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City of Orono ' Building Permit Application for Maintenance / Replacement / Remodel — Residential t�NLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) Oq,. Mailing Address: Permit number: ��vv PO Box 66 � �vQ Crystal Bay, MN 55�6��VED aate received: �7 a� StreetAdd�ss: AUG Q 4 ZO�7 Received by: Y1/l y� `�" 2750 Kelley Parkway Plan review fee: � Orono, MN 55356 �'�xssxo�`�' CITYOFOROND � � � D� 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 applicatlons w111 be returned. (P/ease print) GENERAL INFORMATION:2216 Shadywood Road, Orono, MN 55391 Job Site Address: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a special event permlt!s requlred wlth Palice Department and City Counc!!approva!60 days prlor to the event. Shuttle bus servke will be r�qulred uniess applicant demonstrates su�clent on-site parking Is avallable. Non permltted evenfs wfl!not be aUowed. CONTRACTOR/APPLICANT INFORMATION: Name: Garlock-French Roo�ng State License# BC001423 Expiration Date: 3/31/18 Lead Certification Number. NAT-23999-2 Expiration Date: 4/15/20 (for work on homes that were constructed prior fo 1978 Phone: (cell) (office) 612-276-9934 Mailing Address: 2301 E. 25th St City:Minn .�ap�lis ZIP: 55406 Contact Person: Meg Nathan Applicant is: Contractor / Homeowner (Circie One) ErT1811 8nd/of FBx: mnathan@garlock-french.com - PROPERTY OWNER INFORMATION: Name: Rick Etrheim Phone (day); 612-807-7271 Address: 2216 Shadvwood Road City: Orono ZIP: 55391 Email and/or Fax: PROJECT INFORMATION: Overall ro'ect desc,ri tion:Replace roofing on front and back dormers with standing seam metal. Type of ProJect Any.earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD revlew&permits: ❑ Re-roof,asphalt ❑ Repair ❑Storm Damage Minnehaha C�eek Watershed District(MCWD) 15320 Minnetonka Blvd ❑Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka,MN 55345 ,�Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590 �metal Fax: 952-471-0882 ❑Window(s) www.minnehahacreek.org Estimated Construction Valuation of Project(excluding land) $ 14,szo.00 APPL.ICANT ACKNOWLEDGEMENT: • Agrees to provide all informatlon requi�ed 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 applicabon being aware that upon failure to do so, the staff has no altemative but to reject it until it is complete; • Some or ali of the informatlon 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 informat(on is to annually update our records and records of other govemmental agencies required by law. If ou refuse to su I the information the a lication ma not be issued. Applicant's Signature: � � �� Date: 8�2�17 Owner's Signature: Date: Last Updated:January 2016 '