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� CITY OF ORONO * z 0 1 4 - 0 0 8 B i *
2750 KELLEY PARKWAY DATE ISSUED: 08/12/2014
ORONO,MN 55356-
(952) 249-4600 FAX: 952 249-4616
ADDRESS : 1220 LYMAN AVE
PIN : 35-118-23-34-0016
LEGAL DESC : LYMAN WOODS
: LOT 003 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 20,900.00
NOTE: WINDOW REPLACEMENT
APPLICANT PERMIT FEE SCHEDULE 354.00
SCHERER BROS LUMBER STATE SURCHARGE(VALUATION) 10.45
10751 EXCELSIOR BLVD MAIL-IN FEE 2.00
HOPKINS,MN 55343 TOTAL 366.45
(952)277-1600 Payment(s)
Minnesota State License#: BUIL-BC239369 CREDIT CARD 3989 366.45
OWNER
BENSON, SEAN&ALISA
1220 LYMAN AVE
WAYZATA,MN 55391-
AGREEME1vT 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 goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if wnstruction 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.
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Ap ' ant Permitee Signature Date Issue By Signature Date
� �lug, 12. 2014 2; 03PM �'o. 0412 P, 1/1
� City of Orono
Building Permit Application for Mainten�nce / Replacement / Renovatian
(No structural expansion. Only windows, doars, �iding, re-roof, etc.�
�n��, MallingAddress: Penmt numb�r��-�'���'�
v PO Box 66
Crystal Bay, MN 553Z3 0066 [�afe re�e�ved __, • ° . ���� �
Rec��uec�hy� � ,
St�eet Address; - . '
�.�, � 2750 Kelley Parkway Rd�n��VI�W fe� �
t �G Orono,MN 55356 � ,,�
�kEs�Io� '�o#al����� x
Main: 952-249-46Q0 Fax: 952-249-4616 www.ci.orono,mn.us ,,:�, ``'�
7his application form must be completed in full and all required information must be submitted.
Incomplete applications wifl be returned. (P/ease prinf)
GENERAL INFORMA710N:
Job 51te Address: "
WIII this be a Parade of Homes, R�modef rs Showcase Home or other Display Home? Yes No
lf yes,a speciel eVent pemlit is r�qulr6d wllh Po!(Ce Dapartmenf and City Council spproVe!60 days prlol'(o the event. 5huttle bus service will be
required�mless app!lcenP demonsltales sufflcient on-site parking is svallable. Non-pe�mftfed euents will not be allowed.
CONTRACTOR/APPLICAN7 INFORMF�yT10N:
Name: C,�e.(.-.�i/' «�'��. V►'► �P�t' ��
StaEe License# Expiration Date= ap/
Lead Certification Number: �- - �,�. � Expiration Date:
(for work on homes that w re consbuctod prlor to 9978
Phone: (cell) �r '�"7 � f(p� (vffice)
Mailing Address: O ,5 �,� � City: . �� zIP: '� �
Contact Person: Q r� Applicant is: ontrac�or Homeowner (Clrcle One�
Email andlor Fax; C JSmpV.P�������Ir�V`(�JYt�S•Gi1tn� _
PROP�RTY OWNER INFORMATION:.
Name: e.Q.V1 � C LL, QV) �V1
Phone(day): � - •-
Address; �.[� e City: . .�� p � ZIP: `j
�mail and/or Fax:
PROJECT INF�RMATIQN: Overall ro ect descri tion:
Type oF Project: Any earth movement may also requlre
� Door(s) ❑ Remodel ❑ Fire Damage MCWD revlew&pertnits:
❑ Re-roof,asphaIt ❑Rep�ir ❑ Stomi Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
0 Re-roof, cedar ❑Restoration ❑Water Damage Deephaven,MN 55391
❑ Re-roaf, other(speclfy) ❑5iding ❑Other: (specify) Phona: 952-471-0590
Fax: 952-a71-0682
�Window(s) Www.minnehahacreek.ora
Est(mated Construction Valuat;on of Project(excluding land) $
ApPLICANT ACKNOWLEDGEMENT:
. Agrees to provide all information required or requesied by the Bulfding Department;
• Cerfifies ihat the Information supplied is true and correct to the best of his/her knowleclge. 7he applicant racognizes that they are
solely responsible for submltting a complete epplication being aware that upon fallure to do so, the staff has no alternative but to
reject it until it is complete;
• Some or all of the informatfon that you are asked fo provide on this 2ppllcatlon ls classified by State law as either priv�te or
confldenfial. Private data is information which generally cannot be�iven to the public but can be given to the subject of ihe data.
Confidential data fs information which �enerally cannot be given to elther the public or the subject of the data. Our purpose and
iniended use of this informatlon[s to annu�lly update our records and records of other governmental agencies required by law, If
ou refuse io su I the�nformaiion, the a licatian ma not be issued.
Applicant's Signature: �1� Date: c�� o�Q�
Owne�s Signature: Date:
Last Updated:03/06/2013
�
� DAT�� TIME
CITY OF O ONO CALLED IN �
INSPECTION N�T CE -�O��6CHEDULED 9- - _��
PERMIT NO.o�t� a COMPLETED
ADDRESS �aa� v) �K'�
OWNER ELEPHONE NO��a�7�S3S�
CONTRACTORc S �S
� DESCRIPTION ��� �
� ❑ FOOTING O PLUMBING FINAL EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANOS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
ZO INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� �INAL ❑ SEWER HOOK-UP ❑ COMPLAINT
J ❑ DEMO-SITE O SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET ll�U:_YES_NO
y COMMENTS:
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� ❑WORKSATISFACTORY:PROCEED 1Q�ROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED VO I�SSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN
INSPECTOR W{LL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site•
Inspector: � �
White Copyllnapector's File Canary CopylSfte Notice
DATE TIM
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMR NO. �a����� COMPLETED _���
ADDRESS' � �� ��[ ��� .
OWNER TELEPHONE NO.
CONTRACTOR ���-�� ���� �«�-l'-s'-��
� DESCRIPTION ���w ��1�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADING/FIWNG
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WEfLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� INAL ❑ SEWER HOOK-UP ❑ COMPUUNT
Q ❑ DEMO-SITE ❑ SEPTIC MAINT. �F6tLOW-UP
= 0 DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAI
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATIGN/REMOVAL
Z OWNERlCONTRACTOR TO MEET YOU:_YES_NO
��., COMMENTS:
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W ❑WORK SATISFACTORY:PROCEED �iB�IECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CONERING PERMANENT
❑CORRECT UNSAFE CONDITION WfTHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site:
Inspector: `���- n--
Whits Copyllnspector's Fik Cenary CopylSite Notfee