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2010-00923 - roofing
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3980 Watertown Road - 32-118-23-32-0002
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2010-00923 - roofing
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Last modified
8/22/2023 4:40:32 PM
Creation date
11/25/2019 11:36:23 AM
Metadata
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x Address Old
House Number
3980
Street Name
Watertown
Street Type
Road
Address
3980 Watertown Road
Document Type
Permits/Inspections
PIN
3211823320002
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Sep 30 10 09:34a Pro Custom Builders 952-949-8692 p•1 <br /> AvQ-0510 10:49am From-CITY OF ORONO 49522494616 7-390 P.001/001 F-449 <br /> Or City of Orono <br /> Building permit Application for!Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> O <br /> y Mailing Address: <br /> V `i` PO Box 66 I Permit number: �C�l <br /> Crystal BDate received: <br /> 2750 <br /> 7 ddress: Received by. <br /> 50 Kelley Parkway -Plan review fee: <br /> Orono,MN 55356 <br /> Main: 452-249.4600 Fox, 9522-249-46115 X. M.ci.orono.mmus, Total Fee: <br /> �Y Ol •,� <br /> This application form must be completed in full and all required information must be submitted. <br /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> _T <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display H ie? Yes C9 No <br /> fryes,a special event gamin is requli d v4M Polka Depart/nenl and Cio Counaiapproval¢o days prior loft event Shuffle bus servlce will be <br /> rsauimd unless amikent demonstrates sufficlent on-sl(rp{t?*Jrn Jc igygd b*. <br /> - •r-••• uwi YV VNV./Oy. <br /> CONTRACTOR 1 ATPLICANT INFO ATI <br /> Name: o C Sto C^ Q0 - d <br /> State license# 2 b 6* Expiration Date: _ O <br /> Phone: Jr office <br /> (cell) <br /> Mailing Address: 6 G Cit p ZIP: j~ c <br /> ,�,:rlioant is: :Gi i,'8�tri r' riurnvuwaar (crrsie one) <br /> Email and/or Fax:r <br /> PROPERTY OWNR INFORMATIO <br /> Name: <br /> Phone(day): ` — Rf <br /> Address: O Zlp: S " <br /> Email and/or Fax <br /> PROJECT INFORMATION; <br /> Type ofProject: Any earth movement may require <br /> [3Door(s) ❑Remodel mcwb review&permits <br /> O'Water Damage <br /> I <br /> Minnehaha Creak Watershed District(MCWD)❑Windowfa% 6" Repaif 6"1 <br /> Storm uaffiloac ifuu[IVlinnelOnlcJ Blvd <br /> Siding I n onto;;t;,... I n., .1 . Deephavan,MN 55391 f <br /> SI " , ..thar. (spec„rr Purr*: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Re-roof Q Fire Damage �new.rninnehahacreek.om <br /> Overall Project Deeeri"llon: <br /> Eo irtatow Construction Vaiuedurt of Project(excludhig 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 I <br /> 8fa solely raspbosiwe for submltdng a complete appilcation being aware that upon failure to do so.the staff has no altemative I <br /> but to reject 11 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 inforrnadon 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 vo gmmenta: sgenc;as f <br /> t required by law. If you refuse to supply the Information,the application may not be issued. <br /> Applicant's Signature: Date: <br /> Last Update:: _IS-04-2605 <br />
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