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Home My WebLink About2010-01118 - addn/remodel/repair -' CITY OF ORONO PERMIT NO.: 2010-01118 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 11/16/2010 (952)249-4600 FAX: (952) 249-4616 ADDRESS : 665 ORCHARD PARK RD PIN : 31-118-23-11-0005 LEGAL DESC : UNPLATTED 31 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADDITION/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : 434-RESIDENTIAL VALUATION : $ 6,750.00 NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,ELECTRICAL(STATE) INTERIOR REPAIR OF WALL-TILE-WINDOW APPLICANT PERMIT FEE SCHEDULE 147.50 RLS CUSTOM TILE&STONE STATE SURCHARGE(VALUATION) 5.00 6563 OLIVE LANE N TOTAL 152.50 MAPLE GROVE,MN 55311- (612)986-5610 Minnesota State License#:20638779 OWNER PIDGEON,MAGDALEN 3625 EILEEN ST MAPLE PLAIN,MN 55359- 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 y time ford caul..__ / ie,/,&f -f-/ /7 //‘ ,,,,e) 0 Applicant Permitee Signature Date '- '� �/ / T // Iss.:��:y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) C Mailing Address: Permit number: ,,. _,0/O"0/// S g,0,,. PO Box 66 0 O Crystal Bay, MN 55323-0066 Date received: //7(O //D Received by: T / ,a , : r1� �, Street Address: 'S.1 r'\441N* ' 2750 Kelley Parkway Plan review fee. t 1t;,►h"1 G Orono, MN 55356 ESH04• � Total Fee: 45—pj .61D 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: 05-- �- id) ____. ' Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: 1 L.1 6e• -v- ii T /l. ..C-7 ,42e /,- State License# '206 ? g 77-9 Expiration Date: 3/3// .0/.2- Phone: o/2 9b'6"SG/O (office) ‘/2 '7a'' 56/O (cell) Mailing Address: 65-63 -'C h.,2e et'• City: Atz- -/, 6,-v,, ZIP: s 5 1// Contact Person: /5i 944wn .rv,`soh Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: /76 5 7-7/e. STorJ e e h.964f //.e:4, PROPERTY OWNER INFORMATION: Name: Alc a./y. i2 //////e Phone (day): O Address: acs- orch�z,,d ,a7-,C �efeW City: /�`de ZIP: 3-S-3 sZ Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review& permits ❑ Door(s) ❑ Remodel ❑Water Damage � Minnehaha Creek Watershed District(MCWD) dWindow(s) Ll Repair ❑ Storm Damage 18202 Minnetonka Blvd Deephaven, MN 55391 ❑ Siding LI Restoration ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑ Re-roof ❑ Fire Damage www.minnehahacreek.orq Overall Project Description: :,j f'A i.2 Lu,m..4.._ ._ PAk_:;,yc Estimated Construction Valuation of Project(excluding land) $ `S�-7S V 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 information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information,the application may not be issued. Applicant's Signature: `V--- e mat f-P-7-4-- Date: // --/6 — -2,-,id. Last Updated: 05-04-2009 J DAT TIME V CITY OF ORONO CALLED IN INSPECTIONOTICE SCHEDULED /q7 /O �1%� PERMIT NO. d/O)fi -0( 1 I Q COMPLEED ADDRESS ((v5 Drdia.'d Pa- L ,tel OWNER TELEPHONE NO."/2 $(e) 561® CONTRACTOR S DESCRIPTION r00rh �IN� T Lu 0 FOOTING 0 PLUMBING 0 EXCAV/GRADING/FILLING 0 POURED WALL 0 MECHANICA 0 LAKESHORENVETLANDS c'') 0 FRAMING 0 MECHANICAL FINAL 0 TREE REMOVAL 0 INSULATION 0 WOOD BURNER/FIREPLACE 0 SITE INSPECTION Q 0 RADON SLAB 0 WATER HOOK-UP 0 PROGRESS 1, 0 FINAL 0 SEWER HOOK-UP 0 COMPLAINT v 0 DEMO-SITE 0 SEPTIC MAINT. 0 FOLLOW-UP 0 DEMO-FINAL 0 SEPTIC INSTALL 0 HARD COVER REMOVAL 0 PLUMBING RI 0 SEPTIC FINAL 0 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU: YES_NO COMMENTS: cc W Q. O L I . 0 LUCALVQ4K SATISFACTORY:PROCEED ❑ PROJECT COMPLETE CC W ❑CORRECT WORK&PROCEED CIISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN CISTOP ORDER POSTED.CALL INSPECTOR CI CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor • site: :I111 IP Inspector. White Copy/Inspector's File Canary Copy/Site Notice 13_ TIME CITY OF ORONO ED IN INSPECTION NOTICE Q SCHEDULED /PI r2.0440r2.0440 /o,' PERMIT NO.-20/0-01 /10 COMPLETED , /Q ADDRESS ;4 DIL�� Z/U�-- eL OWNER TELEPHONE NO. -9J-- 41/ CONTRACTOR >; DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q 0 POURED WALL ❑ MECHANICAL RI 0 LAKESHORE/WETLANDS " ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL • ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP El COMPLAINT Cl DEMO-SITE El SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL ❑ PLUMBING RI El SEPTIC FINAL ❑ FOUNDATION/REMOVAL • OWNER/CONTRACTOR TO MEET YOU:_YES_NO o COMMENTS: cc W Q. CC O CC O W CC W W CC 14.1 Lu 0 WORK SATISFACTORY:PROCEED PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ✓ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ID CITATION ISSUED 0 STOP ORDER POSTED.CALL INSPECTOR 0 INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site- i Inspector. S White Copy/Inspector's File Canary Copy/Site Notice