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CITY OF ORONO PERMIT NO.: 2011-00628
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 07/12/2011
952 249-4600 FAX: 952 249-4616
ADDRESS 4085 OAK ST
PIN : 06-117-23-41-0103
LEGAL DESC MINNETONKA SUMMIT PARK
LOT 000 BLOCK 007
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 8,200.00
NOTE: ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR
TO WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED.
SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE.
ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED.
APPLICANT PERMIT FEE SCHEDULE 177.00
TIMBERLINE EXTERIORS,INC. STATE SURCHARGE(VALUATION) 4.10
7026 E FISH LAKE ROAD
MAPLE GROVE,MN 55311- MISC FEE 0.00
(651)329-6916 TOTAL 181.10
Minnesota State License#:20633887
OWNER
ARGABRIGHT,TIMOTHY&BARBARA
4085 OAK ST
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 after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformanc with the State Building Code.This permit may be
revo=ate .due c
l /moi
Ap ' P itee Sig re Date Issued By 09nature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV .
City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
04.,0 PO Box 66
Crystal Bay, MN 55323-0066 Date received:
lwaa Street Address: Received by:
*� " Gtiti 2750 Kelley Parkway Plan review fee:
sxo�`� Orono, MN 55356
Total 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:
Job Site Address:
Will this be a Parade of Homes,'Rlemodelers Showcase Home or other Displa orae? ❑ Yes LZ No
ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus se ice will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: G/-S
State License# 33�;--1?-7 Expiration Date: 313i
Lead Certification Number: AlAj- - y ,376._ � Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: 3— Fff4l.2, (office) (cell)
Mailing Address: E T; ( City:
Contact Person: Applicant is: ontract / omeowner (Circle One)
Email and/ F
PROPERTY OWNER INFORMATION:
Name:
Phone (day): -
Address: -1/0 City: a6h Z01�ZIP: 5�0
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ;Z*Storm Damage 18202 Minnetonka Blvd
/Restoration (specify) Deephaven, MN 55391
❑ Siding ❑ Other:
Phone: 952-471-0590
Re-roof ❑ Fire Damage Fax: 952-471-0682
www.minnehahacreek.orp
Overall Project Description: ' . �- ✓ GD L
Estimated Construction Valuation of Vr6jecxcluding land) $
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 applicant recognizes that they
are solely responsible for submitting a complete application being aware that upon failure to do so, the 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 inform ion is to annually date our records and records of other governmental agencies
required by law. If you refuse to supply t e infqrmation, 60pplication may not be issued.
Applicant's Signature: AX/- 4X44
Date:
Last Updated: 03-01-2011 1r7� Iz1--7 1__J
F) 5 /�� v
E TIME
CITY OF 6RONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. _iz COMPLETED
ADDRESS
OWNER — TELEPHO O _9�5/ 135-3�� y
CONTRACTOR 7_/Ilt �t 'A,,A—
DESCRIPTION
�
❑ FOOTING ❑ PLUMBING FINAL ElEXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKES HORE/WETLANDS
❑ FRAMING ❑ MECHANICAL FINAL
Q El TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
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
❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES_NO
o COMMENTS:
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LUWORK SATISFACTORY:PROCEED 11 PROJECT COMPLETE
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W 11CORRECT WORK R PROCEED CISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN
INSPECTOR WILL RETURN
I STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
C
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector.
White Copy/Inspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO./22011-00(0, i? COMPLETED
ADDRESS O C/
OWNER �� TELEP N NO.
CONTRACTOR
>`. DESCRIPTION _
❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADINWILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
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
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATIONIREMOVAL
OWNER/CONTRACTOR TO MEET YOU:_YES_NO
h COMMENTS:
o�
a
j
0
cc
0
W
Q
W
Z
W
cc
4j ❑WORK SATISFACTORY:PROCEED 4140JECT COMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑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.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site
Inspector.
White CopyMspector's File Canary Copy/Site Notice