2014-00522 - roofing - Laserfiche WebLink

Home Browse Search

� � City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re-roof, etc.) �^'�\ Mailing Address: j ��'V PO Box 66 Permit number: r' ', Crystal Bay, MN 55323-Ofl66 Date received: � ; � : , ,� 5treet Address: Received by: �'F ,�/ 2750 Kelley Parkway Plan review fee: l�kFSH��/� Orono, MN 55356 Total Fee: Main: 952-249-4600 Fax: 952-249-4616 v�rww ci.arono.mn.us This application form must be completed in full and all required information must be submitted_ Incomplete appl�lcations will be returned. (Please print) GENERAL INFORMATION: , � ,��f�� ,,� Job Site Address: ;�/�, Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes H yes,a special event permit is required with Police Dapartment and City Council approval 60 days prior to the event. Shuttle bus senrice will be required unless applicant demonstrates sufficient on-site parking is availa6le. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION:�� Name: S� ` r' State License# (� Expiration Date: Lead Certification Number: p � � Expiration Date: (for work on homes that were construcfed prior to 1978 Phone: (cell) (office) Mailing Address: � . u S City� ' (� ZIP: � Contact Person: ,/ Applicant is: Contractor Homeowner (Clrcle One) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: 1 " �� Phone (day): - Z �� S Address: City: Xc�J� ZIP: SS�� Email and/or Fax: F PROJECT INFORMATION: Overall ro'ect descri tion: Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8 permits: �roof,asphalt ❑ Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) ❑Re-roof, cedar ❑Restoration ❑Water Dama e 18202 Minnetonka Blvd 9 Deephaven, MN 55391 ❑Re-roof, other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590 ❑Window(s) Fax: 952-471-0682 www.minnehahacreek orq Estimated Construction Valuation of Project(excluding land) $ J �� 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 sole�y 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 pubfic but can be given to the subject of the data. Confldential data is information wh' h genera y cannot be given to either the public or the subject of the data. Our purpose and intended use of this inform is II pdat our records and records of other govemmental agencies required by law. If ou refuse to su 'the i atio h I tio not be issued. ApplicanYs Signature: Date: " Z � Owner's Signature: Date: Last Updated:03/06/2013