Loading...
HomeMy WebLinkAbout1994-006370 - tear-off/re-roof PERMIT CITY OF ORONO PERMIT TYPE: r k j T 2750 Kelley Parkway - P.O. Box 815 Permit Number: -:. -1 LD i NG Orono, Minnesota 55356-0815 Vot-370 (612) 473-7357 Date Issued: i;;:;/x:4/9 SITE ADDRESS: G14-S TFJNKAWA RD L':-:*V DESCRIPTION: TtEAR—OFF/RE—ROAF Buildin-:4 Perri-dt. Type INS"T—ADD/RENCIDEL E'uilding Wc-06"..* Type RE—RACIF r `1 Tv gW .,qjkg L W1 I A L-&. 41�.L.J4VVVVV 6 4 L--,�,i 'L 717 0.�) V.i UP.L I A Vun-IT 1 .L 0 ij- J . Q v 1.140, 1 A MCA I 9:j VVAt : *9 u 1: A" , REMARKS: FEE SUMMARY: VALUATICIN 1%34; 900 Base Pee $:317 .Of) -------- Tot-al CONTRACTOR: — Applicant. S'T . LIC . OWNER: i B !i B '-::;HE'ETMlF-1'AL & ROCIFING 4 9 -17EMPLE iSIRAEL 210 CENT INNIAL DR 6.45 TONKAWA RD BUFFALO MN .5 5: 1 CiRONO M N S b 6, 05-1 )377-8680 `--R0L MENTE,- �rm—ckt'QVESTS M PR-or T"HE LJNDER$16NEQ -HER 11full, MAKE T1 ME ft R I",'T T� J& AND;' C D, -As?RgF,$jJ0 ,P, OF, AKE aa' 10 T OR� APPLICANT/PERMITEE SIGTOREISSUED BY:SIGNATURE CITY OF ORONO - BUILDING PERMIT APPLICATION Date Received Total Fee: $ - Date Aonroved: Entered By: Permit V - _ ALL INFORMATION MUST BE SUBMITTED IN FULI, BEFORE PLAN REVIEW WILL BE STARTED (See Check-off List Enclosed) -------------- ----------------------- ---- --------- ___ _ _ ___ ----- THE APPLICANT IS: (circle one) OWNER or CONTRACTOR ZIP: JOB SITE ADDRESS: (work) � PHONE: (home) � NAME OF OWNER: CITY: / ZIP: � MAILING ADDRESS: I - PHONE: CONTRACTOR: J CITY: , � , � ZIP: ' MAILING ADDRESS: STATE LICENSE: PHONE: ARCHITECT/ENGINEER: CITY: ZIP: MAILING ADDRESS: REGISTRATION 4 NAME: Accessory Demo Remodel/Alteration Renovate Structure Move TYPE OF WORK: New Addition , Land Alteration PROPOSED WORK (describe in detail) : STORIES: SQ. FEET OF EACH FLOOR: NO- OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding lana) : $ I hereby apply for a building permit and I acknowledge that the information ete and accurate; that the work will be in conformance w th the above is compl ordinances and codes of the City and with the State Building Code; understand this is nota permit and work is not to start without a permit; and accordance with the approved plan. that the work will be in ✓ �_ DATE: APPLICANT'S SIGNATURE: , CITY ©f ®BODY® M Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices On the North Shore of Lake Minnetonka - DATA PR=pACY ADVISORY Subd. 2, "Rights of subjects of 13.04 , gest for a permit or In accordance with M-S• you that your req wire data" , we would like to inform y of its departments may req license from the City of Orono or any you to furnish certain private or confidential information. You are notified that: The information you furnish will beeQuested..sed to Qetermine your 1• e,-mit or license aualification for the p uire that refuse to supply data, but refusal may req 2. You may the City deny the permit or license.be shareor d with other Local , state 3• The information may rocess the permit or