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Home My WebLink About2009 - 00533 - roofing CITY OF ORONO PERMIT NO.: 2009-00533 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 08/26/2009 (952)249-4600 FAX: (952) 249-4616 ADDRESS : 1110 WILLOW DR S PIN : 10-117-23-24-0011 LEGAL DESC : UNPLATTED 10 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : 0/S BUILDING-UNDEFINED VALUATION : $ 700.00 NOTE: TEAR OFF/REROOF APPLICANT PERMIT FEE SCHEDULE 31.50 GLASER,ROBB STATE SURCHARGE(VALUATION) 0.50 1110 WILLOW DRS WAYZATA,MN 55391 MISC FEE 0.00 TOTAL 32.00 OWNER GLASER, ROBB 1110 WILLOW DR S 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 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 •ponsible for assuring all required inspections are requested in co . ance with the State Building Code.This permit may be revoked at any 'e for due cause. / / — 411P /11.1�1 / � a Applicant Permitee Signature Date I .es By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. I i . City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: ��1`�_ i 53- g,0 \ PO Box 66 / i"v • O\, Crystal Bay, MN 55323-0066 Date received: 0 /(1 I �$` `; -r 1' Street Address: Received by: (M/Lii------ ��, ll. ,� �'� 0�4� 2750 Kelley Parkway Plan review fee: �� / Orono, MN 55356 kESFI04 Total Fee: 5,7. 6-0 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: W//O ()),Y/c71u 7() 5 ._ o ve„i( . - 5-- c?/ Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? n Yes X 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 ill bbbbbe required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: 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: 2ULb ( "a Phone (day): - - dip. / Address: /?-61 e- -V/r ',,i. 1 4i' City:/lLk 10/cei r ZIP: .51 . Email and/or Fax en _�(0 -Li-79- ::-//,(:). PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review& permits ❑ Door(s) ❑ Remodel ❑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 E Fire Damage www.minnehahacreek.orq Overall Project Description: c- _— Y'pQ , .4 � qlr Estimated Construction Valuation of Project (excluding land) $ 3� — / 1 APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Building Department; I • 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 thi in ormation is to annually update our records and records of other governmental agencies required by law. If you refuse t. sup'ily the information,the application may not be issued. Applicant's Signature: Date: -' )Z'' / Last Updated: 05-04-2009