HomeMy WebLinkAbout2014-01446 - roofing , CITY OF ORONO * 2 PJ 1 4 - P1 1 4 4 6 *
2750 KELLEY PARKWAY DATE ISSUED: 12/18/2014
. ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3382 SHORELINE DR
PIN : 17-117-23-44-0100
LEGAL DESC : TOWNSITL;OF LANGDON PARK
: LOT 005 BLOCK 003
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : COMMERCIAL- BUSINESS
CONSTRUCTION TYPE : ROOFING- RUBBER
ACTIV[TY : O/S BUILDING-UNDEFINED
VALUATION : $ 17,000.00
APPLICANT PERMIT FEE SCHEDULE 295.00
STATE SURCHARGE(VALUATION) 8.50
FORCIER MARTY ROOFING TOTAL 303.50
P.O.BOX 243 Payment(s)
HUTCHINSON, MN 55350-
(320)587-8415 CASH 303.50
OWNER
Narrows LLC
PO BOX 36
NAVARRE, MN 55392-
AGREEMENT AND SWORN STATEMENT
fhe work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State E3uilding Code. This permit is for only Uie��ork describcd and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances noverning diis type of work
shall be compied with whether or not specified herein.This permil will
expire and become null and void if cons[ruction authorized is not
commenced within 180 days of the date of issuanee,or if construction is
suspended for a period of 180 daqs at any time afier work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. / ,�-^
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Ap �icant Permitee Signature Date Issued By Signature Date
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. " City of Orono
B�ilding Permit Application for Maintenance / Replacement / Renovation
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
Mailing Address: `�' ��� (�" _ �
� �-��� ` PO Box 66 Permit number:
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��1 Crystal Bay, MN 55323-0066 Date received: / ��? !�
' StreetAddress: Received by: �-- �}
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� � � % 2750 Kelley Parkway Plan review fee:
�`��,� - �l�`�;� Orono, MN 55356
� kt�st�i� ,
�-___�--' Total Fee: �� � , JL%
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: So� ;-��, bs U�' " C J�•f ,��i'
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [c�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 INFORMATION:
Name: ��►�c;�� Mav�..{ �oa��•�C
State License# Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) 320 - ZC� _-j`l5� (office) 3�C- �7`�j�{j S
Mailing Address: ��.� Z�3 City:�.�,�.��ki+,,,<;,�,,., ZIP: �'�'3 5'�
Contact Person: ��m�,. �,.�;t,., Applicant is: Contractor / Homeowner (CircleOne)
Email and/or Fax: -�r�,p, �.�@ f{.,� ra�� �q �:Ja��� , Lc9M
PROPERTY OWNER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Overall pro�ect 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)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
e-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
��� 1'1� ❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $
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 sup I the information, the a lication ma not be issued.
Applicant's Signature: �,�.,-�.. Date: ��. /�' Z-d f�
Owner's Signature: Date:
Last Updated:03/O6/2013