HomeMy WebLinkAbout2011-00326 - roofing ,� CITY OF ORONO PERMIT NO.: 2011-00326
2750 KELLEY PARKWAY
, ORONO, MN 55356- nATE lssuEn: OS/1U2011
i
, (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 781 BOULDER DR
PIN . 33-118-23-11-0008
LEGAL DESC : STONEBAY
: LOT 005 BLOCK 001
PERMIT TYPE : M[NOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING -ASPHALT
ACTIVITY : O/S BUILDING -UNDEFINED
VALUATION : $ 8,000.00
NOTI?: TGAR OFF REROOI'
I
APPLICAI�IT
PERMIT FEE SCHEDULE 162.2�
MIDWEST ROOFING STATE SURCHARGE(VALUATION) 4.00
� 6541 SYCAMORE CT N
MAPLE GROVE, MN 55369- TOTAL 16625
� (763)427-9696
Minnesota State License#: 20637010
OWNER
KAYSER, MICHEAL& PATRICIA
781 BOULDER DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for���hich this permit is issucd shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State[3uilding 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 period of 180 days at any time after work has conunenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked t y time e cause.
� �� 1� � ll �� � �
Ap icant Permitee Signature Date Issue By Signature Date �
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Caty of Orono
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, Building Permit Applicatlon for Internal Work
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This applkarion form must bs canprb�d in fu1 and ad required Irrtiormatbn must be submltted.
h+oo+n �PP�ioaetlons will b�ntu . (PAsese print)
GENERAL.INFORYATiON: � �? ., �
Job sla Addnss: � �;�CJ IG���. "
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CONTRACTOR I INFORIIATION:
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StaUe Lbense# QOII O 7 7 Expiratbn DeLe: Q3/ � b'i ��a.
Le�d Certl�atlan Number Expiraticn Date:
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�un9�wdress: S cY- ccityy: v� ziP: 6 q
Conted Peraon: ti �,� AAPlic�rn is: ! Homeawne� �c�.a.i_.�
Ernal�ancilor Fax: '�63 - Y �7- Qao/
PRQPERTY OWNER�y� //
Name: �''�� �- '��� . �`\'Cp/� S�'/'.
Phone(day): . � __......._ .-
Address: � ��� j i G� _{T" �i';(/� City:�G-C��,`���IP: __..
Email and/or F�x
PRO.lECT INFORMA710N:
Tpp�of ProJrcl: f M�r�tA n�own�nt m�y r�quln ��
MCWD ewrNw i p�mdb:
Q°o�c6) ��""'0d°� �W�°arna�° I NWmet�ahp Cro�k W�Eerst�ed Dtstrict(MCWD)
� ❑Window(e) ❑RepN� ❑8'eoRn Darrwge i 18202 A�u1�tDnka 61vd �
! p sld�ng ❑R�Lor.tion ❑od�:lspeolfy) i pn�one� 9�8��2�i�-0 o,
' (y'�Re-roof ❑Fhe DBmpe � Fex: 952-471-0682
, www.rrun ehahaCreek.orc�
Ov�rall Pr+oj�at D�rlptlon:
EstlR�sd C.orubn�tlon V�atlo�of ProJ�(�xcludl b�nd) s < <��;�',�% _ ^ .
APPUCANT ACKNOWIlD�3EMENT: ^
�- Aprsso m pia+rlcM�A frAortrn�tbn repultrd or reqwso�d by tl�e Bulidin�DepeM�ent;
� C6rtffiBs V1�t Ihe�fNOm�flort�t�pp�e�d i�frW and CortYCt LD the beSt o�hIBlllsf Iu10�wlsdpe. Tt1e �DPIIcaM reCOpnizes V181 they �
i ��Y�����°�P��PD����ew�r�Ihat upon feilun m eo ao,tns�a1T has no a�temeuve ;
� but o�r+eJact R ur�lA ft is oonpl�e;
j SoRw or a0 of� �omatlon d�et you aro asiostl L�povlde on tfda applicatbn la dnsilfed bY Sta�e Isw as eftnar p�vete or ;
� oonlidentlel. Priw�d9�e !t tf�ortn�tlon rKiiCh QeneraMy cennot be yiven �o the publk but can be qiven tc the subjed of the
� ddta. ConAdMltlal d�e b �ortnabon MA11Cl1 �raMy C81rqt be piV�9n OD ONI� fflv p��liC or the silbalCt of trte deta. Our ;
' purpoee and Inb�ded uM ot Ihh Inlom�ttion b b snnuaYyl updaUs our r000rds 8nd ncords of otfwr govsmmental egancles ;
� reaWred by law tf w�e�iae to auoohr!hs h�ort�lion ttw wdlostion mey not be�uod
APPllcant'a Sipnature: Uete: ;' �C�� ��
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