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HomeMy WebLinkAbout2010 - 00762 - roofing CITY OF ORONO PERMIT NO.: 2010-00762 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 08/25/2010 (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 805 WILLOW VIEW DR PIN : 28-118-23-44-0002 LEGAL DESC : WILLOW VIEW : LOT 001 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : 0/S BUILDING-UNDEFINED VALUATION : $ 12,000.00 NOTE: TEAR OFF REROOF APPLICANT PERMIT FEE SCHEDULE 221.25 RUSS RIDER HOME IMPROVEMENTS STATE SURCHARGE_(VALUATION) 6.00 790 WENTWORTH AVE S MENDOTA HEIGHTS,MN 55118- TOTAL 227.25 (651)246-7729 _ -PAID WIT}I CC#-- 2622 Minnesota State License#:20288229 OWNER SAMS,DOUGLAS&MARY 805 WILLOW VIEW DR 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 ca se. Applicant Permitee Signature Date Iss,e; :y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Aug 2510 09:1 1a Rider Home Improvement 651-994-8292 p.2 3,uo-25-2010 08:34am From-CITY OF ORONO +9529494616 T-43T P.001/00I F-569 '-•Fry OT Orono Building Permit Application for Internal Wo• rk (windows, doors, siding, re-roof, etc,) Mailing Address: '� PO Box 66 Permit number: b7b/p 4„, - 0 Vi Q Crystal Bay, MN 55323-0066 Date received: • 7/a5p 14. L? =" y. Street Address: Received by: • 2750 Kelley Parkway og� Orono,MN 55356 Plan review .14t4 ;11 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 submitte/d. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: (�O. S CJ 1 /4j <I I,/ Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a special avant permit is required with Polkas Department and City Council approve/60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sutf/Ctent on-site perking is avai/ebte. Non-permitted events.will not be allowed. CONTRACTOR/APP ICANT INF• - Tia • Name: State License# ..� i F�c Phone: Piration Date: Mailing Address: '/ y6 (office) (cell) Contact Person: ___7_0c7 �� -��� !' . v 612 City: > 74- _ 21P: Ernail and/or Fax: •6-51.---;?,9/ _s2- p, D_ Applicant is: Contractor I Homeowner (circle onto PROPERTY OWNER INFORMATION: Name: `fly C7 S S Phone (day): _— Address: ' we �� fJi� 2?/ City: Email and/or Fax Oc U ZIP: PROJECT INFORMATION: Type of Project: Any earth movemerrt may require Q Door(s) ❑ Remodel MC1ND review&permits �]Water Damage ©Window(s) ]Repair Minnehaha Creek Watershed District(MCWD) ❑Storm Damage 18202 Minnetonka Blvd DeeO Siding ❑ Restoration ❑Other (specify) Phone; 952-4aven, 71-0590 i9-roof Fax: 952-47T-0682 t 0 Fire Damage ww••,minnehahacreek_oro Overall Project Description: Estimated Construction Valuation of Project(excluding land) $ � e7.0c, 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 -.•. the informeti.• .e application may riot be issued. Applicant's Signature: Date: _ �_� /0 Last Updated: 052009