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City of Orono Building Permit Application for Maintenance / Replacement / Remodel - Residential ONLY (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) �o Mailing Address: •Permit number: Aa /7-10 11 97 *4- C r Bax 66 n � JCrystal Bay, MN 55323-0066 Street Address: Date received:Received by: y 2750 Kelley Parkway Plan review f e: d� I--R/0 Orono, MN 55356 '�fSH�� 712/ Total Fee: 1 0 7 Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 2420 Dunwoody Ave. Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 1 No 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: Mint Roofing, Inc. State License# IR657481 Expiration Date: 12/17 Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) (office)952-767-4824 Mailing Address: 2285 Daniels Street City: Long Lake ZIP:55356 Contact Person: Dayna Stephenson Applicant is: Contractor / Homeowner (circle One) Email and/or Fax: dayna@mintroofing.com FAX: 952-473-0805 PROPERTY OWNER INFORMATION: Name: Calvary Memorial Christian Phone (day): 952-471-8511 Address: 2420 Dunwoody Ave City: Wayzata ZIP: MN Email and/or Fax: Remove existing roofing to metal deci.Add lumber at curbs and permeler to accommooale new insuhatian.Loose lay iso'ub taper system to achieve R=00 al lower roof,Mecha PROJECT INFORMATION: Overall project description:attach 2layers 2.6"nal upper roof.Install 60 milEPDMballastedsinglepysystematlowerareaslnstall60milEPDMfullyadheredsingleplyrootsystem.Install24gapretini Type of Project: sheet metal Any earth movement may also require Ill Door(s) CI Remodel CI Fire Damage MCWD review&permits: Ill Re-roof, asphalt ❑ Repair 111 Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 0 Re-roof, other(specify) ❑ Siding 111Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 60mil EPDM, Ballasted ❑Window(s) www.minnehahacreek.org Estimated Construction Valuation of Project(excluding land) $182,490.00 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 failure 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 classified 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 governmental agencies required by law. If you refuse to su•ply the informa ion,the application may not be issued. I +�a � 2.IU llII Applicant's Signatur-: .i, _ Date: l 1 11. Owner's Signature: Yel5t/ / Date: Last Updated.January 2016 / yye,,C, /&/ 7/7