HomeMy WebLinkAbout2011-00315 - roofing - rubber r
s
�___
4
CITY OF ORONO PERMIT NO.: 2011-00315
, � 2750 KELLEY PARKWAY
i ORONO,MN 55356- DATE ISSUED: 05/09/2011
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 725 SIXTH AVE N
PIN : 26-118-23-44-0006
LEGAL DESC : UNPLATTED 25 118 23
: LOT 1 BLOCK 2
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-RUBBER
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 3,000.00
NOTE: FLAT RUBBER ROOF
t
�
i.
APPLICANT pERMIT FEE SCHEDULE 88.50
ALLSTAR CONSTRUCTION STATE SURCHARGE(VALUATION) 1.50
5145 INDUSTRIAL ST
SUITE 103 MISC FEE 0.00
MAPLE PLAIN,MN 55359 TOTAL 90.00
(763)479-8700
Minnesota State License#: 20631575
OWNER
Spring Hill Golf Club
725 SIXTH AVE N
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 sepazate
��permits. All provisions of laws and ordinances goveming 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 commenc .
The applicant is responsible for assuting all required inspections az
requested in ' the State lding Code.This it may be
revoke an due cause.
s� e � j� , ,
A pl� ant Permi re Date Issued By Si ture ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE
�
City of Orono
�
� Building Permit Application for Internal Work
,� (windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
� g,0,�. PO Box 66
� Q � O Crystal Bay, MN 55323-0066 Date received:
�z ' a r���'�<.';;�, ,, Street Address: Received by:
' �'.�, � �'��,��, Gti`� 2750 Kelley Parkway Plan review fee:
1�,;���04� Orono, MN 55356
ESH
'-_— 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: � � � �=�"�y y'
�` ? Will this be a Parade of Homes, Remodelers Showcase Home or other Display Hom ? ❑ Yes �No
� If yes, a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus s e will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
• `t
CONTRACTOR/APPLI ANT INFORMATION:
�,. t r � �� l�
Name:
4 State License# � � Expiration Date:
- Lead Certification Number. ,�,j �--. ,;'� , -- Expiration Date: '"' ^ � '�
(for work on homes that were constructed prior to 1 78 �
Phone: �' "'_e � � — � "" �" (office) (cell)
Mailing Address: �'y�f� � � S�C. City: r �IP:
Contact Person: �,��,� L������ Applicant is: tract omeowner (Circle One)
r:,�:
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: � � Q �,�L'l.
r�' Phone (day): "�
Address: ,� , � City: � ZIP:
Email and/or Fax
PROJECT INFORMATION:
�p Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits:
'� Minnehaha Creek Watershed District(MCWD)
;;;;; ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
i'•_: ❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391
Phone: 952-471-0590
Re-roof ❑ Fire Damage Fax: 952-471-0682
' www.minnehahacreek.orq
i`;.
' Overall Project Description:
r�. Estimated Construction Valuation of Project(excluding land) $ � �i
�:
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
K` 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
r,� 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 info �n is to annually update our records and records of other governmental agencies
�`.: re uired b law. If ou refu su the infor 'on, the a ion ma not be issued.
#`~ ApplicanYs Signature: . Date: �` '��/
LastUpdated: 03-01-2011