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2012-00264 - roofing
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3450 Birch Lane- PID: 08-117-23-43-0023
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2012-00264 - roofing
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Last modified
8/22/2023 5:48:12 PM
Creation date
4/4/2016 1:11:11 PM
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x Address Old
House Number
3450
Street Name
Birch
Street Type
Lane
Address
3450 Birch La
Document Type
Permits/Inspections
PIN
0811723430023
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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: �0� <br /> /�v 0,�\ PO Box 66 / <br /> il � � Crystal Bay, MN 55323-0066 Date received: �-{ <br /> � Received by: <br /> ��a �''�'�-�� s, Street Address: <br /> � aro.� <br /> � � �ti 2750 Kelley Parkway Plan review fee: <br /> L9,kESH�g'F' 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. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��� `r"�'��(� ��,(�(�- ���� <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 Counci/approva/60 days prior to the evenf. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficienf on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM�ION: <br /> Name: ��'� �d��-" ��L-'r�-F��`��� <br /> State License# �_�,c�� �� � Expiration Date: �j / , <br /> Lead Certification Number. ti,a---r __ �� ;�,7-J"� Expiration Date: ���� <br /> (for work on homes af w re construcfed priq�r fo 1978 <br /> Phone: (o .' �'3( 1 � �7 �3 J (office) (pJ � �v�-`-{-�,5. ��L1 (cell) <br /> Mailing Address: � � (��c� Cit � �. ZIP: �' 'C�� <br /> Contact Person: �� _.- , � r Applicant is: Cont or / Homeowner <br /> (Circle One) <br /> Email and/or Fax: ,n� � �J � �-� ` (� <br /> PROPERTY OWNER INFORMATION: <br />� N a m e: � f— c'�.1��f G� ����'1���!� <br /> Phone(day): Cj s a-- y�/— v � ' <br /> Address: �C� j� 2��� (� City: � ��?;�IP: <I J j�� <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> Type of Project: Any earth movement may require <br /> MCWD review& ermits: <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage Minnehaha Creek Watersh d District(MCWD) <br /> Re-roof, asphalt ❑ 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.orq <br /> Overall Project Description: <br /> _ Estimated Construction Valuation of Project(excluding land) $ � �)�� <br /> , <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 alternafive <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 informafion 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 o annually update our records and records of other governmental agencies <br /> re uired b law. If ou refuse to �u I the info ation,t e a lication ma not be issued. <br /> ApplicanYs Signature: �� Date: ��i <br /> Last Updated: 08-09-2011 <br />
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