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. City of Orono �.�r� � C�LI�� a► ��p �' • Building Permit Application for Internal Work `�1��1 r � (windows, doors, siding, re-roof, etc.} Mailing Address: �(�r/ -G��3� Permit number: i.��,•�� i/�Oy �O Cry sal Bay, MN 55323-0066 Date received: �� ) �.� _. �� � Received b \l�, �l�t��, � � StreetAddress: - y� c ;��c, ,,�:��;�, Gti 2750 Keliey Parkway a(�1 ��Cj0 Pian review f e: r��G � ��l "'�:��`� w Orono, MN 55356 � �9�Ko4' �� __-_—:. �M�A Fee: Main: 952-249-4600 Fax: 952-249-4616 v�wv�e.ci.�arono.mn.us ' This application foRn must be completed in full and all required information must be submitted. /� �� r Incompl�e applications will be returned. (Please print) � � GENERAL INFORMATION: 1473 Bay Ridge Road Job Site Address: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No ff yes,a specia/event permit is required with Police Department and City Council approval 60 days prior ta fhe event. Shuttle bus s ice wiR be required un/ess applFcartt cAe�strates suff'�ient on-site parking rs available. Non perrnitted events wiN not be aflowed. CONTRACTOR/APPLICAtVT ��S�QRMATlON: Name: Meyer & Sons Construction _. __ _ State License# 20000613 Expiration Date: 3/31/2012 _ _ .__.___ p .. Lead Certification Number: Ex iration Date: (for work on homes that�ra��w s�nstns�tsr��rior to i978 Phone: ��-�98-58f�� (office� 651-271-4740 (cell) Mailing Address: 8360 Afton Road �� City: Woodbury ZIP: 55125 Contact Person: Kifk Meyer �" Applicant is: / omeowner �ar�b o�� Email and/or Fax: ktRtlt'1'�@�ef@�,.,tl't..�il.,�r PROPERTY OWNER 1�"��'�4��!��TIOI�° Name: �rhomas McCune Phone(day): Q��-473-3245 Address: 1473 Bay Ridge Road � City: �ayzata MN ZiP; 55391 Emai1 and/or Fax tmmccune@me com PROJECT INFORMATION: Type of Project: Any earth movement may require ❑Door(s) ❑ Remodel ❑Water Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑Window(s) ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd ❑Siding ❑ Restoration ❑Other: (specify) Deephaven, MN 55391 Phone: 952-471-0590 ,�Re-roof ❑ Fire Damage Fax: 952-471-�82 w+�vvw.minnehahacreek.a� Overall Project Description: New trusses, roofing, and insulation over 65' x 26' 1960 structure Estimated Construction Valuation of Project(excluding land) $ 24,500 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 solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject it until it is compfete; Some or all of the information that you are asked to provide on this application is Gassified 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 information is to annually update our records and records of other govemmental agencies re uired b law. If ou refuse to su I the information the a lication ma not be issued. ApplicanYs Signature: ��/r p Date: M3y 20, 2011 Last Updated: 03-01-2011 Thomas McCune