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CITY OF ORONO * z 0 1 6 - 0 0 7 1 7 *
2750 KELLEY PARKWAY DATE ISSUED: 06/2ll2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 70 FERNDALE GREEN
PIN : 36-118-23-44-0007
LEGAL DESC : ALLO-RAE TERRACE
: LOT 003 BLOCK 001
PERMIT TYPE : MINOR ALTERAT[ONS
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE . DOORS
ACf�v.-f•� • c/ t�l�`7
VALUATION : $ 3,765.00
NOTE: REPLACE ENTRY DOOR
APPLICANT PERMIT FEE SCHEDULE 108.38
STATE SURCHARGE(VALUATION) 1.88
DESIGN CRAFT CONSTRUCTION INC. TOTAL 110.26
3619 85TH AVE N#B Payment(s)
BROOKLYN PARK, MN 55443- CREDIT CARD 0150 110.26
(612)760-0888
Minnesota State License#: BUIL-BC692134
OWNER
BELLINI,CHRISTOPHER&KELLY
70 FERNDALE GREEN
WAYZATA, MN 55391-
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 Iaws 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 withi days of the date of issuance,or if construction is
suspended a period of 0 days at any time after work has commenced.
The app cant is responsible'for assuring all required inspections are
reques d in conformance ith the State Building Code.This permit may be
revok d at any time for du cause.
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Applicant Per i e Signature Date [ssued, Signature Date
s
City of Or4no
Building Permit Application for Maintenance / Replacement/ Remodel - Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION)
'� �`� Mailing Address:
Permit number:
4��N� Po BoX ss
% Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
y�, � 275U Kelley Parkway Plan review fee: `.
" Orono, MN 55356
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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: �p '�rnn�c�le .�,,,ep,•�
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 approva160 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/APPLICANT INFORMATION:
Name: �'25►cr nrG-F►- ��n5���'�or 1��-
State License# �qrL��y Expiration Date: �{��'���
Lead Certification Number: ��T_ F���,o05_, Expiration Date: 812��2��,g
(for work on homes that were constructed prior to 1978
Phone: (cell) � 1 �,� � (office) -�� �_ 2
Mailing Address: � h. p,�,,� #� � Cit : � ZIP: �
Contact Person: � �.� 1 a,, Applicant is.�Contractor�/ Homeowner (Circle One)
Email and/or Fax: `---
PROPERTY OWNER INFORMATION:
Name: C1�r►-.-tu��r �����n�
Phone (day): g.s2_y�'��. OL��
Address: c19 �v n��� C:���� City: �-�r, ZIP: c���q�
Email and/or Fax:
PROJECT INFORMATION: Overall project description: �1 � o�r,
Type of Project: An earth movement may also require
�Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 1 LDS. �
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 s informatio which generally cannot be given to the public but can be given to the subject of the data.
Confidential data is in(ormation which g nerally cannot be given to either the public or the subject of the data. Our purpose and
intended use of this nformation is to a ual!y update our records and records of other governmental agencies required by law. If
ou refuse to su I the information, e a lication ma not be issued.
ApplicanYs Signature: �� Date: �o�-1�ly
Owner's Signature: Date:
Last Updated:January 2016
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTJCE �j SCHEDULED �f
PERMIT No.26/64 •C45 7V? COMPLETED 0` )-/Se
ADDRESS 70 rawDt.oA ate rk_
OWNER TELEPHONE NO.
CONTRACTOR rOss.T., C -t C'4:0-•t.5t` Z P+C.
DESCRIPTION � �' "CD" r sP
W0 FOOTING ❑ DEMO-FINAL 0 SEPTIC FINAL
• ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
61 0 FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL
Z.• ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION
C 0 FRAMING 0 MECHANICAL FINAL ❑ RATED WALLS
• ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
0 FINAL 0 WATER HOOK-UPOW-UP
• ❑AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
r ❑ DEMO-SITE 0 SEPTIC INSTALL
Z OWN6(CONTRACTOR TO MEET YOU:_YES_NO
COMMENT& ‘4(rot t #4&;.t/w 14•/c.,0 C Q 1l
IZdeC /tet ye-c1/0
% Permit has expired per MN Building Code Sec. 1300.120 subp. 11
N. Expiration, no record of a Final inspection.
ct
14.
W
O:
CC
W 0 WORK SATISFACTORY.PROCEED 0 PROJECT COMPLETE
0 CORRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY
CI 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
0 CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN
INSPECTOR WILL RETURN 0 CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
0 INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
CaN for the next inspection 24 hours in advance. (952) 249-4600
OwnedContractor on site:
Inspector
WMIS CopyMap.otor's Fllo Canary CopyISIM Notice