HomeMy WebLinkAbout2011-01056 - foundation only CITY OF ORONO PERMIT NO.: 2011-01056
2750 KELLEY PARKWAY
' ORONO,MN 55356- DATE ISSUED: 09/20/2011
' 952 249-4600 FAX: 952 249-4616
ADDRESS : 4680 NORTH ARM DR W
PIN : 06-117-23-23-0006
LEGAL DESC : UNPLATTED 06 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FOUNDATION ONLY
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 3,300.00
NOTE: 6 ANCHORS-FOUNDATION REPAIR
APPLICANT pERMIT FEE SCHEDULE 103.25
JESSE TREBIL FOUNDATION SYS INC. STATE SURCHARGE(VALUATION) 1.65
60335 U S HWY 12
LITCHFIELD,MN 56387- MAIL-IN FEE 2.00
(320)9748729 TOTAL 106.90
Minnesota State License#:20446489
OWNER
WESTFALL,MYRON&PATRICIA
4680 NORTH ARM DR W
MOLJND,MN 55364
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 dces
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances goveming this type of work '
shall be compied with whether or not specified herein.This pertnit 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 after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for�ue cause.
��/�-�( � / / / /
Applicant Permitee Signature Date Issued By i ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB .
�
-2011 21:26 FROM:TREBILFOUNDATION SYS 3205938720 T0:19522494616 P.3�3
o�l� I� City of Orono
6uilding Permit Application for Internal Work
(windows, doors, sidin , re-roof, etc.
Mailing Addr�as: permit numbec o�/ —D O
O�O�O PO Box 66
Crystal Bey, MN 55323-0066 Dete receiwd: �
Sheet Adtlress. Received by:
�tv,� o���� Orono MI'N 55356 Y Plan reviaw f�v: .
- Taql Feo:
Main: 952-249-4600 Fsx: 952-249•4616 www.�j�rono.mn.us /� � ��
This spplication form must be completed in full and all�equired information must be submi�teda� O� '
Incomp{ete appllcatlons wlll be retu�ned. (p/ease print) f -
GENERAL INF�RMATION: � �
Job 3ite Address: � j> ' p�
Will this ba a Parada of Homes, Remodele�s Showcase Home or other Dlsplay Home? Yes No
1I yaa,e speelal evsnf ps►mlt la npubsd whh Aalics Qepartment snd GTy Coundl epprou�l 60 deys prbr to Nie�wnt Shuttle bus ssnrke wUl be
Iequ!!ed uAbSS APOIJCA�I�d0lIf0A5N8�98 8lMIC(011f 0!I-6ItB 09I�NRC 18 BVV�IlObIB. �VOIMaR171�(�OVO/1!8 N�ll I10t bB B�OWipd.
CON7RACTOR/APPLICANT INFQRMATION:
Name: 1',�0 =Tr�o�i� ����.f�S�L�r, St�crl�nrL�
Siate llcense# ����4�q ' Expiration Date: 3� 31 - 0101 a
Phone: q - office cell
Meiling Addresa: C� : 't ZIP:
Contact Person: �plicarrt is; Corrtracta � Hom�owner �ciroio ono)
Eniail and/or Fax: s ,
PR�PERTY OWNER INFORMA'1'ION:
Name: ��
Phone(day): q�a��g�� ��
Add�Ss_ y1�51� N. Arr.r. Dr_ , Cl�i:�r�� ZIP: 553(e y
Emaii andior Fax " �
PROJ�CT INFORMATION:
Type of Project: Any earth movemeM m�y requtre
MCWD rovisw&pennita
❑000r(s) p Remodel D Watsr Demage
Minn8h8he Creek 1Net9rsh9d pi9bnct(MCWD)
❑Wi�dow(s) �jtepeir ❑Storm Damage 18202 Mlnnetonka Blvd
Oeephaven,MN 55391
❑Sidnp ❑Restor'�tion ❑�ther.(speclfy) Phone' 952-d71.0580
p Re-roof Fax: 952�t71-088Z
❑Fire pamage wvvw.min��h�hac��k.oro
Overall Pro'ect Desc�i tion: 'c�n cu,rc.
Estimated Construction Valus#ion of Project(axcluding Iand) S � �pp_ p Q
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APPLICANT ACKNOWI.EGGEMENT:
• Agroos to p�ovido all ir�ormetion requirad or requested by tho 6uilding Depardnont;
• CeRifias that the information supplied f� true and correct to lhe best oI hismer knowledge. The applicsnt�ecognizes that they
are solely responsible for submitting a complebe applica6on being aware that upon fallure to do so,the staff has no altemative
but t0.c'BjeCt it urrtil it ia Compl9te;
• Some or alt of the information that you are asked to provide on thls appAcadon is dassified by Sfate law as either prlvate or
confidentisl. Private data is informetion wtiich g�narally cennot be piven to the Dubllc but pn be given bo the subject ot the
date. Confidential data Is Inbrtnation which generally cennot ba given to aither the public or the subject of the data, Our
purpose ertd intended use of this informatlon is to annually update vur records and records of other govemmer�al egencles
uire0 b law. If u refuse to su I th�in(ormetion the a lication ma not be issued.