federal agencies to the extent necessary to p license. iice_;se requires Council ac�-or. e. If your recuested pe-=it °r ublic. to approve, some information may become p M.S. 13.04 to review private C . You have certain rights under J data on yourself. • On or 6 . Your full name is required to process -L -114s appl=-cam- pewit. ,� • � Last � Middle First Address v State Zip City Phone I understand my rights as stated above. SI natitre BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473 7358 • PUBLIC WORKS—473-7359 ASSESSING ;;� �;. <• .,;... .:. :;. S■i ;. .n.}<.;{..:.::.::::::.}:•}:•}:{:}:.}:.^•.•}}}):•:.}:>': }}}}:.}:•:{•}};;;:}:•} ISSUE DATE..`... a4.4 0t.l�® { . .CERT!.(=.tCATEiirt � ..�..k.}.l . f:C•Y � fIC :>i::'.:;:j:::j?i:::::?;i:;:;{:j::}':}:ii i ''{ r.vx:::•: ... .. L... vvi.ti.::::.:.{• n...... v:::.w::•.{{.}}:v:ryv::w::is?:ii:::. .: .... }} t}'4':\w::.�:}}:'•:{v}}i}}}ilii':.}}}'YLw}:�:•:•:{ .. ..:... ..- :. -t<{}i}}}};}{.?moi'}:.}}}::X}4i::4............�. ::. }'".;.•'F•, r.::::v:::,n........... ..::....v.•..•v Q•t.. W.:1.{Y�::iY^}' .. <.":};;SSS:a'•:J�1.'�?,.•: '.• - ..:......•.••}::.t•::• {Jr .. .}. :•{'{}: .r. '•}':y:{}:•}:•:�:.5}},;:�• ,;.:;},:•}:•}:•}}:{:.::c.:;-::::Y:::::�}:;;;::>%:' :?::i?..:::;:;;..:.{r: •r{ �`..r,'�°7r .?w,.{..t••::.d>;}{....:v: -:::a.;}};.x{,..k:{.3�`.t•5.y.+...•}t. ':c,.: (. }:r}... :'•:;'{::�'•S:}::::.::::.::.. .;.{...................::: ��) :•}},S.xii;:iS};Yii SS::>..t.�'a:{:}}}:•{}.,yv}:•..Ev.{:{..Cr.3W.. -t,...r...}..a.:.::,....f�{}}.r:.y}::n�3:.,.�{:.3'M`. PRODUCER }`iS6,.,, a?•.•.^.;• ,r.:$:•:.,c}S:f{�?{'t:<tS:;.:::::}::::: : THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Osborne InsuranC@ CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH 1935 Aes t Burnsville Parkway POLkIEs BELOW. ................................... .................................................................... . .. . . Burnsville, MN 55337 COMPANIES AFFORDING COVERAGE (612) 890-0414 FAX 890-0535 ... .............................................................................. ............................................................ ca�IPArr .... LETTER A Transcontinental Ins. Co. ...................................................................................................................................... ........................ ... ................................................................................................................................. � B Transportation Ins. Co. INSURED ...0 ......................................................................................... ......................................................... &B S ee metal & Roofing, Inc. o►wurrLimC United States Fire Ins. Co. 210 Centennial Drive Buffalo, MN 55313 ................................................................................................................................................ COMPANY LETTER .................................................................................................................................................................... COMPANY E LETTER }• " <:CQVE..AGES. °Y{4 ......................................... :... ••:•}}:•,:a4r a• „ � „t•,t•••.:..,•:;:{•:.