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Home My WebLink About2011-01016 - roofing � . �r M CITY OF ORONO PERMIT NO.: 2011-01016 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUEn: 09/12/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 3745 SHORELINE DR PIN : 20-117-23-21-0025 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 005 BLOCK 007 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RELIGIOUS CONSTRUCTION TYPE : ROOFING-RUBBER ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 26,500.00 NOTE: ADHERED RUBBER ROOF APPLICANT pERMIT FEE SCHEDULE 434.50 NIEMAN ROOFING CO INC STATE SURCHARGE(VALUATION) 13.25 POBOX64 NEW PRAGUE,MN 56071- MAIL-IN FEE 2.00 (952)758-4791 TOTAL 449.75 PAID WITH CC# 6573 OWNER CHURCH,GOOD SHEPHERD LUTHERAN 3745 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 goveming this type of work shall be compied with whether or not specified herein.This pertnit 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 revoked at any time fo�e. ��' �l /—� // LC�I/�- �/oZi'/ Applicant Permitee Signature Date Issu y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. S�� 0�7 2011 10: 38RM HP LRSERJET FRX p• 2 Ci of �rono °� �, �� '` � • • ' n e / Renov t�on � Building Permit Appl�cation for Maintena c � windows, doors, siding, re-roof, etc.) Maping Address: r= ��_'�� -� �� ,�0 A� PO Box 88 _ �-~� '-.�.�.-,�-.�__-.__% ,� O `rO Crystal Bay,MN 55323-0068 _:��.- ....W.�:e=-,��; • ' Street Addness: �,�a r�.�.:>�, � � 2750 Kelley Parkway � j'��.��=�y��"�� .. ::�. �":�i`¢:,y:!.,a�. i w- z�;,_ � � �:. � Orono,MN 55356 ,��__._ . .;�.,,;�. � ::1��• f�......�..�..'� �.9'.X.. :�C:. Main: 952-249-4800 Fax: 952-249�816 www.d.orono.mn.us — - , : -- This application fornn must be complebed in full and ail required information must be submitted. C�7 if j� , Incomplete appllcatlons will be returnsd. (P/ease prin� � GENERAL INFORAAATION: ��-- �- a"'� - � Job Stte Addr�s: .3��5 �i.dr$�`n e r• � - Will this be a Parede of Homes, Remodels�s Showcase Home or oth r Display Home� yes No � r If yaa,e apeael evsnt psnN[is requhed wl�h Police DepsRment and Cify Council epprvva/60 deya prlor to bhe event. ShufNe bus se►v�e w'�ll be reqWred uNess applicant demonshatea suHident on�Ms perkln9 is avallable. IYorr-perndit�ed evsnts wNl r►ot be aUowed. CONTRACTOR!APPLICAfdT INFOR�IA�N: � � Name: ;,J;P rn.ar, �t o �n Q m Q.1'� �r1L� State l.icense# Expiration Date. Lead Cerrtiflflcabion Number: Expiration Date: (for work on homas U►at Nroro conairuc[sd pNor to 1978 Phone: ��- - �°�� cell Mailing Address: o C�y'/�/'� a k Z�P' CoMact Person: Applicant is: ont�ractor / omeowner (arcis o�.� Emafl anci/or Faoc: - 5" - • � � a-� , y PROPERTY OWNER INFORMATION: Name: �LC Phone(day): - �! � `{ ZIP: SS q� Addr�s: ` � ; C�tY�G.�. �a. Email andlor Fax PROJECT INFORMATION: Type of ProJect: Any earth movement may roquire �p��$? ❑Remodel ❑Fire Damage ��ew 8�permlta: Minnehaha Creek Watershed Distrlct(MCWD) ❑Re-roof,asphalt ❑ Repair ❑Stom'i Damage 18202 Minnetonka 81vd �Re�oof.cedar ❑Restorafio� ❑Water Damage Deephaven,MN 55391 Phone: 952-471-0590 �Re-roof.o�ther(spselfy) ❑Siding ❑Other (specify) Fax: 952�71-0682 e��a oa Q�� r � ❑Window(s) www.minnehahacreelc.or+a r Overall Project Descrtptlon• F�tirt�af�ed Constructivn Valuation of Project(sxcluding land) S.2lp S�O � APPLICANT ACKNOWLEDGEMENT: . A�rees to provide all infcrmation required or requested by the Building Depertrnent; • Certifies that the IMormatlon supplied is tnie and cairect to the best oi hislher iv�awledge. The applicar�recogn¢es that they are solely responsible for submitting a complete application being aware that upon feilure to do so,the stalf has no alternetive but to reject it unUl it Is oomplete; • Some or all oi the iMormation thel you are asked to provide on thls sppiication is dassified by State law as sither privete or confldeMlal. Private date is infamstion which generally cannot be given to the publ�but cen ba given lo the subject oi!he data. Confldendal date is informaYbn which ge�rally cannot be �iven to either the public or the subjed of the data. Our purpose and irrtended use of this informetion is bc annually update our reoords and �orda of other govemmental agencies re ui�d b Iaw. If u refuse to s l the information the licetion ma not be issued. 0�1H�If�A11f�A�IAr1S'i�11YR' f// 1�V�/� ...`��— �'�te. gr�r/� _ S� �7 2011 10: 38RM HP LRSERJET FRX p. l � ` � NIEMAN COMPANIES , INC . p . p , BOX 64 ' N EW P RAGUE , MN . 56071 952 - 758 - 4791 TEL • g5Z _ � 58 - 5112 FAX FAC�IMILE TRANSMIT'TAL SHEET FROM: 70: . �ATE: COMPANY: e �� C��/� • TOTAL NO.OP PAG['S INCLIfDING CdVER: FA%NU �� +• / S613ABR S REFERENC6I3UMH�R PHONE NUMHER: . � �� YQUR REFEII�NCE NIiMBER: RE: .(.r.��l ❑URGENT ❑FOR REVIEW ❑PLEASE COMMEN'I' ❑FLEASE REPLY ❑ PLEASE RECYCLE N07Eti/COIUMENTS: `D�V �'-,�, '� �""� • - .�--_..: � �� „�.�...c . .�..•< � '� f�.