HomeMy WebLinkAbout2010-00559 - roofing / � CITY OF ORONO PERMIT NO.: 2010-00559
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �ssuED: 07/07/2010
952 249-4600 FAX: 952 249-4616
ADDR�SS : 1905 CONCORDIA ST
PIN : 18-117-23-14-0015
LEGAL DESC : FAGERNESS
: LOT 014 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTNITY : O/S BUILDING- UNDEFINED
VALUATION : $ 8,000.00
APPLICANT
PERMIT FEE SCHEDULE 162.25
NEWLIFE CONTRACTING INC. STATE SURCHARGE(VALUATION) 5.00
2478 HILLWOOD DR E
MAPLEWOOD,MN 55119- MISC FEE 0.00
Minnesota State License#: 20249486 TOTAL 167.25
OWNER _
BRIGGS,GARY& MARTHA
1905 CONCORDIA ST
WAYZATA, MN 55391- ,
AGREEMENT AND SWORN STATEMENT
Thc work for which this permit is issued 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 foradditional 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 becomc null and void if construction authorized is not
commenced within 180 days of[he date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced
The applicant is responsi le for assuring all required inspections are
requested in conforman with,�he State Building Code.This permit may be �� � �
�-.
evoked at an�me for e c yase. __
/ � , �
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AppYcant Permitee Signature Date Issued By i nature a e
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV
� •
City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address:
Permit number:
��v 0,� PO Box 66
//Q , Q ' Crystal Bay, MN 55323-0066 Date received:
��.
�� �'��'" Received by:
�.� � �,� ��'�:� �, Street Address:
�'�,n �� °�� �ti`�' 2750 Kelley Parkway Plan review fee:
\r9kES80�`'�� Orono, MN 55356
�� _i
---- 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:
Job Site Address: �
��70.� �'�✓��c��--ci�� -`_�,
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 sufficient on-site parking is available. Non-permitted events will not be allowed_
CONTRACTOR/APPLICANT INFORMATION:
Name: _�_, �J�.z::j 1���C� l r,�1-4-r't�_c t—`�rz Ca
State License# �Z,y r��p = Expiration Date: _3/31 � �Z
Phone: ��l_��y_�`�y2 (office) (cell)
Mailing Address: g` _ C2Clc:�.,� � '�( ry Cit : � ZIP:
Contact Person: m�,� q��.�- Applicant is: Contractor / omeowner (Circle One)
Email and/or Fax:
PROPERTY OWNER INFORMATION:
Name: ' -;� �G( � c�
Phone (day): (�fz-,s��(� _?�
Address: fG/p� [_�;;-���,•c,(;� S�_ City:�rc;n� ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review&permits
❑ Door(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
�Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
Re-roof ❑ Fire Damage www.minnehahacreek.orq
Overall Project Description:
Estimated Construction Valuation of Project(excluding land) $ ��(`'X`� —
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: 7��--�f b
Last Updated: 05-04-2009 \