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Home My WebLink About2015-01013 - roofing v ��-�� ' CITY OF ORONO * 2 0 1 5 - 0 1 0 1 3 * �.� �r�'� 2750 KELLEY PARKWAY DATE ISSUED: O8/10/2015 , I �� (�O ORONO, MN 55356- 3� (952 249-4600 FAX: (952) 249-4616 ADDRESS : ,3472 SHORELINE DR PIN �':/ 17-117-23-43-0094 LEGAL DESC : NAVARRE HEIGHTS : LOT 018 BLOCK 006 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RES[DENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-LTNDEFINED VALUATION : $ 5,000.00 NOTE: VALUATION OF PERMIT:$5,000 ROOFING PERMITS[SSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED. S[GNS-ADVERTISING S[GNS 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 12391 STATE SURCHARGE(VALUATION) 2.50 TO ROOFING& REMODELING TOTAL 126.41 5220 YORKTOWN LN N PLYMOUTH,MN 55442- Payment(s) Minnesota State License#: BUIL-117085-1 CREDIT CARD 4152 126.41 OWNER BLOCK,JAMES 3472 SHORELINE DR 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 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 days at any time after work has commenced. The applicant is responsible for assuring all required ins ections aze requested in co formance with the State Building e.This permit may be revoked at an ime for du se. � � �� v - Zol '� � � D - 6 S� O � r� � � Applic t Permitee Signature Date Issued By Signatu Date City of Orono Buiili��ng Permit Application for Maintenance / Replacement / Remodel • (�i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION) ��T Mailing Address: � � �V� PO Box 66 Permit number: � Crystal Bay, MN 55323-0066 Date received: �D Street Address: Received by: �-� y�, G� 2750 Kelley Parkway Plan review fee: � 1qKESH�� -Qrono, MN 55356 � � � U Total Fee: � � Main: 952-249-4600 ax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Inco�te applications will be returned. (Please print) GENERAL INFORMATION: ��`'' / Job Site Address: ,�!7Z. S�1 o re�i he �f�V�. Will this be a Parade of Hames, Kemode�ers 5howcase Home or other Display Home? ❑Yes ❑ No /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: TD 2ooF�ivG c� Qt•�►no��a�v� State License# �qG G7G/b�, Expiration Date: ,�'l,S,Lt� Zc/� Lead Certification Number: �/7d8s'_� Expiration Date: zn�L StD�. 3o t� (for work on homes that were constructed prior to 1978 Phone: (cell) (�/Z-Z/v-Z g�u (office) Mailing Address: s"tZa YwIC�a„� �.N N� City: I r,e�f++ ZIP: s-r yyZ Contact Person: ,ost,�H Tk.o.•�k s Applicant is: ontrac / Homeowner (Circle One) Email and/or Fax: a� C �.f.dn.{,►u, ��,,,,, PROPERTY OWNER INFORMATION: Name: 5�,.,.,..s BG��k Phone (day): Address: 1t�f�Z S ��►�+tl•►►< D^•� City: ZIP: 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 15320 Minnetonka Blvd ❑ Restoration ❑Water Damage Minnetonka, MN 55345 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek orq Estimated Construction Valuation of Project (excluding land) $ o v 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 apptication 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 su I t e infor lication ma not be issued. ApplicanYs Signature: Date: 0 8-��' z��,� Owner's Signature: Date: Last Updated:January 2015