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2011-00953 - roofing
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1460 Tanglewood Road - 26-118-23-32-0014
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2011-00953 - roofing
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Last modified
8/22/2023 4:17:15 PM
Creation date
4/17/2019 9:39:25 AM
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x Address Old
House Number
1460
Street Name
Tanglewood
Street Type
Road
Address
1460 Tanglewood Road
Document Type
Permits/Inspections
PIN
2611823320014
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City of Orono <br /> Building Permit Application for Maintenance / Renovation <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address. Permit number: <br /> O�,OPO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a s Street Address: Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> t9kES140 Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. ~4 <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ) <br /> Job Site Address: 1416 0 <br /> Will this be a Parade of Homes, Remodelers 9howcase Home or other Display Home? ❑ Yes ❑ No <br /> 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 <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP LICAN NFR A�TION: <br /> Name: ��"r � <br /> L0 /?JC <br /> State License # Expiration Date: <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: �� _ j� (office) �� ���"oy'6 (cell) <br /> Mailing Address: `4 City: , ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax.- <br /> PROPERTY <br /> ax:PROPERTY OWNER INFORMATION: <br /> Name: -i .e r r 0 17 t <br /> Phone (day): &-c— "F �.✓✓ <br /> Address: ��(�U J�.ts/C cv ao City: �ra��G, ZIP: <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review& permits: <br /> QRe roof, asphalt Minnehaha Creek Watershed District(MCWD) <br /> p ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 <br /> ❑ Window(s) www.minnehahacreek.org <br /> Overall Project Description:", ,• �, ,<<�, 6v��;�✓ + / it �-� �� <br /> Estimated Construction Valuation of Project excluding land) $ <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the <br /> data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the 'orma 'on,th lication may not be issued. <br /> Applicant's Signature: a't ._ Date: ; <br /> Last Updated: 08-09-2011 <br />
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