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Home My WebLink About2016-00041 - adn/remodel/repair CITY OF ORONO * 2 0 1 6 — 0 0 0 4 � * ,. 2750 KELLEY PARKWAY DATE ISSUED: OU26/2016 . ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3640 JACOBS MILL RD PIN : 32-118-23-24-0010 LEGAL DESC : JACOBS MILL : LOT 004 BLOCK 001 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 110,000.00 NOTE: SEPARATE PERM[TS REQUIRED: PLUMBING,MECHANICAL,FIREPLACE,ELECTRICAL(STATE) BASEMENT FINISH APPLICANT PERMIT FEE SCHEDULE 1,172.92 STATE SURCHARGE(VALUATION) 55.00 WOODDALE BUILDERS INC. TOTAL 1,227.92 6117 BLUE CR DR MINNETONKA, MN 55343- Payment(s) (952)345-0543 CHECK 84513 1,227.92 Minnesota State License#: BUIL-BC002926 OWNER HOPFMAN,KEITH&MARY 3640 JACOBS MILL RD 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 afrer work has commenced. The applicant is responsible for assuring all required inspections are ��n requested in conformance with the State Building Code.This permit may be � ��J revoked at any time for due cause. ^ I� ! i.^�1 �� I_�- � � � � �v�� ( / � / � f•,,/�` J l � L� � L Applicant Permitee Signature Date Issued By Signatu Date .� � � �� . � � City of Orono �-� � Buil�ing Permit Application for Maintenance / Replacement / Remodel �(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) O Mailing Address: Permit number: �D� - Q�� PO Box 66 � C.,�� Crystal Bay, MN 55323-0066 ✓ ,L��'� Date received: � "�3 �S 2 Street Address: `� Received by: y� � 2750 Kelley Parkway , Plan review fee: ��, � - t � L Orono, MN 55356 , '��, ' �—��(C � �KfSHO � L � J �_ _.� __ =-=---- �otal 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: L. Job Site Address: �6y� p!C Op s ��t` �,� d�dUJ� �/� 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 approva/60 days prior to the event. Shuttle bus service wil/be �equired unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: State License# Q(� Expiration Date: Lead Certification Number: ��w� Expiration Date: �.ry� � (for work on homes that were constructed prior to 1978 Phone: (cell) . ` • (office) • s�s • Q,� �/� Mailing Address: �„� City: � »�'r��,,,R,M ZIP: ,Ss Contact Person: J • �_�,'�``y�,,s Applicant is: ontractor Homeowner (Circle One) Email and/or Fax: bT E V t 0 '�. w00� ��.E B t�1 �•�� + �O N�1 PROPERTY OWNER INFORMATION: Name: �i � N t h1 1/� d � V� Iq��' Phone (day): . • � Address: �L` � City: ZIP: Email and/or Fax: XE�T N N o FF �► i+w �C S'�S�i � M 1Ai l. � Cp �w► PROJECT INFORMATION: Overall project description: l l " F��►�+ �b N • �� C�,s T 0 D� 1� 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) �.1� ��Ni'N � www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ �(900� 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 ap icant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so, t 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 an u date our records and records of other governmental agencies required by law. If �-�� - ou refuse to su pl th ' ion, the a lication ot be issued. Applicant's Signature. 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"- � , Firep�aC�; : �. ��erbrer�or��ei�n .. � �� - C7.;Nlsstmry ' . �f�';I,a�n!ta t�g��or� �Ml�g . �1'1a�r�ds�aping _ lnst�c►r� - O�'tet{spet�fNj � !�s-1�uiit��inr�y . � , pec' Finaa + - � ` � l.�tfie . . . . Requireci S t�E'�rmF�s ' � Other fspeci'fY) � . � WeN � : Electri¢al . R�RA�.6tt�(in-house)s . . , � , , . � ��FFE�l1��6�E.�i�K�d TQ��[�01r�l�C?i�' �ERR�f E A�1� 6�i��6►►�,�LD: 'j � S��uilc#r�r�c6crro�le��e��enf�orm _ � � Prior to release of escrow money an as-built survey and hardcover calcula#ions must be submit�ed and approved. i , ; f ' - � _ _ . . " ` _ - � u�decea: oo�o��zo�s . �•ifnrmc4nian rouiow rhPr4lief 1(1-9M.ri rinrr i V DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED _!r�_.�— PERMIT NO. a�V��n r MP EfE 6�/�r•`. ADDRESS OWNER � TE PHONE NO. CONTRACTOR � DESCRIPTION , ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RAD SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION _ ❑ AMIWG ❑ MECHANICAL FINAL ❑ RATED WALLS � SULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNER/CONTRACTOp TO MEEf YOU:_YES_NO y COMMENTS: � W a � J O ). o� O � W � Q �i r � 2 W � W � � d W RKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COYERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice C=�. ��/ DATE TIME CITY OF ORONO CALLED IN INSPECTIO�N� CE SCHEDULED `-� � ��' �� '—�� PERMIT NO.�-�/ �� COMPLETED ADDRESS 3 C�'-� G � ,c.�c•!� � C`l.�� _ OWNER TELEPHONE NO. CONTRACTOR ��-'�'�,� ��`�_ ��`�-`-�c-,�-�Zv � DESCRIPTION ��•�=:, ��':��lL`� �.\_� a�1L' ��C:� W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAI ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � ,�,,FINAL �j(t�,<-h u-C1� ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ � ❑ DEMO-SITE ❑ SEPTIC INSTALL � OWNERICONTRACTOR TO MEET YOU:_YES_NO ��., COMMENTS: � W a � � O �. - � O � W � Q � 2 W � W � J d W ❑WORKSATISFACTORY:PROCEED ❑ JECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSU CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. ,=' Call for the next inspection 24 hours in advance. 249-46�� OwnerlContractor on site: Inspector. `-' � White Copyllnspector's File �� Canary CopylSfCe Notice �/� C<� ATE TIME' CITY OF ORONO cnILED IN 3�" � INSPECTION NO I E SCHEDULED - � PERMIT NO. �� C MPLETED ADDRESS � OWNER ELEPH O.��Z Z 7D 1�./ CONTRACTOR � DESCRIPTION � 4~j ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL 2 ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q �RAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP �4 ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET Y�IJ:_YES_NO � COMMENTS: ��G+�- � r 3- '�1' �� o ��'K v„I,•r �/� �. 0 � �'/�' .S�� e o�' F�• cif•�s� Q �� a-��S— ? r-� ��r � ,�j �P.�. �/c.-c_ j.y�o�- m�s�z�L� � fu, 7�d.n �/Gl�GS - - � ; ✓'�'b � �� W ❑WORKSATISFACTOHY:PROCEED ❑PROJECT COMPLETE ��►�9RRECT W'ORK 8 PROCEED �ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COMERING PERMANENT ❑CORRECT UNSAFE CONDITiON WRHIN HOURS. p pHpTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 br the next inspection 24 hours in advance. (952) 249-4600 OwneNContractor on site: � Inspector:��^-�� White CopyllnspectoY's File Cenary CopylSite Notics