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2015-00588 - roofing
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2700 Pheasant Road - 21-117-23-23-0017
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2015-00588 - roofing
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Last modified
8/22/2023 4:03:23 PM
Creation date
6/27/2018 1:34:51 PM
Metadata
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x Address Old
House Number
2700
Street Name
Pheasant
Street Type
Road
Address
2700 Pheasant Road
Document Type
Permits/Inspections
PIN
2111723230017
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. = City of Orono <br /> Building Permit Application for Maintenance / Replacement / Remodel <br /> (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) <br /> �O�O MailingAddress: Permit number: �j"�� g <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: S��J S <br /> Street Address: Received by: <br /> y ` 2750 Kelley Parkway Plan review fee: <br /> F �, <br /> t �, Orono, MN 55356 <br /> q'�FSH�� �� � �U <br /> 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: �.-� '�" ��Le���, � �o� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> 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 <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 'r ; (�. , ' �������r- <br /> State License# � �� � Expiration Date: �� <br /> Lead Certification Number: Expiration Date: <br /> (for work on homes that were consfructed prior to 1978 <br /> Phone: (cell) (office) � - 7" - ��, �j <br /> Mailing Address: (�j " � �� � _ � 'u � , City: H ZIP: �3 <br /> Contact Person: �,�� -Te��;,S Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: �— <br /> PROPERTY OWNER INFORMATION: <br /> Name: /�'��J�� (,c�.�(�ev� <br /> Phone (day): y5�.- "�(� d � <br /> Address: 2'7od P���.�+ ,. City: Q��;--d ZIP: 5�j j� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Overall project description: 1�'a/-� n � �' -�� I�; ' � -:��'� <br /> Type of Project: earth vement may also require <br /> ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&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) $ (). <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 t informa'on li tion ma not be issued. <br /> Applicant's Signature: �� � _� Date: �/�fT�� <br /> Owner's Signature: Date: <br /> Last Updated:January 2015 <br />
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