�t:,:•:..t..t/L :.,. ..,,:}.....,c:o:,:.{..,x:..::.:,�.t,.}.{.,}...+a x:.. .}..Yo}:. N.:: <..,{,••.:,c.•�csaa•:.:i•::sac•St..•.�A::xta�'aL� ottwx'��'ir :?.,:. ... :......: }� �{.}}t• '`E?;; ��•..3. 3 W:}:,r}}:�:•.:,. •;a:::}:.�}•:: ��'.uY3x:{{-}.Y;..t...,,,,hxll{•:,ro:a•:{>a{2o.4.,,..�;aoxa�L�•t�c�ob':t.:'�b:{YiC'{i:%:;'�"' .'',niif.:: `.hrtt}y:42:::%?JL4,.:YEN..�.w:� t:�:`+�{4.'`'�nY:}:�}:::.%};:•'i}�{•+`; -,;•;ix.•�.yGF,.:.ytv.:: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT ETO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ... ........................................................................... LTR: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION DATE PA40WM DATE(MMIDONY) LMRTS .......................................................................................................'............ ... . A:GENERAL UABtLTTY GENERAL AGGREGATE S 2,000,0 C % COMMERCIAL GENERA!LIABILITY 113705209 PRODUCTS-COMP/OP AGG. i 1,000,0 ......... ;. , cLAuws MADE ` % ::OCCUR. xx :05/01/94 ' 05/01/95 PERSONAL ADV.INJURY = 1,boo, 0 C 6 OWNERS&CONTRACTORS PMT. EACH OCCURRENCE :t 1 ..........................................................f.........0,0 C % €Gen.A Pro . F DAMAGE(Any pe�.) S 50,0 C ........: .. ..............ggL............]..... ... MED.EXPENSE(Any on poison)::3 510 C ................................................................................................. AUT... LIABILITY COMBINED SINGLE B: % :AN AUTO 113695572 LIMIT :S 1,000,0 C ALL OWNED Auros ......................... :05/01/94 0 5/0 1/9 5:BODILY wuRv SCHEDULED AUTOS .r :S-------- — (P Tenon) %..i HIRED AUTOS ................................................ .................................. BODILY INJURY % ;NON OWNED AUTOS (PN.0-ono :5-------- GARAGE LABL1TY ............................................... ................................... { PROPERTY DAMAGE .........:.......... ........................................:.......... EXCESS LIABILITY fi�dl OCaJ _ fICE ............ ........................ 0 C % 'UMBRELLA FORM 553.012434-9 ::05/01/94 0 5/ 0 1/9 5 AGGREGATE : 1,00010{ C .........{ .......................y....-...., ............. ......... OTHER THAN UMBRELLA FORM WORKER S COMPENSATION % STATUTORY LIMITS AND :05/01/94 05/ O1/95 EACHACaooNr -_. .........1 113695586 00,OOC B EMPLOYERS•LIABILflYDISEASE.POLICY LIMB s 500,O O C DSS EACHYEE S 10 0,O O C ETHER ......:....................................... DESCRIPTION OF OPERATIONS/LOCAMONSIYEHICLES/SPECWL no r Certificate Holder and AMBE, Ltd; are additional insureds un " -the General Liability regarding: Camp Teko, Lake Minnetonka, MN �. vx,:::...... };- ,{,r•:::;::;.rtiy..:;}•}Y:.a,• •::•:%'f•}:::%;r::tr :r�c•}rr•:}:•}••}:;�}}rr CEAT1Fi.CATE'::HOLD {..::.,:... .:,r:.,:.;: : .:.; ...:.. ..... ..'