2016-00872 - roofing - Laserfiche WebLink

Home Browse Search

From: 07/2�/20�6 �0:17 #057 P.00�/002 • City of Orono � Bui(ding Permit Application for Maintenance/ Replacement/ Remode! — Residential ONLY {i.�. v�indc�ws, c�oors, sic#i€�g, re-ro�f, etc. — t�0 �S�'�dt�C�U�.,�L EXPl�NSIS��t) A' Mailing Address: . ,-.� y ��r VO PO Box 6fi Permit number 1�; �(%� Crystal Bay, MN 55323-0066 Date received: �-� �, Street Address: Received by: yF � 2750 Kelley Parkway _ ` Plan review fee: -� ��kESHOa�`` Orono, MN 55356 Total Fee: v� �j � �� y Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono mn.us This application form must be completed in fuli and alt required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 1385 FOX STREET-ORONO, MN Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No !f yes,a specral event permit is required with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service will 6e required unless applicant demonstrates su�cient on-site parking is available. Non-permrtled events wi!!not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name� ALLSTAR CONSTRUCTION COMMERCIAL State License# BC706473 Expiration Date: 3-31-2018 Lead Certification Number: NAT-F152851-1 Expiration Date: 4-30-2020 (for work on homes that were consirucied prior to 1978 Phone: (cel!) 612-865-8262 (office} �63-479-870� Maiiing Address: 5145 INDUSTRfAL STREET, SUITE 103 City: MAPLE PLAIN Z�p: 55359 Contact Person: BRADEN LAR50N Applicant is: Contractor / Nomeowner �crroie o�,u� Emai1 and/or Fax: gRqDEN@ALLS7ARTODAY.GOM PROPERTY OWNER INFORMATION: Name: Carol Bergenstal and Marilyn Gehrman Phone(day}: UNKNOWN Address: 1385 FOX STREET City: ORONO Z�p: 55356 Email and/or Fax: UNKNdWN PROJECT INFORMATION: OveraA pro ect description: Type of Project: Any earth movement may also require ❑Door(s) ❑Remodef ❑Fire Damage MCWD review 8 permits: �Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) ❑Re-roof,cedar ❑Restoration 15320 Minnetonka 81vd ❑Water Damage Minnetonka,MN 55345 ❑Re-roof,other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-Q682 ❑Window(s) www.minnehahacreek orq Estimated Construction Valuation of Project(exctuding land) $ 14,150,00 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 tailure to do so,the staff has no alternative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is cfassified by State law as either private or confidential. Private data is information which generally cannot be given to the public but can be given ta 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 fnformation is to annually update our records and records of other governmental agencies required by law. If ou refuse to su I the i fo ation the a lication ma noi be issued. ApplicanYs Signature: � � � -�"" Date: �'"�-�'`� � Owner's Signature: Date: �ast Updated:January 2016