HomeMy WebLinkAbout2014-01011 - roofing ____ CITY OF ORONO * z � 1 4 - 0 1 0 1 1 *
2750 KELLEY PARKWAY DATE ISSUED: 09/09/2014
� ' ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3255 CRYSTAL BAY RD
p�N : 17-117-23-41-0012 / ��
LEGAL DESC : TOWNSITE OF LANGDON PARK � ! � /! � �I���
: LOT 001 BLOCK 002 r'�� `J
PERMIT TYPE : MINOR ALTERATIONS ����
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-OTHER
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 16,782.00
NOTE: RE-ROOF-FLAT
APPLICANT PERMIT FEE SCHEDULE 295.00
STATE SURCHARGE(VALUATION) 8.39
WALKER ROOFING CO., INC. MAIL-IN FEE 2.00
2274 CAPP RD
ST PAUL, MN 55114- TOTAL 305.39
(651)251-0910 Payment(s)
Minnesota State License#: BUIL-4229 CREDIT CARD 4291 305.39
OWNER
WOLFE, MR&MRS WILLIAM
3255 CRYSTAL BAY RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permi[is issued shall be performed according to
the approved plans and specifications,applicable City approvals.and the
State Building 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 governing 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 commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issue y Signature Date
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�;i ty oT Ur ono
2750 Keiley Parkway
Orono MN 55356 �5z-249-4600
R�ceipt No: 3.011732 Sep 9, 2014
Walker Roofing
Frevious Balance: •�»
Permits
P2014-01011 3255 Crystal 295.OU
Bay kd
101-32530
Mechanicnl/Septic,/Other
Permits
P2014-G1011 3255 Crystal 8.39
Bay Rd
101-2U$02
Due to govts-State
Permits
P2014-01011 3255 Crystal 2.00
Bay Rd
101-34440
Bldg Permits-mail in fees
Total: 305.39
Lredit Card
rheck No: 4291 305.39
Payor:
Walker Roofing
Total Applied: 305.39
Change Tendered: •��
09/09/2014 1U:�2AM
City of Orono
'Building Permit Appiication for Maintenance / I�eplacement I l�enovation
(No structura! expansion. Only windows, doors, siding, re-roof, etc.)
���Q Mailing Addr�ss: I PErmit number:
PO Box 66
Crystal 8ay, MN 55323-DD66 � bate received:
� � � � St2et Address: I Received by'
y� ; 2750 Kelley Parkway
�,� �,�' qrono, MN 55356 � Plan review fee:
�'�sxo�`
II Toial 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.
Incomplefie ap�lications will be returned. ( /ease prinf)
GENERAL INFORMATION: �� " �
Job Site Address:
Will this be a Parade o#Homes, emodelers S wcase Home or other Display Home? Yes No
!/yes,a special evenr permit is required with Police Depsrtmenf and Ciry Council approval fi0 days priorto the event. Shuttle�us service wi/l he
requrred unless epplicant demonstrates su�cient on-site parkinc�is avflilab/e, Non-permrtted evenfs wil!nof be allowed,
CONTRACTOR/ P L! T INF MATI�N:
Name: G� �~�-�.1y'1 �
State License# Expiration date: r
Lead Certifcatian Number. � Expiration Date: �
(for work on homes that were cons ru d pri !0 797 i D
1'hone; (celf) �� (office) �1 - ( � 4 �
Mailing Address: � City: ZIP:
Contact Person: Appficant is:• 'Contrac or / hiorrteowner �ci��ie oae)
Email and/or Fax�
PROPERTY OWN R INFORMATION:
Name' �,�, a� � l�-�
Phone(day): '�� 1 � (�
Address� � CA �� City: ZfP: ���'1 �
Email�nd/or Fax:
PRQJECT INFORMATION: Overalf ra ect descri tion,
Type of Project: Any earth movement mdy dlso require
� �oor(s) ❑RemodF� ❑ Fire Damage
MCWD review 8�permits:
Minnehaha CrEok Watershed DistriCt(MCWp)
i ❑Re-roof,asphalt []Repair ❑Storm Damage tig20Z Minnetonka Blvd I
❑Re-roof, cedar ❑ Restoration ❑Water Damage peephaver,, MN 55391
`�Re-roof,o her{spscly) ❑Siding ❑Other�(specify) Phone; 95z-479-0590
� Fax: 952-471-0682
❑Window(5) I wv✓w.minnehahacreek.or
Estimated Construction Valuation of ProJect(excluding land) $
APPLfCANT ACKNOWLEDGEMENT:
I . Agrees to provide all informati�n required or requested by the BuiEding Department; I
� • Certifes Yhat the information supplied ls true and cprreCt to the best Of his/her knowledge. The applicant recognizes that they a�e
solely responsible for submitting a Complete applicaYion being aware that upon faifuro to do so, the staff has no alternative but to
reject i[until it i$Compfete;
. Some or all of the information ihat you are asked to providE on this applicatlon is GI355ified by State law as either privatE or
Conftdential. Pfivate d3t�is information which generally cannot be given to the publie but can be given to the subject of the data.
Confidential data is information which generaily cannot be g�ven to eitfter t11e public or the subject of the daia. Our purpose 2nd
� intended use of this nfor io �s to ally u ate our records and records of other governmental agencies requlred by law. If
ou refuse to su I he f r h a lica n ia not be issued.
Applicant's Signatur Dafe: �- l�
Owner's Signature: Date: � — �'�'
Lasi Jpdated:03l06/2013