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Home My WebLink About2011-00488 - roofing � "' CITY OF ORONO PERM[T NO.: 2oli-oo4ss 2750 KELLEY PARKWAY � ORONO, MN 55356- DATE [ssuEn: 06/22/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4250 FOREST LAKE DR PIN : 07-117-23-12-0022 LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN : LOT 000 BLOCK 002 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDINC -LINDEFINED VALUATION : $ 9,700.00 NOTE: 1'EAK OFF REROOF-ASPHALT APPLICANT PERMIT FEE SCHEDULE 191.75 GIERTSEN COMPANY STATE SURCHARGE(VALUATION) 4.85 8385 IOTH AVE N GOLDEN VALLEY, MN 55427- TOTAL 196.60 (763)546-1300 Minnesota State License#: 1796 OWNER ETAL, ROBERT DONGOSKE 4250 FOREST LAKE DR MOUND, MN 55364 AGREEMENT AND SWORN STATEMENT The work for which this permit fs 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 compicd with whether or not specified herein.This permit will expire and become null and void if c tru tion authorized is not commenced within 180 days of t date of ssuance,or if construction is suspended for a period of 180 ys at any ime after work has commenced. The applicant is responsible for ssuring II required inspections are requcste in c ' form c �with e State uilding Code.This permit may be revqKed at an time o d e c se. , � . � � � l l � �,l{.� �i ��-�� Applicant Permitee Signature Date Issue y Signature Date SEPARATE PERM[TS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. J��n, 17, 2011 11 ; 48AM Giertse� Company No. 1611 P, 1 . � � ��,� City of Orono � �_ � 5 Build�ng Permit Applica �ion #or lnternal Work � �� (windows, doors, siding, re-roof, etc.) Mailing Address: Permlt num6er: 011—v� 0 O�Q,�.O PO Box66 Crystal Bay,MN 55323-0066 Date reoelved: � Street Address: Reoeived by: z750 Kelley Parlcway Plan reviewf�e: ��qk,�� o$�� Orono.MN 55356 ,l. Total Fee: I � � , �U Maln: 852-249�600 Fax: 852-249-4616 www,ci,QrQno.mn.us 7his application form must be completed in full and all required informatlon must be submitted. Incomplet�applications will be returned, (Please print) G�NEI2AL INFORMATION' ,. , Job 8iFe Address: � � �- �� b� Will this be a Parade of H�mes,Remodelers Showcase Home or other Display Home? Yes ' No lf yes,a speciel eVenF permlf Is required with Police DepartmenC end City Coundl appmval 60 days prior to the event, ShuPf►e Dus servlce will be requl�ed unless appllcant demonst�tes auf/icrent on-sire perking Is avallable. Non•permitted events Will not 0e alfoWed. CONTRACTOR/APP�ICANT INFORMATION: N�me� , State Llcense# �xpiratlon Date: '3 iv Lead Certification Number: i � Expiration Date: (for work on homes that were constru fed prlvr to 1978 Cell Phone: - 6-�1� � (o��e) �b -2 —Dk�► �,t ( ) Malling Address: e. Clty; ' zlp: Contact Person: Applicant is: ont actor Ho OWflef (Circle One) Email and/or�ax; ��`=��A -fl�j j,� PROPERTY OWNE f FORMATION• Name: �I 5 Phone(day): � � Address: Y� City: ZIP: Email and/or Fax PROJECT INFORMATION: Type of ProJect: Any esrth movement may requlre MCWD review 8 permlts: ❑Door(s) ❑Remodel ❑watar Damage Minnehaha Greek Watershed Dlstrlct(MCWD) ❑Wlndow(s) ❑ Repair ❑Storm pamaga iB202 Minnetonke Blvd beaphaven,MN 55391 ❑Siding ❑Resloraiion ❑Olher:(specify) Phone; 952�71-0590 .�,�-rooF ❑ Fire Damage Fax: 952-471-0682 n wv�w rpinnehahacreek.om Overall Praject Deacriptlon: Estimated Conatructlon Valuation of Project(excluding land) $ '� 0 � APPLICANT ACKNOWLEDGEMENT: . Agrees to provide all inFormation requlred or requested by the Building Depariment; • Certifies lhat the information supplied is true and correct io the best oF his/her knowledge. The applicant recognizes lhet they are solely responsible for submilling a complele applica�lon being aware lhat upon faflure to do ao,ihe slaff haa no alternaliva but to reject it unlil it is complete; • Some or all of lhe inFormation that you are asked to provide on this appllcalion ie classified by Stale law as eilher prlvste or confidential. Prlvate data is information which generally cannot be given to the public but can be given to the subject oF tha data. Confidentiai data is informatlon which' ly cannot be given to elther lhe public or lhe subjecl of lhe da1a. Our purpose and fntended use of this informatio is i a ually updale ouP records and records of other governmental agencies re uired b law, If o�ref to s I th i o m ion, he a lioation ma not be issued. Applicant's Signatute: Date: � Last Updaled� 03-01-2411 / _DF�j TIME � CITY OF ORONO CALLED IN �� L INSPECTION NOTI E SCHEDULED —' — --l%7� PERMIT NO.aO — D COMPLETED ADDRESS �a�� yL- � OWNER TELEPHONE NO. CONTRACTOR ��5�-� >: DESCRIPTION �� '�� ll� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS ti O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C o � C'� t21��,�`� c:..'' ( � � ��' a � , i -� � .� �. f��_- �l -+��_ 0 � w � Q � z W � W � � � W,.ie1`u+tORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor o site: Inspector. .�- � 1 J� White Copyllnspector's File Canary CopylSite Notice ATE TIME �/ CITY OF ORONO CALLED IN � INSPECTION NOTICE ��,-s CHEDULED PERMIT N0. c�l�l�� 25 cOMPLETE ADDRESS `f �� —e - OWNER TELEPHONE NO/d�%-�./��-D7"y� CONTRACTOR �/ s >; DESCRIPTION �v � � ❑ FOOTING ❑ PLU BING FINAL ❑ EXCAV/GRADING/FILIING Q ❑ POURED WALL ❑ MECHANICAL RI � LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o —� L jL �cj'�T ��l�� S 6t ��•d S � . ; � l�fc� S � �ic� �'-c�tA.� L� o � � / W � Q � �l � f�� /�5 '��3�� W � W � � d W �❑, WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE � ►�CORRECT WORK&PROCEED _^, ISSUE CERTIFICATE OF OCCUPANCY W O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. G PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Cail tor the next inspection 24 hours in advance. (952� 249-46�� OwnerlContractor on site: Inspector. ��( �/ o� � White Copyllnspector's File Canary CopylSite Notice