HomeMy WebLinkAbout2014-00663 roofing-expired • CITY OF ORONO * 2 0 1 4 — 0 0 6 6 3 *
2750 KELLEY PARKWAY DATE ISSUED: 06/30/2014
" ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1920 COUNTRY CLUB RD �
PIN : 27-118-23-42-0017 r �'�� � �� �
LEGAL DESC : L,ONG LAKE COUNTRY CLUB ADDN ��(
: LOT 005 BLOCK 002
PERMIT TYPE : MINOR ALTERAT[ONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOfY TYPF, : ROOFING - RUBBER
ACTIVITY : O/S BUILDING - UNDEFINED
VALUATION : $ I,500.00
NO"I�E: VALUA"I�ION OP PF.RMIT:$1500.00
ROOFING Pt:RMI�I'S ISSUF,D WITHOUT ENOUGH NO"I'10E FOR"1'{�:AR OPP INSPEC"CIONS. (WE RF,QUIRF,2d-48 NO"i'ICE, PR[OR TO
WORK [3EING STARTED) MUST PKOVIDE COMPLETG SET OI' PICTURGS OR A PtNAI,INSPECTION MAY NOT BI� [SSUED.
SIUNS-ADVF,R"I�ISINU SIGNS MAY ONI.Y E31;ON"CIIE PROPGR'I'Y DUR[NG T}[G TIMG"CHF? ROOF IS I3EING DONi;.
ONCE WORK IS COMPLETFD TFIP,SIGNS MUST BI?R}�;MOVF.D.
APPLICANT PERMIT FEE SCHEDULF 57.50
STATE SURCHARGE (VALUATION) 0.75
KUHL'S CONTRACTING MISC FEE 0.00
1515 S STH STREET
HOPKINS, MN 55343- TOTAL 58.25
(952)935-9469 Payment(s)
Minnesota State License#: BUIL-BC195769 CREDIT CARD 2216 58.25
OWNER
CARLSTEN, KEITH & DEBORAH
1920 COUNTRY CLUB RD
LONG LAKG, MN 55356-
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 Building Code. "I'his permit is tbr only the work described and docs
no[grant permission for additional or related worl:�chich requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied wi[h whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced�vithin 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after w�ork has conunenced.
�he applicant is responsible 1�or assuring all required inspections are
requested in conformanec���ith thc State Quilding Code.This permit may bc
revoked at any time r due cause.
Y� ,� r l.l��j��l�-1 � �
Applic� t Permitee Signature Date Issued [3y S� ature -Datc
, City of Orono ��� �
B�.:ilding Permit Application for Maintenance / Replacement / Renovation
� (No structural expansion. Only windows, doors, siding, re-roof, etc.)
�O�O Mailing Address: Permit number:
PO Box 66
Crystal Bay, MN 55323-0066 Date received:
Street Address: Received by:
�� � 2750 Kelley Parkway Plan review fee:
L Orono, MN 55356
`qkFSH��� 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 INFORMATIO •
Job Site Address: ��Z,� � � L�,rJ- �`
Will this be a Parade of Homes, Remodelers Sh case Home or other Display Home? ❑ Yes No
!f yes, a special event permit is required with Polrce Department and City Council approval 60 days pnor 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: �til,i� t S t�N �..�3�-� �N t� ►N L •
State License# ��,� (�� ��,� Expiration Date:
Lead Certification Number: Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: (cell) (office) ��5•�� �3 E; .�l�,�,�
Mailing Address: � - j s� 5 t-� F�� S City: � ° N ZIP: SS3�i �
Contact Person: ����� ��-��p�, Applicant is: ont actor / Homeowner (Circle One)
Email and/or Fax: p�E;�:1� d7 �u,H t�ti S� �-.�N�L'�i�iXJ , [,J�✓1
PROPERTY OWNER INFORMATION:
Name: �t=;i t�1-) G'A f�.�' tJ
�_.�.
Phone (day):
Address: i"I"Lll � U WN E�i/I GI,tA.� 14�t0 City:l:o�� �� ZIP: S'S�3S�
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review 8�permits:
❑ Re-roof, asphalt ❑ Repair ❑ Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 Minnetonka Blvd
❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391
`�Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Phone: 952-471-0590
i Fax: 952-471-0682
��/�Q,$� t l-�l ❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project (excluding land) $ � �C � `'
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 informa'on i to annually update our records and records of other governmental agencies required by law. If
ou refuse to su I the in t' n,the a li ation ma not be issued.
ApplicanYs Signature: Date: � �%�,� (L1
Owner's Signature: Date:
Last Updated: 03/06/2013