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Home My WebLink About2015-00531 - roofing � CITY OF ORONO * Z 0 1 S - 0 0 5 3 1 * 2750 KELLEY PARKWAY DATE ISSUED: OS/04/2015 ��a ORONO, MN 55356- �\� 952 249-4600 FAX: 952 249-4616 ADDRESS . 65 SHORELINE DR PIN : 20-117-23-12-0033 LEGAL DESC : REG. LAND SURVEY NO. 1422 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-OTHER ACTNITY : O/S BUILDING-LJNDEFINED VALUATION : $ 19,000.00 NOTE: EPDM-FLAT ROOF APPLICANT PERMIT FEE SCHEDULE 340.77 STATE SURCHARGE(VALUATION) 9.50 NOKOMIS ROOFING CO. TOTAL 350.27 5053 36TH AVE S Payment(s) MINNEAPOLIS, MN 55417- CHECK 1325 350.27 Minnesota State License#: BUIL-BC583383 OWNER Shoreline Center REALTY LLC,NAVARRE PO BOX 3 MINNETONKA BEACH,MN 55361- 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 governing 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 d at any time after work has commenced. The applicant is responsible�br assu � g all required� s are ` requested in conformance th the St e Buildi ode.This, imit may be rev d at any time for du cause. -'c�_� • ��'� �`� �� -n( / _. � , L� ��.- — V`_"�� ..�'��i�'l 7 / ( �� /�. Applic t ermitee S nature Date Issued By Signature Date City of Orono � � uilding Permit Appl�cation for Maintenance / Replacement / Remodel � (i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) ��' � A,. Mailing Address: Permit number: `� �Ol yO PO Box 66 Crystal Bay, MN 55323-0066 Date received: Street Address: Received by: y G� 2750 Kelley Parkway Plan review fee: � Orono, MN 55356 `qKFSH�� 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. (Please print) GENERAL INFORMATION: � Job Site Address: �-{`�'J ��C:l'��e� '� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes o 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT�ORMATION: Name: �� -�� . State License # p��53�_� Expiration Date: � 3i(�� Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: (cell) i�ld-�J.1-�{�� (office) �p�{/K� Mailing Address: �-k� ,� �_ City: ZIP: Contact Person: � ' Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: ��,,�:.��(�M�S�,��„a � �,,.` PROPERTY OWNER INFORMATION: Name: Phone (day): �-Z_'��V _ �t{yy Address: 3�� (�,�� City: ��`tgt�"� ZIP: �3� t Email and/or Fax: �„`��, �e,�� C,,�v�a� � �c�,v� PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits: ❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345 �te-roof,other(specify) ❑ Siding ❑ Other:(specify) Phone: 952-471-0590 l�p�,� Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project (excluding land) $ �q i�c'z= - " 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 wh' e ot be given to the public but can be given to the subject of the data. Confiden al is information which g erally annot be e to either the public or the subject of the data. Our purpose and intended se of t 's information is to a ually pdate�our re ds and records of other governmental agencies required by law. If ou refus to su the information, e e issued. Applicant's Signat . ��Z L� Date: ��U�c�ct� Owner's Signature: Date: Last Updated:January 2015