{`}t}%t{•: .. ib,;r:r{h.{v{v:.v.v:v..:... ..:.tv .:....•JJ 4:::•}'.v... .. : :{:v�::.}S:'•}}'Y•h•"v.:i{r:•':r'{{�:h}':iii:•}:•}::vv}: ..... .......:•:::..;... .......Vii.}. ...v., .. .:.:. ....... .:.;5:}.{ C ..... t ......... ..{ :.;}.:.v{v.. ...I.........+� '•}Yf.•}}}}>}v}}}:{x. . .:...,,..,4,.,,...r...r:..w.,,cz{w:.w.•..{,,.•.,•. a� � .S'-:GANt.`E1.Ll1TION.. r......... t•:i::::i.�.:':::.:•. d:ct,,.•.•,czt9tY �{#� };R{-3:•:v;::..• f ••::t;:•.{ •:y ,... ............ .......}..vY{S2 a•:..•:.•.•,:{4^}f!::'r:•}}:.,}},�:.;.y;:.}}-:.}:•}'•'�'{:::'!•'a:}::}x•}i ..;fi•.Y••y{���::{:}.R;:.2 r'::}•..}:;;;::i::: ,:..}T:tkF.a4{fb.,...,:xY,::,r'7�.t{,V..J.w.}}{t:rc.{w.•.•,x.•.v:r.•so✓,•r:.a:;T-£Tai•S:{:�:5:; o:�:•}:{{{;{{;::#a`:4::ti`t::c::i}:A@:srSi.B:»ti ti?}Aoti4y`:ia�{�+U.Msy���>. 3;F.t�:�#:;i_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Temple Israel � LEFT, BUT FAILURE TO VAIL SUCH NOTICE SHALL11e1pCSE No OBLIGATION OR LIABILITY OF ANY UPON THE WOPANY. ITS AGENTS OR REPRESENTATIVES. 2324 Emerson Avenue South" :.:{AUTfWR�D R V f .! Minneapolis, MN 55405 k•{.. ::ri?:ti{4:::.•r:: :.•.vv....:.:.vJ:{n:;:j•:?:•K •}}:{•}: :{N.:fr •:�y: .: :.. :....... ,n-..}...n.:::w::n-{:•::•:.v:w:nv:nv:::::}::.v:r............n ir........,...v.........., 4N .S.}"}'. :....r r{ry'i_:{{.Y '.�J..:..r.,:..uv:x::.v:xm:.v:.vu::.,v.,..:.x ,.ACOR :}25:5::y. :•}:•}::.}::.,•}:: .....:.::{,::.:::.....................:::.�::{..�..{.{..�:'r:{•}:•:{{{•:::.......:.:.:{•:::.:......f:.r. ..r.:+:�;s.:,...::..:.......Mas•:.�.{�..,�.�..+..�..::. . .Ra. ... . .. .....}..:•.,{:::.}:.;. ......1..'.��.F.>.:<•:?-}i:•}: :.}:`:{try:^:-}}}i}:{.:v:v::::,:v:::.::}::::.::.......:nv:::::::}}:::4.........,n.......:...tY•.vvv:n::v:n vv}.v v:.:v.v ...v::.v::r.{•:::::•::.._..v...n... .. v. -::. .......:..:.:. ..................... ........-.�:.:::,..� O :.:L� a'Ti�H::�990::; .,% •ice COMPLET JOB B NUMBER. SH # 421 TEAR-OFF? MAT TEAR- OFF? PERMIT: YES / NO OVERLAY? NEW ROOF REPAIR ? GENERAL CONTRACTOR: NAME: SAME AS OWNER (OR FIRM TO BE BILLED) ADDRESS: CONTACT PERSON: DAVID SUSSMAN PHONE# FAX# ARCHITECT: NAME: AMBE, LTD ADDRESS: 4445 W 77TH STREET #105 CONTACT PERSON: EDINA, MN 55435 RICK GROBOVSKY PHONE# 932-0962 FAX# 835-2861 CAR 867-8992 HOME 933-6133 OWNER: NAME: TEMPLE ISRAEL ADDRESS: 2324 EMERSON AVE SOUTH CONTACT PERSON: MINNEAPOLIS MN 55405 DAVID SUSSMAN PHONE# (612) 377-8680 FAX# (612) 377-6630 PROJECT: NAME: CAMP TEKO ADDRESS: 645 TONKAWA ROAD PROJECT MANAGER/ LAKE MINNETONKA MN 55343 SUPERINTENDANT: , gfj�T, RS(612) 471-0217 FAX# A DAVID SUSSMAN rCOUNTY: ROOFING WARRANTY: YES / NO CIRCLE ONE: SHINGLE TAMKO CONTRACT PRICE: $34.900.00 CARLISLE GAF- JOB AREA: gs SOS SHINGLE 7.5 SQS BUR GENERAL TIRE" HICKMANI CONTRACT DATE: a-4-94 -FIRESTONE OTHER 1 CIO -7b _ - 611E az, azl c.cs (�-�( - TP - D-�-----p s � D . ______- �2 090 --- -------------- ----- - - - - - --- - - Q 41A' Q 1� om - - _ - - ---