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. CITY OF ORONO PERMIT NO.: 2012-00012
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: OU09/2012
952 249-4600 FAX: 952 249-4616
ADDRESS : 505 FERNDALE RD N
PIN : 36-118-23-13-0006
LEGAL DESC : FAIRWAY VIEW
: LOT 002 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING -UNDEFINED
VALUATION : $ 13,477.00
NOTE: R[;PLACE(�)WINDOWS AND(l)PATIO DOOR WITHIN EXISTING OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 250.75
RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 6.74
1920 COUNTY RD C. WEST
ROSEVILLE, MN 55113 MAIL-IN FEE 2.00
(612)502-4777 TOTAL 259.49
Minnesota State License#: BC130983
OWNER
BIERMAN, EDWARD&NANCY
505 FERNDALE RD N
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
Thc work for which this permit is issued shall be perfonned according to
the approved plans and specitications,applicable City approvals,and the
State Quilding Code. This permit is for only the work described and does
not grant permission for addi[ional or related work which requires separate
pennits. All provisions of laws and ordinances governing this type of work
shall be compied with whe[her or not specitied herein.This permit will
expire and become null and void if cons[ruction authorized is not
conunenced widiin I 80 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.
`�'�-�--�.-Q_ C� / / , / /
Applicant Permitee Signature Date Issued By Si ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
Jan-04-2012 01�13pm From-CITY OF ORONO +9522484616 T-366 P 002/002 F-028
,,�,., v���t v� v�v��v
, . � Building P�rmit Application far Int�rnal Work --,
� (windows, doors, siding, re-roof. etc, ,
Malung addreas: Permit number:
„ ��� Pd eox 68 —
.
, � � Q Cryetel Bey, MN 66923-OQ6B Date roceive� � - �
� � ' Sfreef Add�as; Recaived by:
� 275D Kelley Parkwey Ptan revlew fee:
'� o� Orono, MN SS356
� ,� T«�F�. � �q �9
Main� 852-249-4600 Fax: 952-24�4618 www.ci.orono.mn.us
' this applicatfon form must be completed in fu11 and alt required infarmation rnuat be subrnitted.
; � ,, „ Incomplete applicationa wIN be�eturned. (Please pnnt�
G�NERAL INFORMATION:
,Job;Sfto Addres�: �5 ���(r�,p��� 11 . �•
.Will this be a PersOe of Homea, Remodelers Showcase Home or othe�Diaplay Hc�me� Yes No
.,, Il y9s,e ype6lal ewnf p�rmlf l��eOWtid wllA PoNCe deperrin�nf ond Clry Counell Apprpvp!BO q�yd Wbi to the e�enL 3hu�btN Selvlpr WI/I DO
requ4�d unMss eppJkant tbmOnatrefes suNicrent on-sitg parMqp Is su+e�eb/e. NoA-permllled oNants w!M mtde olbwed.
;�.ONTRACTOit/APPI.ICANT INFORMATION:
,;Narne: Kenewat �sy AnQersen
=-S'tate Ucenae# 19Z0 CounLy Road "C"West Expiraticn D�te: �
.Phone: Rnsevslle, MN 55113 (�e��)
� Melling Address� LiCense #BC130983 Cft�.-�y. ZIP:
Contact Person: 651•264-4777 �►is: Cantracb�r / Homeawner �c���ec�e�
�mail and/or Fax;
PROPERTY OWNER INFORI�I�710N:
Name: Ed t
Phone (day): � 5
Addr+e8s: C � ZIP:
Email and/or Fax
PROJECT INFORMATION:
T�rpe of Projeat: Any sarth rnovement m�y requlre
MC WO_rrviow b psrmlta
(�Doot(s) ❑ RemodN ❑Water Oamege '
Minnehaha Creek Weterehad Disfrict(MCWD)
'�VN11�few($� " ❑ R6peir ❑ Storm Damage 18202 Minnetonka Blvd
[]Sltll Deepheven,MN 65301
n9 I ❑ Restoratlon []Other: (apecifjr) Phone: 932�471-05�0 ,.
❑Re-roof ❑ Fire Damage ��eX: A62�471-b8B2
Overall ProJeCt D9scription:'r�,�lc►�[n 5 .;,n.�n�.,a. � 1?��.}�a �r�f W�,h •Q1X�S�no,
Estlma�d Conatruetion Valuatton of Proleet(mxeludlnp land) i 1314�� �b _ ���,
�
� APPUCANT ACKNOWLEDdEMENT: �
• Agrees to provlde ell Infarmatlo�requlred or reque�ted by the Bu►Iding Depsrtment;
. CeRi�es that the informetion eupplled iB true and oorrect to the best of hle/he�knowledsa, Yhe applfcant�eoognfzes fhet ther
are solNy respor�sible for aubmitting e Cpmpleto appllcation being aware tt�gt upon 18ilure Yo do gp,the etaif Mes no�Itemetl�e
but to re�ec! it until it Is oomplete;
• 8ome ar ell of the informetlan thet you are asked to provide on this abplication Is cl8sslfied by Stal�law ea either pr"Naie ot
oornldentlal. Prfvate data is intormation which ggnerelly Cennot he glven to the publlc but can be given to Ihe subjed a1 the
data. ConAdendal date ia infamadOn Wh'rch 9enetelfy cennot be gNen to eltll�r fhe publ{c or the Bubjed of thi daf�e. Our
puryose and intended u9e ot ihis informefion la Lo annually upOgte our recor0a and �eaords oi ofher EJovernmen181 eger1c188
required by lew. (f�rou refuse to euppiy the IniormeUpn the eppliceiio�may net be Issued
ApplicanYs Signature� _ Date: y � � � a
Laat Upasted: OS-04-2008
Z •d D6T9til.9ZS9 3�If+a3S lIWa3d Q '� S � Lt =2t 2TDZ b0 UeC
/
S AT� TIME (/
CITY OF ORONO CALLED IN ���,
INSPECTION, OT)CE p�D SCHEDULED s'��
PERMIT NO.�O/ � � COMPLETED
ADDRESS SO Pi1'�
OWNER TEL PHONE NO.��� �� ���
CONTRACTOR
>: DESCRIPTIO�LV����L'Pl�C/-S � Cy D�Y
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREM/ETLANDS
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
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v � PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW ❑WORK SATISFACTORY:PROCEED ,�PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED '�� ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
C INSPECTION REQUIRED.CALI TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-46�0
OwnerlContractor on site:.
Inspector. lP,/ /�' �
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