HomeMy WebLinkAbout2014-01313 - roofing CITY OF ORONO * z 0 1 4 — 0 1 3 1 3 *
` 2750 KELLEY PARKWAY �ATE �ssuE�: 11/07/201�
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2615 COUNTRYSIDE DR
PIN : 04-117-23-12-0004
LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN
: LOT 002 BLOCK 003
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING - CEDAR
ACTIVITY : O%S BUILD►NG - UNDEFINF_-,D
VALUATION : $ 13,000.00
NOTE: VALUA'I�ION OF PERMIT: $ 13,000.00
ROOPING PERMITS ISSUED WITHOUT ENOUGFi NOIICE I�OR l�I�:,�R OI�I,INSPI:C"�IONS. (WG REQUIRF:2�3-48NOTICE. PRIOR"I�O
WORK BEING STARTED) MUST PROVIDF.COMPLETE SET OF PIC���I�RI:S OR A FINnL INSPF,CTION MAY NO��BI-: ISSI'ED.
SIGNS-ADVERTISING SIGNS MAY ONLY BG ON"I�HE PROPER"I�Y [�URING�fFll�: IIMG I�HE ROOF IS BF,ING DONI;.
ONCI; WORK IS COMPLETED THE SIGNS MIJST BF. RI:MOVF,f).
APPLICANT PERMIT FEE SCHEDULE 236.00
STATE SURCHARGE (VALUATION) 6.50
SELA ROOFING& REMODELING, INC. TOTAL 242.50
4100 EXCESIOR BLVD Payment(s)
ST. LOUIS PARK, MN 55416-
(952)915-7227 CHECK 35;00 242.50
Minnesota State License#: BUIL-BCI050
OWNER
T(CHY, PAUL& MARY
2615 COUNTRYSIDE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The N�ork for�chich this permit is issued shall be performed according to
the approved plans and specitications.applicable Cit_y approvals,and the
State Buildinc Code. This permit is for only the work described and does
not grant permission for additional or related work��hich requires separatc
permits. All provisions uf laws and ordinances governing this type of work
shall be compied with whether or not specitied herein.l�his permit�+�ill
expire and become null and void if construction aud�orized is i�ot
commenced ti'ithin 1 RO da��s of Ihe date of issuance.or if�construction is
suspended for a period of� 180 da��s at am�time alter work has a�mmenced_
The applicant is responsible for assuring all required inspections are
reques�t d in conformance with the State Building Code.�I�his permit ma� he
revo�¢d��t anv time for due cause. ///„�
' � '�_--- C c�� (.�/ �/ _7 /
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cant Aermitee Signature a e Issued 13��Signatu e Date
. �
City of Orono -�a
Buildin Permit Application for Maintenance / Replacement / Renovation -��j
9
(No structural expansion. Only windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number: �v `�� �
� �Q PO Box 66 �
� Crystal Bay,MN 55323-0066 Date received: �
Received by:
Street Address: _
2750 Kelley Parkway Plan reviewfee�
�r G� Orono, MN 55356 , / � ,
1�kLSH��� Total Fee: ��f� _
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 pri�
��
GENERAL INFORMATION: r� � � /�� G �/
Job Site Address:
Will this be a Parade of Homes, Remodelers Showcase Hom r other Display Home? ❑Yes No
If yes,a special evenf permit is required with Police Deparfinent and Cify Council approva!60 days prior to the event. Shutt/e bus servi will be
required unless applicant demonstrates sufficienf on-site parking is available. Non-permifted events will not be allowed.
CONTRACTOR 1 A�LICANT INFORMATION:
Name: Expiration Date: �j �
State License# Expiration Date: !
Lead Certification Number� {\j�"T'' Z, '�
(for work on homes fhat were constructed prior to 1978 (offiCe) Z,• � � ����
Phone: (cell) ZIP:
c�ty: �- t pK V�
Mailing Address: � �
Contact Person: Applicant is: ontracto / Homeowner (Circle One)
Email andlor Fax: '
PROPERTY OWNER�FORMATI : ��
Name: .� _._._
Phone da �' �
� y�' City: ZIP:
Address: L � �' � �
Email and/or Fax: , h �����I
C�I �� �� , � r ' �� � �
PROJECT INFORMATION: Overall pro'ect description: 1 qny earth movement may also require C�G `
Type of Project: MCWD review&permits: /�
❑Door(s) ❑ Remodel ❑ Fire Damage �
Minnehaha Creek Watershed District(MCW )
❑Re-roof,asphalt ❑ Repair ❑Storm Damage 18202 Minnetonka Blvd
Water Dama e Deephaven,MN 55391
Re-roof,cedar ❑ Restoration ❑ g Phone: 952-471-0590
❑Re-roof,other(specify) ❑Siding ❑Other: (specify) Fax: 952-471-0682
❑Window(s) www minnehahacreek.orq
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. Ptaaseinormation whach gener Ilycannot be gven together the ppblbclobthe subje clof the�dataSuOur purpose and
Confidential da
intended use of this information is to annually u date our records and records of other governmental agencies required by law. I
ou refuse to su pl e�i ation,th " plic 'on a not be issued.
Date:
Applicant's Signature:
Date:
Owner's Signature:
Last Updated:0310612013