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' ' CITY OF ORONO * 2 0 1 6 - 0 1 z z 5 *
2750 KELLEY PARKWAY DATE ISSUED: 09/29/2016
ORONO,NIN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 4041 NORTH SHORE DR
PIN : 07-117-23-44-0077
LEGAL DESC : REG.LAND SURVEY NO. 1420
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 5,326.00
NOTE: REPLACE(2)WINDOWS WITHIN EXISTING OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 13936
STATE SURCHARGE(VALUATION) 2.66
RENEWAL BY ANDERSON TOTAL 142.02
350 73RD AVE NE Payment(s)
FRIDLEY,MN 55432 CREDIT CARD 8788 142.02
(612)502-4777
OWNER
MCCURDY,DALE
4041 NORTH SHORE DR
MOUND,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. T'his permit is for only the work described and does
not grant permission for addirional 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 construcNon authorized is not
commenced within 1 SO 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 asswing all required inspections are
requested in conforcnance with the State Building Code.This permit may be
revoked at any time for due cause.
C �/��/ ��
Applicant Permitee Signature Date Issued Signature Date
� r '
4f'�y t�fio��n0
Buildrng Permit Applic�tion fQr �Ifaintenance / Renovation
{win�ows, doors, siding, re-roof, etc. .
Ma;1ingAddress: Peimitnumber:: . � d ����J �
��� PO BOX BB ' ' �, . .� ., rl � •
a Q �rystal Bay,MN 55323-4066 aate,rec�ived:�
Reoe'rved br. � .
� �' i s�t��rd�: . . .
` 2750 Keltey F�rkway ' PI'an review'�e:
� �,� I Qrono,MN 5535� �
.3ota!Fe�: ,/'� ,��
Ma9n: 852 248-a800 Fax: 952 249-4G1i '.uro .mn. �
This application fo�n�must be co►r►pleted in full and all required infomlation must be submifted.
lndomp��te applic3�lons will[�e retumed. (please prirrt�
GEN�RAL fiN�CRMAT'lON: �in �j n�, � �'-�. ��►t�-�.�
Job SFt�Adctress: N ( i v
Wiil f�'�ts be a Parade of Home�� eiers S[�ow��''�Hcme or otlter DEsplay Homs7 Yes No
!i ye5,a speC[af eve»t pen►dt Ls requl wiPh Poltce Qep�rfinenf and CKY GoUncr!appli►val BO d�ys p1�or fa fhe eveM. Shut�(8 bus servlce wlll be
!���g���s�t'1ols�on�slfe parklr+g i�evaDable. Nori-Agmri[ted everl�wtll no!be a!lowed.
r�gulred unlesa eppl
CONTRACT4R/APPLtCANT IN�jt�RMATION:
Name: ���f�'1'a'�'�.�5�'� EXpitation Date: '�i 3 i
State L.ice�# �1��'3� 3 Expiratian D�te:
Lead Certficatlon Number: � -� c� c�S3 � y1��'�'
{for Wo�lr orr hom�s�f�re� sti'v�i�d AriQ►'to 7.87�tofFi�e) (Cell}
Phone: ta5t-� �! �4•4$�'" Z(P: $S I r3
N{2�tling Address: � p � 1 •• •• W��!" ��� ► �
Cr�ntac#Person: � ApPlicant is: on cto / Homeovvner �c�a,e1
Emsil�nti/or Fax:
PRdPERTY OWNER 1NFORl�4A iON�`� r�G����
Name: ti
Phone(day): c�- '�' Z1P:
A�ddress: ��ty. '
Ema11 andlo��ax ,
PRQJECT lN�QRMATION: Any ea�rth movement�ay r�qulre
Yype of Frojeata MCWD revie�n►�permifs:
Q p�t�� ❑R odel �Fire I��cnaga Minnehaha Creek W�tershed Distric�(MCWD)
1$Zp2 Minnetonka Blvd
L!Re-roof,sspha[t ❑Rep3ir ❑Storrn Damage De��en.MN 55391
❑1�roof,cedar �Ra�toratbn ❑Water Da►nage Phone: 952-471�590
Q Re-roof,ather(sPac�fj►) ❑Si��ng Q Other:(speolfY? Fax: g52-47i-U682
www.mEnnehahac eelc.ors
❑WinBow(s) • �
r f "
Qverall ProJ�ct De�cr�p�i�n: � -
Estimatsd Constructiori Valu o of Pro�act(excluding far�d) $ j
APPL(CANT ACKNOWLEQ EMENT:
. Agre�s to provide af1 info �ort required w requ9sted by the�u'slding Departme�nt: .
. Certlfies that the fi[ifamna n suppfied is�ue and li�ca�'an bei�atnPar�that upoowled�to do�5n.�th�ensteff h�ssnnO�sitem�y .
are solely responsible for ubmltting a c�mplet��pp 't9 .
but to rejer•t it untt!it is co pl�te;
. Som�s or aft af tk�e info on t�at yau are asked ta pr�►ide on thi5 epp(�an i�dass�ed by State iew as either privs�te or
corfidentiai. Private dsta ' informatton whlch generally cannot be given ta the pub{ic but can �given to the subJect of the
data. Corfidential data i iriform�flon wi�tCh 9Q����Y �n�t be given to elther th� pu�tc or the subJect of th� data. Our
purpos$s�nd ir�enderl use of this iniormation!s to annu�lly update our rewrds and rec�rds of other'gnve�nmeni�al agendes
ulred b law. ft refuse to su the information,the a lic.��ot►ma not be issued.
Date� ���� ��
A�olicar�#s Si�natttre:
��� V
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED 1 I-�'-1�j �
PERMIT NO. L�I 1�' - C�I2� COMPLEfED
ADDRESS ��1�I N�'►��� S 4�} i� �' �
OWNER TELEPHONE NO. �51 - Z�G�f'—���
CONTRACTOR �
� DESCRIPTION V � Y�-� - 1��I-Y�IG"�����
lN ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
J�INAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERlCONTFiACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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a �WORK SATISFACTORY:PROCEED �F.�OJECT COMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 forthe next inspection 24 hours in advance. (952� 249-46��
OwnerlContractor on site:
Inspector. w"J
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