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Applicent's Sipnature: � ;������U,r, �ate: I/N I/j _
�� T
Lasc Updated: 03-Os-2006
. , P��a� �l��e�i��v �C:h�c-.�Iis# ���r �� ����tur�s ;1 �4�I�difii�ns
}lddress./PID I LegaL• �/6�D fV`6/rT�l /4�i�'l �Olt'1 `/C� `
Description ofi work: 1"�v�J�1J1�r��� V�-''1A;/4-��
5��i�,re�ri��v:by: /t���' ' D��e.;�►;ppro.Wed: �
.�oning,T,eeriew�b�y. , /`�l/.t �ate�'AProar.ect: ;
Bri�l�in.g°reari�w�Y: ' prate�►�pt�rerl: `�^/S�"ZO!�
�Gratling:r�view;b.y: /'`�fI'� Da'te�ppr�ver7:
Zoning:F.ile�: Resoluti�n#: ��ss�lutitan:Date: .
: ��onin ':DEstrict F�re`.D�e ar#mer�t �nst=OfiFcE � axil::Dis#ri�t _' `
" ��oning: .' `:Lo��rea: _ , SF�/;�� ' U1lirlth: :Depth; "
Surv��r�:t�brni�te . �!'�'�s� ;Li'i�:� 'Date of:��ra�ey:
Pro o�ed��e#ba�ks:
� �ro�'�x��:ak���� ��ar• �rs�t)� '`� ���� ��' �_� ���1 ) ' ;� '1�1 �� � ;, � ) ,��i�er="^Bwldin,gs �fle'ttani]`
� .��itle � � ���ie
Buildin,g �e�'rns�i,�:�leigtit: Builiiin� A�ak HEig . #:af-Stories Dk�: a 1'FS
':f.OR�aABU1L:fl1N6+�1lII'��3�A�i4S�MENT.L�R:�R�4i1lyL�5P.a4��: �:�R,�1;�BL-J.IL'DIN�°OM=�►'SL:�AB'�F..�t�ND�1TtC�N: ' „ :
START.�ITH ' tthe�distar�r.e.b�tween;the:basement�loz�r/ . wl START :th��.distance�bet�veen:ths slab�nd:ihe'highest
s�ace:floor an,d:the°#iighest mofipeak,,�:ttre�#ap, 1AG(TH -rpofpeak;:the.topa�ftMe:comice of;a f�at+7DDf,
?�the.comice of.a�flat�roziif;:tMe�tleck fine rofi a the xieck Jine.of-�mar�sar��roa'f,.c�r.�he
�mansardrnof,�rthe.uppermost,poin�vns:ro nd ; ;uppermostpdirit�on.arnuntlnr�otherarch,ty{�e '
or other.:�rch=,; e°roo# . ` roof ::.
SG.BTRACT haff:the:�di�tanee::betweEn�the�highest:�ri w;:antl � TR�CT . �half:the-�istanee between�ihe.hi,gMest�ruin�low ;
. ' �hi est:roof�:�e�k�fi.a.. itched<roDf �nd hi�'hest.ronfi.. eaknf�� itcheti;�AD�
SL1BTRl#�T the�:rlistance�beiween the:basement� Dr/crawl ADD :the�distance between�tt�e;slab�n��he,highest :
:spac�.`flaoranti'the�hi,ghest.:�zistin rade�:witfiin :ezisfin rade�within"th��€ountlat�nn•
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iE(]lJALS ':Deflnedbuildin hei ht
L�t°Gnv.erage: : :�� -_
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' SEP-13-2011 21:26 FROM:TREBILFOUNDATION SYS 3205938720 T0:19522494616 P.2�3
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ApProximate number of days for jc�b complet�on:
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Addi[ional charge for moving Gopher One �ounc of bid $ r 3� � U
objeets ouc of the work �rea $ �'Yes ❑ No Plus permit fe�s if rEquir�d
❑ H�meowner t�get nermit
Our p�iority is to�x the problem with you.r foundaCibn, that's what our customers rely on us for, Keep in mind that
we ean noc be responsible for any finisl�carpentry, painunb,panelinb,ere. ch�it may be nece,ssary after our work is
completed.Jcsse 1'rebil F'oundation Systems,Tnc.will not be responsible for any landscaping, ces��din�or re-soding,
unless otherwise noted on brd.
We will call "Gnpher One" to h�ve all publ.ic underbround lines located, lf you have private lines such as satellite dish
cables,propane line, sprinkler system,ete. you acc responsible for marking them. �esse Tr.ebil Foundacion Sys�ems,
Inc. will no[<<ssume respons,ibility if ther�is damage ta priv�►te lines,If you livc;lc a rural address,pub.(ic lines will
only he located to the pole o.r your property line. If damagc co any of these li.nes in an area that was not marked
occurs,yo�� will be responsible for all r�pairs. If your city �equ.i�es oucsid� engineerinb, this quote mf►y need t� be
rewritten t� mcr;l cheir recommendations. Any additionfil Fees incurred �re not included in this bid and are the
customer's respunsibility.
�A � dr'�J � ?��eNri'h���p�on Mnlieh�nnUVsa/Dircovar
Represtn��ive'�Si6n:�ture � �` Authori�ecl Si�nature ,
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.`� ATE TIME V
CITY O OR NO CALLED IN /C� !�
INSPECTION NOTICE SCHEDULED /� � �
PERMIT NO.C�iD!/--��OS�COMPLETED
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ADDRESS �f!/�� �l ��/'✓L
OWNER � T LEP,HONE NO.�C�3 �-
CONTRACTOR �[ /
�: DESCRIPTION �l/I�
�
� ❑ FOOTING � PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREM/ETLANDS
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
� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ❑WORK SATISFACTORY:PROCEED �Q,�ECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. -
Cail for the next inspection 24 hours in advance. (952� 249-4600
OwnerlContractor on site:
Inspector.
White Copy/lnspector's File Canary Copy/Site Notice