HomeMy WebLinkAbout2011-01496 - roofing CITY OF ORONO PERMIT NO.: 2011-01496
2750 KELLEY PARKWAY
4 ORONO,MN 55356- DATE IssuEv: 12/Ol/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1860 SHADYWOOD RD
PIN : 17-117-23-24-0018
LEGAL DESC : SHADY-WOOD
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-CEDAR
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 28,766.50
NOTE: VALUATION OF PERMIT:$28,766.50-DOUBLE FEE-WORK STARTED WITHOUT PERMIT.
ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 2448 NOTICE,PRIOR TO
WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED.
SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE.
ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED.
APPLICANT pERMIT FEE SCHEDULE 456.00
SIMON CONSTRUCTION STATE SURCHARGE(VALUATION) 1438
12366 RIVER RIDGE ROAD
BURNSVILLE,MN 55337- MISC FEE 456.00
(612)861-7000 TOTAL 926.38
Minnesota State License#:20593656 PAID WITH CC# 7521
OWNER
OMLIE,WILLIAM&RHONDA
1860 SHADYWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if consWction authorized is not
commenced within 180 days of the date of issuance,or if conswction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature � Date f '" `� ��� �� �� � �/
Iss d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NOU-30 2011 14:30 From: 6785736615 To:9522494616 Pa9e:1�1
Cit� of Orono
Building Permit Applicati.on for Maintenance / Renovation
(windows, doors, sidin , re-roof, etc.
Mailing Addr�ess: Perm1�number: O�� ��� '�J
O�L�j�O PO Box 66
Crystal Bay,MN 55323-�066 Date r�ceived: - O—
a � SheetAddr�sS: Recei�led by:
'� E. 2750 Kelley Parkway Plan 'ew fee:
'�tq����' Orono,MN 55356
T�� �: ��,3�
Main; 952-249-4600 Fex: 962-249-4816 www.a.orono.mn.us
This application form must be campleted�in full and all required information mus#be submitted.
Incomplete applications will be returned. (P/ease p� t)
GENERAL INFORMATION�
Job Site Address: �`3�a� woo �,
Wil�this be a Parade of Momes, Remodelers Showca Home or othe�Display Hor�e? ❑Ye� No
yes,e speaa/evenf permit is required with Police Depa/trnent and City Council approval 60 days prior In the event. Shuttle bus seivice will 6e
requiied unless applicant demonstiates suli5cient on-site pa/ldnq is av8i/eb/e. Nonpe►mitted�vents will not be allowed.
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�ONTRACTOR/APPLICANT INFORMATION: -
Name: Si w�� C.�.S�c��..s n
State License# q�,,� � �S�-� � �� E�cpiration Date: �4f �-�,
Lead Certiflcation Number. Expiration Date:
(for woik on homes thai were constructed prior tn 1978 I
Phone: (Z S6l �oaa (o�ce)
(cell)
Mailing Addrass: lL'3 b� 1�-�-� l/L�R� ��.. City, �,��. s�� ZIP' �r �3^�
CantaCt Person: ��,,�.��„�,`, Applicant is: Contrac�'r / hlomeowner �C1role One)
Email and/or Fax: �„�, � ����� ������� S���
PROPERTY OWNER lNFORMATIt)N:
Name: Q.l,.o...�A.� �,�,`�.
Phone(day): �
Address: V �- City: t7r o ZIP;"S'T 3 q
Email and/or Fax
PROJECT INFORMATION:
Type of Preject: My e ,rth movement m�y require
❑Door(s) ❑Remodel MCWD review 8 permits:
❑ Fire Damage Minnehaha�reek Wstershed District(MCWD)
❑Re-roof,asphalt ❑ Repair [v�'Storm Damage 1I8a02 Minnetonka 81vd
[✓]�te-roof,cedar Q Restoration ❑Water Damage �eephaven, MN 55391
❑Re-roof,other(specity) ❑Sidin hone: 952-471-0590
g ❑Other: (specify) Fax: 852-471-0682
❑Window(s) . in eh ha .or
Overall P�oject Desc�iption: � '���o�F 's y� _�o� �
Est�mated Construction Valuation of Pro�ect(exclud�ng land) � � , �j 6� •��
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Departmerrt;
• Certifies that the information supplied i�true and correct to the best of hislher knowledg . The applipr�t recognizes that they
are solely responsible for submitting a complste application being aware that upon failu ' tv do so, ths staff has no altemative
but to reject it u►rtil it is complete;
• Some or all of the ir�formation that you are asked to provide on this application is class fled by State law as either private or
oonfldential. Prnrate dats 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 cannet be given to either the p4blic or the subjed of the data. Our
purpose and intended use of this iriformation is to annually updats our records and reoords of other govemmental agencies
re uired b law. If u retuse to su I the information, he a lication ma not be issued.�
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