2017-01548 - roofing - Laserfiche WebLink

Home Browse Search

NOV/21/2017/TUE 05:05 PM Garlock—French FAX No. 612 722 9754 P. 002 City of Orono Building Permit Application for Maintenance/ Replacement/ Remodel — Residential ONLY (Le.windows, doors, siding, re-roof, etc. —NO STRUCTURAL EXPANSION) Mailing Address: Permit number: 'AO/7 —0/WW G W SLOIV ox 66 04 0 Crystal Bay,MN 55323-0066 Date received: ` 7 Street Address: Received by: 11 f, 2750 KelleyParkway '"/" F M� cPlan review fee: r'f Orono,MN 55356 Total Fee: / Main: 852-2494600 Fax: 952-249-4616 www.ci.orono.mn.us • ( V 1J 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; rP p O Q/rte C sf/Z?'. / / . Will this be a Parade of Homes, Remodelers Showcase Home/or other Display Home? 0 Yes No N 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 1 APPLICANT INFORMATION: Name: Garlock-French Roofing State License# BC001423 Expiration Date: 3/31/18 Lead Certification Number. NAT-23999-2 Expiration Date: 4/15/20 (for work on homes that were constructed prior to 19x8 (office) 612-276-9934 Phone: (cell) Mailing Address: 2301 E 25th St. City: ` I " -- •• IS ZIP: • Contact Person: Meg Nathan Applicant is: Contractor / Homeowner (circle one) Email and/or Fax: mnathancgarlock-french.com PROPERTY OWNER INFORMATION: Name: Frances Graham Phone(day): 612-747-1900 Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Overall project description:Tear off and replace small EPDM roof(see attached drawing) Type of Project: Any earth movement may also require ❑Door(s) ❑Remodel IDFire Damage MCWD review&permits: ❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration 0 Water Damage Minnetonka,MN 55345 0Re-roof,other(specify) 0 Siding ❑Other:(specify) Phone: 952-471-0580 Fax: 952-471-0682 EPDM 0 Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $8.500.00 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 supply the jnformation,the application may not be issued. Applicant's Signature: Date: 11/21/17 Owner's Signature: U Date: Last updated:January 2016