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2011-00634 - roofing
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4345 Watertown Road - 31-118-23-13-0003
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2011-00634 - roofing
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Last modified
8/22/2023 4:29:12 PM
Creation date
12/3/2019 3:17:46 PM
Metadata
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x Address Old
House Number
4345
Street Name
Watertown
Street Type
Road
Address
4345 Watertown Road
Document Type
Permits/Inspections
PIN
3111823130003
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City of Orono <br /> Building Permit Application for Internal Work <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: oQ <br /> � /f - .q"0(0.-3 y <br /> O P O Box 66 <br /> /v Crystal Bay, MN 55323-0066 Date received: 7//-3/// <br /> L „, :‘._-z- a. ! Street Address: Received by: .7L7Z <br /> \'$4, )I`,., 1- G..I 2750 Kelley Parkway Plan review fee: <br /> t g3Ho"1O;S Orono, MN 55356 E� <br /> <U /a D, �U <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.cLorono mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: /� / <br /> Job Site Address: /3y5 Gtlq rcj ,GAJ /1',/ <br /> Will this be a Parade of Homes, Remodelers Showcase 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 se ice will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed <br /> CONTRACTOR I APPLICANT INFORMATION: , <br /> Name: A- L rci-j 0.0 r1. .NJ a L,c_. --/. <br /> State License # (9 O T j '--Sa a Expiration Date: <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: —2 --C.A-- -7.1 cc ( )7(,3-Lsr7-716') (cell) <br /> Mailing Address: Sc ' (, ,;,,r , _ • City;3i _,,,j p i ZIP. k/ <br /> Contact Person: 5' }4,( Applicant is: ..r -c ., Homeowner (circle one) <br /> Email and/or Fax: 7 '3— ( '7r).G 7 '7 t) - ,.. p€,, - 6 rite i <br /> PROPERTY OWNER I�OR�MATION: <br /> UC_- <br /> Name: A- 13 ip- ..la-a.S'r:"'ti <br /> Phone (day): 5-3/ �'�, _ ,. (� c� <br /> Address: L/34,/ c 'moi 2'l' ti cJ City: QQ ha 0 ZIP: 51-3 ..c qI <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review&permits: <br /> ❑ Door(s) ❑ Remodel El Water Damage Minnehaha Creek Watershed District(MCWD) <br /> ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd <br /> � ) Deephaven, MN 55391 <br /> ❑ Siding 0 Restoration r] (specify) <br /> Other: s ci Phone: 952-471-0590 <br /> -Ike-roof ❑ Fire Damage Fax: 952-471-0682 <br /> www.mmnehahacreek ore <br /> Overall Project Description: ( ., c;c- oc �\:5 0 .e .. l� S~�''ri�r' <br /> Estimated Construction Valuation of Project(excluding land) $ �L 0 . `L) <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 th's information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse t upply the information,in / the application may not be issued. <br /> Applicant's Signature: !'� Date: -7— / )- <br /> Last Updated: 03-01-2011 <br /> I'd L9ZL-L99-€9L °NI'uollona}suoo p.relegy d917170 1. Zl, In(' <br />
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