HomeMy WebLinkAbout2011-00294 - roofing * . s
CITY OF ORONO PERMIT NO.: 2011-00294
. 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �SSUEn: OS/04/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 753 BOULDER DR
PIN : 33-118-23-11-0074
LEGAL DESC : STONEBAY THIRD ADDITION
: LOT 002 BLOCK 002
PERMIT TYPE : M1NOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING -ASPHALT
ACTIVITY : O/S BUILDING- UNDEF[NED
VALUATION : $ 6,000.00
NO"fE: 1'EAR OP�RGROOF
APPLICANT PERMIT FEE SCHEDULE 132J5
MIDWEST ROOFING STATE SURCHARGE(VALUATION) 3.00
6541 SYCAMORE CT N
MAPLE GROVE, MN 55369- TOTAL 135.75
(763)427-9696
Minnesota State License#: 20637010
OWNER
O.T. Development, LLC
LLC, O.T. DEVELOPMENT,
2670 KELLEY PKWY
ORONO, MN 55356-
AGREEMENT AND SWORN STATEMENT
The wark Cor which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
Statc Building Code. This permit is for only the H�ork described and docs
not grant permission for additional or related work which requires separate
� permits. All provisions of la���s and ordinances governing lhis 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[3uilding Code.This permit may be
rcvoked at any time for ue cause.
� �� � �/� / / !
Applicant Permitee Signature Date Iss By Signature Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
, .
• City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number: l l- (�U a�/
O.��,�0 PO Box 66
Crystal Bay,MN 55323-0066 Date received: J�"l'� /
� � Street Address: Received by:
2750 Kelley ParkwaY Plan review fee:
�� Orono,MN 55356
Total Fee: �3 j ,�
Main: 952-249-4600 Fax: 952-249-d616 www.ci.orono.mn.us
This applicatlon form must be completed in full and all required information must be submitted.
Incomplete applications wfll be retumed. (Please print)
GENERAL INFORMATION: � �
Job Ske IWdross: ��„�� ;�JC�L'�t'��!� ��`
WIII this be a Parads of Homes, Remodelers Showcass Home or other Display Home? Yes No
H yss,a speda/e►rerN pemiit!s required wlth Pdke Depertment and C1ty Coundl epprova/60 days prior to the event Shud/e bus service will be
requlred uNess a�pplkant dertansbstes s�dBdent on�clte peAcing!s ave11a61e. Non-pennitted events wYl not be a0owed.
CONTRACTOR/APPUCANT INFORMATION:
Name: /�1��(✓l5�'- �oOF� ��i l�✓�'�IdO(� Li►�
State License# ;Z p p/p a 7 7 Expiration Date: �3/3/ � p�a
Lead Certfication Number: Expiration Date:
(for wnrk on homss that wsro construc�prlor to 1978
Phone: 7f�3—�/a� 7'9('9�v (office) 76 3 o�gO— /.3� � (celp
Mailing Address: $'/ �-,,pr� f* City: Qp�e �� ZIP: s3 (q
Contact Person: /�pnn.f� �fiS6•� Applicant is: n or / Homeowner �c�.o�.�
Email and/or Fax: ')63 — y �7� jp0�
PROPERTY OWNER INFORMATION:
Name:
Phone(day):
Address: -7 S_� ��K,,t e�� :����/� City:��L�k� ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movemsnt may require
❑Door(s) ❑Remodel ❑Water Damage MCWD roview 3 psrmits:
Minnehaha Creek Watershed DisVict(MCWD)
❑Window(s) ❑Repair ❑Storm Damage 18202 Minnetonka Blvd
❑Siding ❑Restoratio� ❑pther:(spec;ify) Deephaven,MN 55391
Phone: 952-471-0590
�Re-roof ❑Fire Damage Fax: 952-471-0682
www.minnehahacreek.orQ
Overall Project Description:
Estimated Conatruction Valuatbn of Project(excluding land) S `c�
APPLICANT ACKNOWLEDGEMENT:
Agrees to provide all infom�ation required or requested by the Building Department;
Certifies that the infortnation supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they
are solely respo�sible for submitting a complete application being aware that upon failure to do so, the staff has no altemative
but to reject it uMil it is complete;
� Some or all of the information that you are asked W provide on this application is dassified by State law as either private or
confidential. Private data is infom�ation which generally cannot be given to the public but can be given to the subject of the
data. Confldentlal data is infoRnatbn which generally cannot be given to either the public or the subject of the data. Our
purpose and intended use of this infortnation is to annually update our records and records of other govemmental agencies
uired b law. If u refuse to su rtnation the a icabon ma not be issued.
ApplicanYs Signature: l/� Date: s � �='�I
Last Updated: 03-01-2011