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Home My WebLink About2011-00535 - roofing � R CITY OF ORONO PERMIT NO.: 2011-00535 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 06/28/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1930 SHADYWOOD RD PIN : 17-117-23-24-0022 LEGAL DESC : SHADY-WOOD : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 9,352.42 APPLICANT pERMIT FEE SCHEDULE 191.75 SIMON CONSTRUCTION STATE SURCHARGE(VALUATION) 4.68 12366 RIVER RIDGE ROAD TOTAL 196.43 BURNSVILLE,MN 55337- (612)861-7000 PAID WITH CC# 3038 Minnesota State License#:20593656 OWNER ELMQUIST,DAVID A ' 1930 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 separate permiu. 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 construction authorized is not commenced within 180 days of the date of issuance,or if construction 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 revoke at any time for due c use. � �� / l lJl Applicant Permitee Signature Date Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OT ER THAN DESCRIBED ABOVE. JUN-28-2011 07:20 From: To:19522494616 Pa9e:2�2 City of Orono 6uilding Pertnit Application for Internal Work (wlndows, doors, sidi�g, re-rvof, etc.) Mailing Addness: permit number. I - O.Q,O,�O PO Box 66 Crysbl 8ay,MN 55323-0066 Dale received: / � � Sbeet Address: ��ed by: 2750 Kelley Parkwey Plan rc�rlew fee: i��F+ Orono,NAN 55356 Maln: 952-249-�60� Fax: 952-249-4616 www.ci.orono,mn.us Tats�Fee. / G�/, [�� l�� T This application form must be oompleted in full and all requl�ed information must be submitted. Ineomplete applEcatlans will be retumed. (Please print) GENERAL INFORMATION: Job Site Address: � � /�9 �� Will tbis be a Parade of Homes�Remodele�s owcase Home or othe�Oisplay Home? ❑Yes No flres,e special event pemv7 es requi�d w�7A Police DepaRment and Ciy Coune�approva160 days prlo�to the everrt. ShutUe bus ' w�l be r�quired wless appGcairt demonsaates suHPcfent on�ke park(ng is evapable. Non-per►nifted evenGc wa!not be allowed. CONTRACTOR/APPUCANT INIFORMATION: Name: 6il/s9D� �GOA�� / S'tate Licens�e# B��.�fp S/� Expiratio�Date: D1�//,� Lead Certification Number. Explration Date: (f+ur wv�k on homes that were co�cted prior to 1978 Phone: �/,a -�/. ��D p (office) (cell) Mailing Address: / �j� �l,p/ City: � y ZIP: Contact Person: �gq�/g,g� �;E,rj'W/y Applicar�t is: o�ractor / Horneowner �cr�a o�.� Email and/or Fax: lp/a� • 5�' (p`p/�' �/g��s�e� �Oy�fi�yut�s�s,y. �R�1 PROPERTY O�NNER INFORMATION: Name: 7�ei'.l� �L✓�'lQ��?� Phone(day): Address: �� j��,� ,�,� �� 01�d/Ill� ZIP' �"��/ Email and/or Fax PROJECT INFORMATION: Type of Project: Any sarth mavement may require ❑Ooor(s) ❑Remodel ❑Water Oamage MC��a`pe�m�s: Minnehaha Creek Watershed District(MCWD) ❑Window(s} ❑Repair ❑Sbrm Damage 18202 Mnnetonka 8�vd ❑S�d�ng ❑Restoration ❑Other.(speciiy) Deephave�,MN 55391 Phone: 952�71-0590 �te-roo( ❑Fire Damage Fa� 952�71-0682 www.m i n ne h aha cre e k.org Overall ProJect Descrfqtion:_y�D¢� $',��—�d� Estimated Construct;on Valuation of Project(excluding land) a 3s� _ �� APPI.ICANT ACKNOWLEDGEMENT: • Agrees to provi0e sll iMotmadon required or requested by the Building Departrnent; • Certi�es that the informaGon suppGed is we and correct to the best of hisTher knowledge. The applicant recogniies Ihal lhey �re solely responsible For submitting a oomplete applicativn being aware that upon failure to do so,the staif has no eltemative bul to reject it unt�l il is complete; • Some or all of the informa6on tha!you ere e5ke4 to ptovide on this application is dassified by State law as ailher privata or wnfidential. Private data is infonnaGon ur�fich generslly csnnot be given to Ifie public but can be given to the subJed ot the dafa. Confidsndai data is infortnadon whicfi generally cannol be given to eiiher the public or the subject of 1he dala. Our purpose and iMended use of this i�ormaGon is M ennually updete our recOrds end�ecords of olher govemmenlal agencies re ulred b lew. If u retu 1 ' o alion �e s lication ma no1 be issued. Applicarrt's Signature: . Date: �� /� 16�,�r DATE TIME � CITY OF ORONO CALLED IN � INSPECTION NOTIC HEDULED '� PERMIT NO.ao��o o�s3s oMPLETED ADDRESS � �� OWNER TELEPHONE NO. ��-�h� �7� CONTRACTOR s�'"''�'�� DESCRIPTION �� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATIOWREMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o —�� , N� �`�!�lo�F(% � � �� ° �� _- � t4 ► W � Q � z W � W � � d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN INSPECTOR WFLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 2a hours in advance. (952) 249-4600 OwnerlContractor on s� e: Inspector. �,�� White Copyllnspector's File Canary CopylSlte Notice