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Home My WebLink About2011-00320 - roofing CITY OF ORONO PERMIT NO.: 2011-00320 • 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE ISSUED: OS/10/2011 952 249-4600 FAX: 952 249-4616 , ADDRESS : 767 BOULDER DR PIN : 33-118-23-11-0006 '', LEGAL DESC : STONEBAY : LOT 003 BLOCK 001 ' PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING -ASPHALT ACT[VITY : O/S BUILD[NG -UNDEFINED VALUATION : $ 8,000.00 APPLICANT PERMIT FEE SCHEDULE 162.25 MIDWEST SIDING ROOFING & W[NDOWS STATE SURCHARGE(VALUATION) 4.00 6451 SYCAMORE CT N MAPLE GROVE, MN 55369- TOTAL 166.25 Minnesota State License#: 20010277 OWNER GARDINER, PATRIC[A 767 BOULDER DR LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this pernlit is issued shall be performed accordinc to the approved plans and specifications,applicable City approvals,and thc State Building Code, This permit is for only the work described and docs no[gran[permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied wi[h whether or not specified herein.This pemiit will expire and become null and void if construction authorized is not commcnced within l80 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 arc requested in conformance with the State[3uilding Code.'Chis permit may be revoked a y ti ie � ue cause. - `Zl� � l'� O � � , Applicant Permitee Signature Date Issued By Si ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. � ' City of Orono ' Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: Og,�,�0 PO Box 66 Crystal Bay, MN 55323-0066 Date received: ��' Received b � ��!.i,� s, Street Address: y� �'�c, "r ��ti 2750 Kelley Parkway Plan review fee: L�kESHOg'� 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: -7 -� Job Site Address: /�� l�r-✓�c,��✓��'✓� 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 suKicient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLIC�/°►Nj INFORMATION: N ame: /vl �d�-�S r- /�.�>t��l,`� S/L�, 1,.�,�fo..,� State License# �;;�/ �;�� 7 � Expiration Date: �''� -3(- � Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: �U �-�-(.�7�Y��, (office) 7(0 ;�� - l=��a (cell) Mailing Address: (J °� ��rr,�� , City: 4�i� i��.•� ZIP: � ,��r'� Contact Person: ,,,, � Applicant is: ontrac / Homeowner �c��ie o�e� Email and/or Fax: 7� s . �,� �- p�� PROPERTY OWNER IN ORMATION: - �� 6�/�; Name: r,c, c�' L+.(f Phone (day): Address: _ �� _S�L��_ ��„� City:��j��4'� ZIP: Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits: Minnehaha Creek Watershed District(MCWD) ❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd ❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391 Phone: 952-471-0590 �Re-roof ❑ Fire Damage Fax: 952-471-0682 www.minnehahacreek.orq Overall Project Description: Estimated Construction Valuation of Project(excluding land) $ ��;'J APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all 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 I the information, the a lication ma not be issued. Applicant's Signature: Date: �'—�V� Last Updated: 03-01-2011 DAYE TIME - ✓ '��`�� CALLED IN E��8�� 9��'�t� SCFiEDULED ��,'�'�� —��-- ��6��d��'�Ri�. U/�' '�b �n��-� ��tyG�� '�6�� 6�� . ��°�'�i��T�� ' .� � �: ��S�F�9�`�101� (1 f � � ❑ FOOTING ❑ PLU NG FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREM/ETLANDS � ❑ FRAMING (] MECHANICAL FINAL ❑ TREE REMOVAL � � WSU TION ❑ WOOD BURfJER/FIREPLACE ❑ SITE INSPECTION I a ❑ ON SLAB ❑ WATER HOOK-UP ❑ PROGRESS i ;_,. FINAL ❑ SEWER HOOV<-UP ❑ COMPLAINT � � ❑ D MO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � � ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL ,� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/RE�lIOVAL ; � 6�Rl�/Bi9fE4i/�OPdTRACYOR YO RAE�9 VmflD:_Y�S_�d�D � ��a a"�, *OLD PERMIT — NO FINAL INSPECTION REQUESTEDo � � � ;, .�. � � � � �� ' � � � ' � o;� � � � � ❑WORPC SATISFACTORY:PR�EED FiOJECT COMPLETE � ❑CORRECT UNORK�f'ROCEED SUE CERTIFICATE OF OCCUPANCY � ❑CORRECTl/UOR6C,CALL FOR REIi�SPECTIOIV TEMPORARY � �EFORE CWERING PERMANENT ❑ CORRECTUfdSAFECDPJDtT10MWITHIN HOURS. � pHOTOTAKEtV II�SPECTOR WILL REfURf� ❑CITATIO�f iSSUED ❑STOP ORDER�DSTED.CALL if�SPEC70R ❑ IfVSPECTIOfV REQUIRED.CP�LLTO AR6�ANGE ACCESS. ��os�o��a��o��o��, ( 5�� 249�4600 �e�c��/�me�t4r��a��a�s6�e: a�s��r v� �AlhoBe Copyl9nsp�cYor's F'sle C�raan�CopylSiSe�VoYice ! I