HomeMy WebLinkAbout2015-00444 - roofing CITY OF ORONO * Z 0 1 5 - 0 0 4 4 4 *
i 2750 KELLEY PARKWAY DATE ISSUED: 04/29/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2389 BLAINE AVE
PIN : 17-117-23-34-0012
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 005 BLOCK 009
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : COMMERCIAL-BUSINESS
CONSTRUCTION TYPE : ROOFING-OTHER
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 56,000.00
NOTE: EPDM(RUBBER ROOF REPLACEMENT)
APPLICANT PERMIT FEE SCHEDULE 763.12
STATE SURCHARGE(VALUATION) 28.00
MINT ROOFING TOTAL 791.12
2285 DANIELS STREET Payment(s)
LONG LAKE,MN 55356- CHECK 66232 791.12
(952)473-8080
OWNER
Harding&Harding, LTD
2391 BLAINE AVE
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 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 cau e.
/ �� � : ,Z i /.�
'can ermit ignature e Issued y Signature Date
. 0�/16/2015 16:36 9524738080 DALBEC ROOFING � PAGE 62/02
City of �rono �� D C�Cp �i,3 �
Building Permit Applicatior� for Maintenance / Replacement / Remodel
(I.e. wFndows, daors, siding, re-�oaf, etc. — NO STRUCTURAL EXPANSiON)
Mailing Address_ �'� �_
��� Po Bux 69 Permit number. (�/ ��� l �-J�
� Crystal Bay,MN 55323-0466 Dete recefved� �� � — I`�_=;
a
St�et Address: RPr.PI�PcJ hy� ?
�^�, � 2750 Kelley ParkwBy Plan review fee: - �
t,�k�sWQ��,� Orono,MN 55356 � � s �
�� Yota� Fee: �`"l `�j , / �,-. ,�'�
Main: 952-249-4$00 Fax; 852-249-4616 wv�w.ci,orono.mn.us ��
This application form must be completed in full and all required information musf be submitted. �
Incomplete appll�at�vns wnl be returned. (Please print) t 'n�`-' �
G�NERA�, INFORMATION: I�M ,
�ob site Address:
Will thls be a Paratie of Homes, Remodelers Showcase Home or other Display Hame? Yes No
ff yes,a speclal event p�mtit is requbed wlth Pol'roe pep�rfinerrf and City Council approva!60 days p»pr to the event. Shuttle bus ice will ba
requfred�nless appGcant demonstrates sufficient on�srte parkrng is aVBilable. Non-permined�vents will nOt be 9110wed.
CON�'RACTOR/APPLICANT INFORMATION:
Name: M�NT ��FItJ �� IN�,
5rate L�cense t� ���A��j��i Expiration Date: �30
Lead Certification Number: N�,� Expiration Date: N�A
(f»�work on hom�s u►at xroro constructed prior M 7978
Pr,one: (ce�q - - (office) q5a�
Mailing Address: r"j City_ ZIP;
Contact�erson: Applicant i Contractor / Homeowner (ClrclaOne)
Emaii and/or Fax: � r �
PROPERTY OWN�R�NFORMATION:
Name: ��LS'[�I N��� --
Phone(da}/�: q�a-4-Y1- �153 ,.,
Address; ���l BLA 1 N� Av� City: �� ziP: 5539 I
Finail and/or Fax:
�iF�l"1G�vc ��STfN(� F N � �Of� k-
PROJE,C7 INFORMA7iON: Overall pro'ect descri tion: T T f-O �5� 20� �Z rU�-�Y /�'DKC�C�
rype of Project: Any earth movement may also require rrnc�i
❑Doar(s) ❑ Remodel ❑Flre Damage M�WD revlew&permlts:
�-�� ���
❑Re-ro0f,aspnarc �Repair U StDm1 DamBge Minneheha Creek Watershed Dis4rict(MCWp}
18202 Minnetonka Btvd
� Re-roof,cedar ❑Restaration ❑Waler Damage Deephaven,MN 55391
'�Rc-iovf, ot e�(speclf� ❑Sltling �Vthe�: (speClly) Phone� 652�171-0590
Fax: 952-471-OQ82
�-'�' ❑window(s) �C��
wnvw.minnehah�Cr�ek.or4
�st�mated Constr ct n Varuation oi Projeci(excluding lanq) $ b
APPLIGAN7 ACKNOWLEDGEMENT:
• Agrees to provide all information requlred or requested by the Building Department;
! • Certlfles that the intnrmation supplled fs true and correct to the best of his/her know�edge. The applicant recognizes that they are
soteiy responsiUle for submiiting a complete appncatlon peing aware that upon tailure to tlo so,the staff nas no altemative but to
reject li until it is compl�te;
• SnmP �r All nf 1he infoRnaGon that you are asked to provide on tnis applicatlon Is claseifiad by Sta4a law as 0ithar privaie or
confidential. Private data is information which generally canttot be given tp the publiC but can be given to the subject of the data.
Confidential data is Informetion wnicn generally cannot be given to either the publlc or the subject of tne data. 4ur purpose and
If1t2�1Cjed USe OS YI113 I�OfTT12tlOf1!R}C1 aT71�IlAlIY 1141fJAiP.Alll'fPfftiric Ar1f1 YP.r_nrri¢nf nThRr r�nvprnmantal 2�anrlp�requ�rpd hy I&w. IS
du refuse to su I the information,t not be issued.
Applicant's Signature: - Date:
Owner's Signature: bate: _ _
I ast Il��lalpd�.IanuAry 2015
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