HomeMy WebLinkAbout2009-00539 - roofing ' CITY OF ORONO PERMIT NO.: 2009-00539
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 08/28/2009
952 249-4600 FAX: 952 249-4616
ADDRESS 3105 SIXTH AVE N
PIN 28-118-23-32-0007
LEGAL DESC UNPLATTED 28 118 23
LOT 000 BLOCK 000
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ROOFING-ASPHALT
ACTIVITY O/S BUILDING-UNDEFINED
VALUATION $ 1,400.00
APPLICANT PERMIT FEE SCHEDULE 54.25
YOUNG,BENEDICT&DENISE
3105 SIXTH AVE N STATE SURCHARGE(VALUATION) 0.70
LONG LAKE,MN 55356 TOTAL 54.95
PAID WITH CASH 54.95
OWNER
YOUNG,BENEDICT&DENISE
3105 SIXTH AVE N
LONG LAKE,MN 55356
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 inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. ^�
Applicant Pe 1-4e Signature Date Issugfl By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address. Permit number:
0 PO Box 66 iCrystal Bay, MN 55323-0066 Date received: /
Received b
a a. Street Address. Y
2750 Kelley Parkway Plan review fee:
sxo�� Orono, MN 55356
Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee:
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: 14ve �--�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 5�1_No
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/APPI jEANT INFO, yYATION.
Name: 1( 2
State License # Expiration Date:
Phone: (office) (cell)
Mailing Address: city.. ZIP
Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name. )6e ,u, 'fO 0 rt
Phone (day): S - 1)73- 6,S;,20 Cell r912- C7`�3
Address: 3io5- A✓✓ City: 4c1L,, ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
ElDoor(s) ❑ Remodel MCWD review & permits
❑ Water Damage
Minnehaha Creek Watershed District(MCWD)
❑ Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
[,Re-roof ❑ Fire Damage www.minnehahacreek.o
Overall Project Description:
Estimated Construction Valuation of Project (excluding land) $ We) 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
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
re uired by law. If ou refuse to su I the information, the application may not be issued.
Applicant's Signature: L Date:
Last Updated: 05-04-2009