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2011-00928 - roofing
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4385 Chippewa Lane - 31-118-23-42-0017
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2011-00928 - roofing
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Last modified
8/22/2023 4:32:24 PM
Creation date
4/14/2016 1:14:31 PM
Metadata
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x Address Old
House Number
4385
Street Name
Chippewa
Street Type
Lane
Address
4385 Chippewa Lane
Document Type
Permits/Inspections
PIN
3111823420017
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Updated
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� <br /> City of Orono <br /> � �uilding Permit Application for Maintenance / Renovation <br /> . <br /> (windows, doors, siding, re-roof, etc.) <br /> Mailing Address: Permit number: <br /> �,�,�. PO Box 66 <br /> � �, � <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a � ,` ���: s, Street Address: Received by: <br /> � <br /> �',�c,t `� '�'� �ti 2750 Kelley Parkway Plan review fee: <br /> 9kESFI�4� 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: � ��S C�'� ����/if [ � <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 service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM�TION• � <br /> � <br /> Name: r`�1 �L%��i '�tx��, ,, Gt � �' � �j <br /> State License # "7�� � � �� Expiration Date: ;� j 20� <br /> Lead Certification Number: �/'�,��''� 3i��3��- J Expiration Date: y�i��y �� �'� <br /> (for work on homes that we er constructed prior to 1978 ' <br /> Phone: �� ? -�� �� �J�(�C� E (office) ;'� �� �-���C � � 1� � (cell) <br /> Mailing Address: " �s-� �� X � ,,,,,,�o r-,�r � ;-. /� City:/y1;,�"z- G�2�v� ZIP: s's��;�:'�-'- <br /> Contact Person: r,��y ,,. � : Applicant is: Cor�for / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION�, <br /> Name: — ` - <br /> '�� C' � �Z E. <br /> Phone (day): S'z - C��� _ `� �� <br /> Address: L� ���S` � l-t:'j-';�vL,�, �� City: C.�--�L� 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 /> Minnehaha Creek Watershed 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: '��� �,� � �<> - ��r L,z� �" �— �?�f� ;;;, � � i/'1,,;, �-f=- <br /> Estimated Construction Valuation of Project(excluding land) $ 1 �o � � <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 /> re uired b law. If ou refuse to su I the information,the a lication ma not be issued. <br /> ApplicanYs Signature: `�7���� �-��'� Date: ������� <br /> —� <br /> Last Updated: 08-09-2011 <br />
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