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Home My WebLink About2011-00671 - roofing CITY OF ORONO PERMIT NO.: 2011-00671 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 07/18/2011 952 249-4600 FAX: 952 249-4616 ADDRESS 1160 WILLOW DR N PIN 27-118-23-32-0004 LEGAL DESC UNPLATTED 27 118 23 LOT 000 BLOCK 000 PERMIT TYPE MINOR ALTERATIONS PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ROOFING-ASPHALT ACTIVITY O/S BUILDING-UNDEFINED VALUATION $ 9,000.00 NOTE: ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED. SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE. ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED. TEAR OFF REROOF-HOUSE APPLICANT PERMIT FEE SCHEDULE 177.00 EXECUTIVE EXTERIORS&REMODELING STATE SURCHARGE(VALUATION) 4.50 4205 LANCASTER LANE TOTAL 181.50 PLYMOUTH,MN 55447- (763)432-4677 Minnesota State License#:20592356 OWNER HILLSTROM,CLIFFORD 1160 WILLOW DR 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 aatpany time for due cause. /� / 11A I 1 /`601 l l l 1 /Y-/1 Applicant Permiteignature Date Issue6by 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: �\� Cr Box 66 \ Crystal Bay, MN 55323-0066 Date received: ` ' I Street Address: Received by: 2750 Kelley Parkway Plan review fee: L9kES140�`� 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: I 'r Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 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/APPLICANT INFORMATION: , Name: k /n State License# 2x592 3-66 —Expiration Date: 0, Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 '1 Phone: 3;�_ 6"Z` (office) 6Q- �— 4 3 (cell) Mailing Address: Q .60 r'J 2,626 City: ZIP: / Contact Person: r Applicant is: ontractor Homeowner (circle one) Email and/or Fax: Ss PROPERTY OWNER INFORMATION: Name: )s ( Phone (day): 52- L4-73,4- Address: I 10 City: LdoQ Late- ZIP: fj Email and/or Fax PROJECT INFORMATION: 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 ❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391 Phone: 952-471-0590 E] Re-roof ❑ Fire Damage Fax: 952-471-0682 www.minnehahacreek.org Overall Project Description: oee- fe_—Ccpr�]� 'AsphCAff 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 you refuse to supply the information, the application may not be issued. p / Applicant's Signature: l�f Date: 7(O ^l( Last Updated: 03-01-2011