do�r(s) ❑ Remodel �Water Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑Window(s) � Repair ❑ Siorm Damage 18202 Minnetonka Blvd
�Siding ❑Restoration ❑ Other:(specify) Deephaven, MN 55391
Phone: 952-1471-0590
❑ Re-roof ❑Fire Damage Fax: 952-47�-0682
www.m i n n��ha�reek.orq
Ove�all Project Description: a;cr Infr sion C a, s -�A I'ar a .5�ucao
Estimated Construction Valuation of Project(exc uding land) $ �
APPLICANT ACKNOWLEDGEMENT:
. Agrees to provide all information required or requested by the Building Department;
. Certifies thai 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 altemative
but to reject it until it is complete;
• Some or all of the lnformation that you are asked to provide on this application is classified by State law as either private or
confidential. Private data is information which generelly cannot be glven to the public but can be given to the subject of the
data. Confidential data is infvrmation which generally cannot be given to either the public or the suhject of the data. Our
purpose and intended use of this information is to annually update our records and records of other governmental agencies
re uired b law. If ou refuse to su I the Information,th lication ma not be issued.
Applicant's Signature: Date: �'J'�'�`— � l'
Last Updated: 03-01-2011
DATE TIME
CITY OF ORONO CALLED IN �
INSPECTION NOTICE SCHEDULED __L���
PERMIT NO. �dL/-�l�G���1 COMPLETED
ADDRESS l�a-b �� /�a'�J'�^ �✓
OWNER TELEPHONE NO. ��Z �l z ���
CONTRACTOR �
>; DESCRIPTION ��� � ' C�
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILUNG
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ 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
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: �DS C(��. �f'Y�
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W� ❑WORKSATISFACTORY:PROCEED [� PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 C�RRECT WORK,CALL FOR REINSPECTION TEMPORARY
V�ORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WlLL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL{NSPECTOR
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-46�0
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
QDA, TIME J
CITY OF ORONO CALLED IN U� �
INSPECTION NOTICE SCHEDULED � �
PERMIT NO.aDI I -Gb�S COMPLETED
ADDRESS ��°�-� � ���� �
OWNER TELEPHONE NO.
CONTRACTOR
>; DESCRIPTION ���
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q ❑ 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
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑ ORRECT WORK 8 PROCEED CI ISSUE CERTIFICATE OF OCCUPANCY
W
0 ❑ ORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �952� 249-460�
Owner/Contrac or on�te�
Inspector. �
White Copylinspector's File Canary Copy/Site Notice