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y F.rL,cn: 09/25/2017 10:15 4321 P.002/002 City of Orono Building Permit Application for Maintenance / Replacement/ Remodel —Residential ONLY (i.e. windows, doors, siding, re-roof, etc. —NO STRUCTURAL EXPANSION) Mailing Address: PO Box 66 Permit number: d — Crystal Bay,MN 55323-0066 Date received: a � Street Address: Received by: ti C� 2750 Kelley Parkway Orono,MN 55356 Plan review fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us I Total Fee: 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: 4535 NORTH SHORE DRIVE-ORONO,MN Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No !f 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: ALLSTAR CONSTRUCTION COMMERCIAL State License# BC706473 Expiration Date: 03/31/2018 Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) 612-865-8262 (office) 763-479-8700 Mailing Address: 5145 INDUSTRIAL STREET,SUITE 103 CiLAIN ZIP:55359 Contact Person: BRADEN(ARSON Applicant is: ( Contractor)/ Homeowner (Circle One) Email and/or Fax: BR4DEN ALLSTARTODAY.COM PROPERTY OWNER INFORMATION: Name: ROGER AND ELAINE HAYDOCK Phone(day): 952484-2499 Address: 4535 NORTH SHORE DRIVE City: ORONO ZIP: 55364 Email and/or Fax: ELAINEHAYDOCK@HOTMAIL.COM PROJECT INFORMATION: Overall project description: PARTIAL ROOF REPLACEMENT Type of Project: Any earth movement may also require ❑Door(s) ❑Remodel ❑Fire Damage MCWD review&permits: ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd Re-roof,cedar ❑Restoration ❑Water Damage Minnetonka,MN 55345 ❑Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahaereek.org Estimated Construction Valuation of Project(excluding land) $ 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 supply the inf Oion,t application may not be issued. Applicant's Signature: AI' T Date: 9 -Z_ ' Za Owner's Signature: Date: Last Updated:January 2016