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2016-01406 - roofing
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1115 Brown Road South - PID: 10-117-23-24-0005
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2016-01406 - roofing
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Last modified
8/22/2023 3:21:21 PM
Creation date
11/15/2016 3:55:16 PM
Metadata
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Template:
x Address Old
House Number
1115
Street Name
Brown
Street Type
Road
Street Direction
South
Address
1115 Brown Road South
Document Type
Permits/Inspections
PIN
1011723240005
Supplemental fields
ProcessedPID
Updated
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City of Orono <br /> Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY <br /> (i.e. windows, doors, siding, re-roof, etc. - NO STRUCTURAL EXPANSION) <br /> �O�O Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> � � Street Address: Received by: <br /> tiF � 2750 Kelley Parkway Plan review fee: <br /> t � Orono, MN 55356 <br /> qKESH��� 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � � �rj ���Gr,r� �� �, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus s 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: NM �= �-�, !-G/'�r�- S <br /> State License# �Z,�y y,� � ;��; Expiration Date: � �j� <br /> Lead Certification Number: �f���j- �y� 7 y '�.� Z Expiration Date: �� Z� <br /> (for work on homes that were constructed prior to 1978 <br /> Phone: (cell) �':� Z S�, - I � �;�- (office) �� ��`��-U7Z <br /> Mailing Address: 'c./.�7�,, �2�; ,/�„� �/ City: "��/ �,-,L,,,, ZIP: S 5 �- � <br /> Contact Person: � �"�S G�,,��� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: LL[i✓�I �Lf" � .�,yx. � �t�C:��- s � ��r� <br /> PROPERTY OWNER INFORMATION: <br /> Name: � 1-�,�,`s /1-f�� l<�r�u <br /> Phone (day): � ��Z ��(i � -S���� <br /> Address: �� � c� ����� � �, City: ZIP: <br /> Email and/or Fax: /1��- <br /> PROJECT INFORMATION: Overall project description: <br /> Type of Project: Any earth movement may also require <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits: <br /> Re-roof,asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) <br /> 15320 Minnetonka Blvd <br /> ❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 <br /> ❑ Re-roof,other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> ❑Window(s) www.minnehahacreek.orq <br /> Estimated Construction Valuation of Project(excluding land) $ S��,� `� <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 are <br /> solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to <br /> 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 data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> ou refuse to su I the information, the a lication ma not be issued. <br /> Applicant's Signature: �--�'�i,l Date: �!��--�' /`J �J- -� ���v <br /> Owner's Signature: Date: <br /> Last Updated:January 2016 <br />
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