HomeMy WebLinkAbout2010-00907 - roofing .
CITY OF ORONO PERMIT NO.: 2010-00907
' ' 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 09/27/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2515 COUNTRYS[DE DR
PIN : 04-117-23-11-0007
LEGAL DESC : COUNTRYSIDE MANOR
: LOT 003 BLOCK 002
PERM[T TYPE : M[NOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING -CEDAR
ACTIVITY : O/S BUILDING - UNDEF[NED
VALUATION : $ 22,000.00
NOTE: TEAR OFF REROOF-CEDAR SHAKES
APPLICANT PERM[T FEE SCHEDULE 368.75
RALPHS EXTERIORS INC. STATE SURCHARGE(VALUATION) 11.00
17850 GLADIOLA ST.NW TOTAL 379.75
ANDOVER,MN 55304
(763)213-0502
Minnesota State License#: 20319816
OWNER
KAHLER, CHRIS& DELPHINE
2515 COUNTRYSIDE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
'I'he work for which this permit is issucd shall be performcd according to
the approved plans and specifications,applicable City approvals,and the
State F3uilding Code. This permit is for only the work described and does
not grant permission for additional or related work which rcquires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compicd with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 da��s 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 fo un all required jnspections are
requeste ' co formance rth the S te Buildin Code.This pexc�it may be
revo� at a time fo u oau .
�
�
��, , _—� �/o� / /�
` p ic Permitee Si at te Issu y Signature Date
S PARATE PERMITS 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: �j/b-(��'7 ��
g,�,�. PO Box 66
� „ O Crystal Bay, MN 55323-0066 Date received: 9��7��
,a �}���-�:,�. ��� Street Address: Received by:
�',�, � �q;,�„_ ti 2750 Kelley Parkway Plan review fee:
G
'� � `� ��� Orono, MN 55356
`�kEsxo�
Total Fee: �� �'; 7 j
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: � r � \ I1
+., ? � / !S:_.�"� �zG -Y � �" ,
Will this be a Parade of Homes, Remodelers Show ase Home or other Display Home? ❑ Yes � o
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/APP6JCANT INFORMATION:
i �
Name: �-�t� �� r� �;. ,�;�,�� :�i,v%� ,
State License# ,-,7� i',���6� Expiration Date: � s. \ —
Phone: ^ 2% � � office ^ �— ''�;� . _� �, � cell
Mailing Address: • ' ` Cit : �J = I : � + p
Contact Pers � - ,� — Applicant is: Contract6r•, / Homeowner (Circle One)
Email and/ Fax.; � � •
"�-------='
PROPERTY OWNER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
MCWD review 8�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
�e-roof ❑ Fire Dam www.minnehahacreek.orq
Overall Project Description:
Estimated Construction Valuation of Project(excluding land) $ ; �'�
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.
A licant's Si nature: � Date: � �' �
Pp 9 Cd c� � �/_ �
Last Updated: 05-04-2009