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Home My WebLink About2009-00264 - roofing � • CITY OF ORONO PERMIT NO.: 2009-00264 2750 KELLEY PARKWAY ORONO, MN 55356- DATE IssuEn: 05/28/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 420 BIG ISLAND PIN : 23-117-23-32-0063 LEGAL DESC : SCRIVER SUB LOT E MORSE ISLAND : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-��R.� VALUATION : $ 1,000.00 `='�jS �iir��{ � �� APPLICANT PERMIT FEE SCHEDULE 41.25 O'CONNOR, GREGORY STATE SURCHARGE(VALUATION) 0.50 1551 LIVINGSTON AVE-SUITE#1 MN 55118- MISC FEE 0.00 TOTAL 41.75 PA1D WITH CC# 1638 � OWNER O'CONNOR, GREGORY 1551 LNINGSTON AVE-SUITE#1 , MN 55118- 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 goveming 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 pe�iod of 180 days at any time after work has commenced. The applicant is sponsible for assuring al -r quired inspections are reques[ed i co ormance wit te ding Code.This permit may be revoked a1'any time for du c e. � �/ G� / � � ��n_ / / AppPicant Pe ite ature Date Issued By i nature D e SEPARATE PERMITS REQUIRED FOR WORK OTHE HAN DESCR[BED AB E. � . ' City of Orono � Building Permit Application for Internal Work .� (windows, doors, siding, re-roof, etc.) ' Mailing Address: / �,i,�,� PO Box 66 Permit number: , 0 ,, � Crystal Bay, MN 55323-0066 Date received: � ��'� � 1�� Received by: ��, �,� Street Address: �'� �� "� �ti�� 2750 Kelley Parkway Plan review fee: � �`�.gEs�o�`'� Orono, MN 55356 Total Fee: 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: '�J�� ,�±/� .��L�h/� 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 INFORMAT N: _ Name: (/�c�I��' ��(�!/j✓�� 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: �_,��G c�,2,� � ��p,n/�,/f�� Phone (daY)� �.�/-'S��7 �- yD� � Address: jS�Y9 Lrifrnl�:.��nJ FfYc �/D� CitY:' �<�( �4i�u,L ZIP: �.�/<<,� € Email and/or Fax �� T: Cp,y� 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 ❑ Fire Dama e www.minnehahacreek.orq Overall Project Description: - �,� Estimated Construction Valuation of Proje (excludin land) $ �} (� APPLICANT ACKNOWLEDGEMENT: • Agrees to provide alt 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 re uired b law. If ou refuse to su the informatio the a lication ma not be issued. � � Applicant's Signature: Date: � � Q Las?Uodate�: 05-04-2009