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CITY OF ORONO * 2016 - 00191 *
2750 KELLEY PARKWAY DATE ISSUED: 02/25/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)2494616
ADDRESS 2585 OLD BEACH RD
PIN 21-117-23-22-0020
LEGAL DESC THE MARSH AT LAFAYETTE
LOT 007 BLOCK 001
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 38,724.00
NOTE: REPLACE 14 WINDOWS& 1 DOOR WITHIN EXISTING OPENINGS
APPLICANT PERMIT FEE SCHEDULE 589.73
STATE SURCHARGE(VALUATION) 19.36
RENEWAL BY ANDERSON MAIL-IN FEE 2.00
1920 COUNTY RD C.WEST TOTAL 611.09
ROSEVILLE,MN 55113
(612)502-4777 Payment(s)
Minnesota State License#:BUIL-BC130983 CREDIT CARD 8788 611.09
OWNER
FREIVALDS&LINDA KELLEY,JOHN
2585 OLD BEACH RD
WAYZATA,MN 55391-
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 conformance with the State Building Code.This permit may be
revoked at any time for due cause.
Lt
Applicant Permitee Signature Date Issued By Signature Date
i
City of Orono
BuildingPermit Application for MaintenancO ! Renovation
(windows,
doors, siding, re-roof, et •)
Bf iingAddreas: P :number.
PO Box 66 i 2
Crystal Bay,MN 55323-0066StamitAddre8V neca�ived•
Q Regl�efwed bjr � .
2750 Kelley Parkway Abe rgview-ldik
Orono,MN 55356 p
Tn&[Fee
Main: 852-249-4600 Fart 952-2494616 a o ono.mn.u$
This application form must be completed in full and all required information must be subri,iitted.
Incomplete applications will be returned- (Meese print}
GENERAL INFORMATION: i
Jab Site Address:
Will this be a Parade of Homes,Ramodeler9s Showcase Home aro r olsplay Mom? sr bus sa>�bu
N y8s,a 4m"avant permit is required with ponos Deparb»ent and Cyty Couro epproyst 60 days prtpr
mgwvd untm applloard demonan3tes sufdfclant white podit is ova aWq Non-permaI!ad eymts wX not be Am ed.
CONTRACTOR I APPLICANT INFORMATIOW
Name: Ar�d'er 'i`�
State License# 15C X W1$ Expi tion Date: 31
Lead Certification Number: — ,l o�g 3 Expii n Date: 14
1116
L� i
(tar worts an"MM trent ware rd>ts&acttsdadsr to.1978 I (cell)
Phone: (a51 oZ (office) i
yq %! "G" t�Jt4SrL' C'tY' :1 a ZIP: 'FS
Mailing Address: [
Confect Person: Applicant is: / Homeowner (ctde one)
Email and/or Fax: i
PROPERTY OWNER INFO TION:
Name: Li Com, f z %o:7Ac4i
Phone(day): may_ 1 ZIP:
Address:
Email end/or Fax
PROJECT INF'ORNIATION: Ai earl!+tmovemeht niey eq
Type of Project: IYICYVD review pormlts:
❑Door(s) ❑Remodel ❑Fire Damage Minna ha Creek Distrlct(MCWD)
trek Repoli ❑Storm Damage 18202 Minnetonka Blvd
❑Re-roof,asp � Deephaven,MN 55391
p Rwroof,cedar Restoration ❑Water Darrrage Phone: 95271-0580
$idg [�C3ther:(speclty) Fax: 952*4 1-0682
d Rei-rcW,other( A I . • ne
D Window(s))
Overall Proect Description:
ftHmated ConaftiWon Valuation Of Prolect exaiudin Ian $ 3
I
APPLICANT ACKNOWLEDGEMENT:
Agrees to provide all information required or requested by the Building Department,;
The app!cant recognizes that they
Certifiers that the information supplied is true and correctikation bei atma�rs that upo rf hisiher ree•to do so, a staff has no alternative
are solely responsible for submNng a complete app
but to reject it until it is complete;
Some or all of the fnfonmatdorr that you are aslaad to provide on this application rJs classified by State law as edifier private or
Fcordidentiai. Private data is information whiedt generally cannot be given to the bUc but can be Iven to the subject of the
data. Confidential data Is information which generally cannot be gnren to eithe,the public or the subject of the data. Our
purpose and intended use of this Information is to annually update our records and records of other governmental agencies
puired
uose b law. N refuse to su the information thea Gcation m not W issued.
armf�
Anolicarifs Sb)ature: Date:
t)d-a-vc)
DATE TIME
CITY OF ORONO �'(,� CALLED IN
INSPECTION NOTICE SCHEDULED ti, !
PERmrrNO. 001at COMPLETED
ADDRESS 2.5&S CWHCI in Ra_
OWNER TELEPHONE NO.CQ512ItO LQ 1d X
CONTRACTOR
DESCRIPTION l( I �►1L6�Y�-�
W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
C ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
vAFINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
WS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
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COMMENTS:-
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LU ❑WORK SATISFACTORY:PROCEED >ftO ECT COMPLETE
W ❑CORRECT WORK&PROCEED _ ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next Inspection 24 hours In advance. (952) 249-4600
OwnedContmctor on site:
Inspector.
White Copyflnspectm%File Canary Copy/Site Notice