HomeMy WebLinkAbout2017-00998 - roofing '� � � CITY OF ORONO * Z 0 1 7 — 0 P1 9 9 8 *
2750 KELLEY PARKWAY DATE ISSUED: 08/22/2017
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2695 SHADYWOOD RD
PIN : 21-117-23-24-0056
LEGAL DESC : CHAPMAN ADDN
: LOT 002 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : 102-SINGLE FAMILY HOUSES,ATTACHED
VALUATION : $ 7,000.00
NOT'E: VALUATION OF PERMIT:$_7,000.00 •
ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQLJIRE 24-48 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 154.85
STATE SURCHARGE(VALUATION) 3.50
SELA ROOFING&REMODELING,INC. TOTAL 158.35
4100 EXCESIOR BLVD Payment(s)
ST.LOUIS PARK,MN 55416-
(952)915-7227 CHECK 038792 158.35
Minnesota State License#:BUIL-BC 1050
OWNER
PAULSON, STEPHEN&BOTHAINA
2695 SHADYWOOD RD
EXCELSIOR,MN 55331-
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 gant 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 perrnit will
expire and become null and void if consWction suthorized is not
commenced within 180 days of the date of issuance,or if constructio(i is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for asswing all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
► - - i� 0 r � �,� , � 1
pplican Permitee Signature Date Issue y Signature �� Date
� � �.
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel — Residentiai ONLY
(i.e. windows, doors, siding, re-roaf, etc. — NO STRUCTURAL EXPANSION)
A,. Mailing Address:
��`VO PO Box 66 Permit number. ZC?�[� '
Crystal Bay, MN 55323-0066 Date received: � '� "� 1
Received b
� � Street Address: Y�
?�, ti� 2750 Kelley Parkway
�.q��s��Rti�', Orono, MN 55356 Plan review fee:
Total Fee:
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (P/ease print)
GENERAL INFORMATION:
Job Site Address: .r� �,,,�v( �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes No
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus s rvice will be
required unless applicant demonstrates sufficient on-site parking is avai/able. Non-permrtted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Na m e: ��� ��n5 a�,w( �ew+�Ii�5
State License# C�Z C��I v 5� " Expiration Date: 3/31�(�(
Lead Certification Number: ��T-a5o3y-a Expiration Date: c��aa�a�
(for work on homes that were consfructed prior to 1978
Phone: (cell) (office) �j5a- �IS-7dd6
Mailing Address: y aa Exa.ls;.r 131� City:S{�. (.�,,;s )���1< ZIP: Ssy((,
Contact Person: .�� Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax: �(�,,�, (��4ro ���, �.�-,
PROPERTY OWNER INFORMATION:
Name: ��,�� ��µJs`�
Phone (day): 61�. - 85 C�- 5�y
Address: �k, S���v.�o„� 1�( City� ���h`� ZIP� .�s33�
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
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)
❑ Re-roof,cedar ❑ Restoration 15320 Minnetonka Blvd
❑Water Damage Minnetonka, MN 55345
❑Re-roof, other(specify) ❑Siding ❑Other: (specify) Phone: 952-471-0590
❑Window(s) Fax: 952-471-0682
www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 7� °'
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
ou refuse to suppl the information,the application ma not be issued.
ApplicanYs Signature: Date: ����Ij7
/ � v
Owner's Signature: Date:
Last Updated:January 2016