HomeMy WebLinkAbout2011-00324 - roofing CITY OF ORONO PERMIT NO.: 2011-00324
� " 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISSUEn: 05/1 U2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 752 BOULDER DR
PIN : 33-118-23-11-0015
LEGAL DESC : STONEBAY
: LOT 012 BLOCK 001
PERMIT TYPE : MINOR ALTERAT[ONS
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : ROOFING -ASPHALT
ACT[VITY : O/S BUILDtNG - UNDEFINED
VALUATION : $ 8,000.00
NOTE: '1�EAR OFF REROOF
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APPLICANT PERMIT FEE SCHEDULE 162.25
MIDWEST ROOFING STATE SURCHARGE(VALUATION) 4.00
6541 SYCAMORE CT N
MAPLE GROVE, MN 55369- TOTAL 166.25
(763)427-9696
Minnesota State License#: 20637010
OWIVER
INDAHL, DENNIS&ELAINE
752 BOULDER DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this pennit 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�rant pennissfon for additional or related work which requires separate
permits. All prov�sions 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 constriiction is
suspended lar a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
reques d in confonnance with the State I3uilding Code.This perinit may be
revo� at a time for d ause.
� � �� � � �
Applicant Permitee Signature Date � Issued 13y nature a e
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
� , zs`f��
� y City of Orono
, 6uilding Permlt Appllcatlon for internal Work
wl�dowa, doors, sidi , re-roof� etc.
���' Permn nurnber o�Ol l-d0 a7
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Sb�et Add�►+rsa: Rsosived by'
� � 2760 Ksley Parl�weY Plen teviaw�ee:
Crono.MN 66956 �
Toml Feo: ��O�O. � �
Mpin: g62.a4g.�6pp Ft�c 952-�816 .a.oron4;mn.us
Thle appYcatlon 1bm�must De compls�ed In fu1 and�tl requtred Infomwtlon must be submitted.
h�cwnpl�applicd�r�ts wlll b�nfum�d. (Ple�es+e pNirt)
GENERAL tNFORrAT10N: `'�
Job Sla Addnss: � � p�L7C'•'��� �i
WIII thls h�a P�rad�af HoitNs,R�mod�s BAowoas�Han�or otlrr Disp�y Honw? Y�s No
Myrr,a�r wwr w�+���rd wv►�o.G.p.ro�,r►K«�d c�aouwwr��p�a►�eo�aas aior�or�..varr. s►w�m.�,s s.rw�or wrr ae
r�p�irr0 t�ts�prO�rY aWno�lf9�IM�rllld�rw ondls pvlmp is avaldere. Non�pMrr�Itlyd�r�MrN nof os s�Mowse.
COM'RAC70R/ INFORMATION:
Name: /t1; (�/d s�- vbF� Sid� d..��0(� 1:n�
Stete Lk�ense# ,Z Q 6V�a 7 7 Expl�ation D�Le: Q3/3/ t� 0��.
Lead Cerblt�tfon Number: E�irbtion Dete:
(fb�wonk on honNr�htt � b 1l70 -
fb
��: 76 3�r� ?- � c�� ?6 - v- l3 � c����
Meiling Addreas: �' C`t' CItY' vG ZIP� 3 (q'
Con�d Persw�: �qyn�/� /t��G►„� APP�ant is: / Hwneowner �crtl.o�.i
��i�a Fax: 763 — ti a�� 4oQ/ .. ._
PROP�nr owN�t i��at�u►�or�• �
Name: _ ��'""fi�l,�- ��7 �� r _
Phone(day): , ��(��
AddtesS: � ,, r� ,�C:� .G�i� Q'r' G1y: �'`�;� '� ZIP: _,._
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PROJECT INFORYATION: ,�.
i Ty�p�(p�p�p� My N1!!1 mv'rMrM11t 1n�y trqWn
i ❑Daor(s) ❑Rsrnodsl D wa�r Damape � � YCwD nv�wr a p�rn�tb:
� MJnnehahe C�Ic W�os�shsd Olstrict(MCWD)
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� ❑3iding ❑R�Y�atlots ❑ORher. (spedfY) i ��,MN 55391
Phon�: 852�T1-0590
! 1('�Re'ro°f ❑FN�p�mep� Fax: 952�71-0882
www_minng[l�acreek.or�
ov�au Pr+oH�t o.ac�ipao�o� .xd �.nd s ��'� � _ _
esw�a com�eion P�l �+o ) _ _ .._ ..._._--
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APPLICANT ACKNOWL.EDOEMENT: ._ ,
i ,qgross Uo Drc'vlds aN k�tlon recNk�d or r�qu�bd b�the Buildlnp�eP�M:
' Certifles tnat fhs inlOm�llon�uDi��trus an0 oonacx oo tlw D�st of Rii/her I�vwle0(ie. The applk'.oM recopnixes tl'tet they '
i ��y���p e cd++Dls'1e applfcsrion bsinp awore�et uPon fauure to do so, ths s�A hoa no altemadve �
� but to reJec!ft urNN It!s oo+r�pl�6e;
i Sorrw or aR d the Inlbm�llon fAst you �wlcsed to pra�ids on d� appdcetlon 1s�ed Dy Staoe lew es ellt�er pmra�e or ;
( oor►ilder�tl�l. PrivsOe d� la kKom�sllon wFilrh potyerslly c�nnot be given �o the pu0lic but can be glven m tl�e subjea oi the :
� data. CoMbdeMld d� Is kdbmWlO� wtikti pYnere�y Camot bs plVen �o eill�er t� publlc vr the wb�eat ot the deie_ Our
I purpose and MOsnded ua d it�s ir�fametfon 1� �o snrutdly upde0a our �ecord� and reoorba cf other gwemmentel sgencies ;
� revulrod bY IAw IE vw ti0 K�[�oh N1A�orrnbl01�L1M soDhoalia�mev nOt b�lasued- ,_..
�aa�re s��re: �: �%.5;�«."l� .
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