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Home My WebLink About2009-00433 - repair exisiting chimney , , CITY OF ORONO PERMIT NO.: 2009-00433 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUE�: 07/28/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 560 DEBORAH DR PIN : 31-118-23-23-0005 LEGAL DESC : MCCULLEY FARM : LOT 002 BLOCK 002 PERMIT TYPE : ADDIT[ON/REMODEL/REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR ACTIVITY : O/S BU[LDING-UNDEFINED VALUATION : $ 3,800.00 NOTE: REPAIR EXISITNG CHIMNEY APPLICANT PERMIT FEE SCHEDULE 103.25 SELA ROOFING& REMODELING, INC. STATE SURCHARGE(VALUATION) 1.90 4100 EXCESIOR BLVD ST. LOUIS PARK,MN 55416- TOTAL 105.15 (952)915-7227 Minnesota State License#: 0001050 OWNER LUTH, W&MARCOUX 560 DEBORAH DR MAPLE PLAIN, MN 55359 AGREEMENT AND SWORN STATEMENT The 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. 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 l80 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 revoke ny time o ue cause. � �' a� '��' � � � A lica Per it 'g ture Date I s ed By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � � ��,��o� City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) /�_\, Mailing Address: Permit number: � —O� `�'J�3 ��,�,�.� PO Box 66 Crystal Bay, MN 55323-0066 Date received: 7� O i ��.��- .. a ;;�, s.�� Street Address: Received by: �'�,� � �� Gti 2750 Kelley Parkway Plan review fee: �kESH�4'� Orono, MN 55356 Total Fee: �D5 l� 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 INFORMATIQN: '�. Job Site Address: ��; `>��;�,�,h �41,�� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �C 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/ ,PLIC IW�ORMATIOpJ;� Name: �Q�C:.��:°.4;ik� ��t� '.�"1�12�1,1t\�. State License# �' ;�, ,•'� �— Expiration Date: Phone: � `" , _ `�� o�ce `� - �� ,l �, cell Mailing Address: � � � �r� Cit :` � � � ^, - ZIP: -- Contact Person: `' � �r, � 'r, � -,r.S Applicant is: Ea�t�as�c. / Homeowner �c��ie o�e� Email and/or Fax: ,- cr � � �� , ,� ;.,. -, ,. � � �, PROPERTY OWN� INFORMATION: Name: ` �, Phone (day): �"��° �.�C . Address: �' '„ �` . - Cit : �� 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 `1 Fax: 952-471-0682 ❑ Re-roof ❑ Fire Damage ' `� ' • ��, Lt! �•h' www.minnehahacreek.orq Overall Project Description: � t,� ,•. Estimated Construction Valuation of Project(excluding land) $ jy� �� 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. n r-- ; � ApplicanYs Signature: , _ , ,: Date: _��'Z T_� G� Last Updated: 05-04-2009 !,�I� �p �ssV( v F,NAI ��s� °�`Y `/� r �-Z�. o� � Jul1� JUL.17.2009 9�57AM 9527077505 EXEC OFFICES n�.�i� r.i�� 4100 Excelsior Boulovard 3t.LoU{e Pdrk,MN b541B .��-: CONTRACi' a�oB: es2-s��ta35 •E�, � ,F� e ucensed . :.�. -��= 9t,Paul; 65�-844-OOaO � Bonded � . • Fax; a�a-aas-io�a � '� � Insured ' ' r.* �� vww.crownmasonry.com �� • , � . , � � i�i`�s � ASONRY PRO LSU9MIT'fEOTD PFiOfVQ OAT6 � • � lG . � Sl'aEEf N� � �� .Pi cm.:r•�enc aiP 000� ��T.a+'� G19 E 1AlDa CcLLPNONE AnN� ��P�"p'y� '�i�'1 l —7'�� W�pROPOBE ner�y to Iurn�sh malerlal and lahor—complele In accord6�ce wtth sRecilioatiorle hslow,lor Ihe surn oh � B� P�YmcNaec r-�G douara • i as follows; , ,� b� wrxn 3ianed§ �o0 61aR S � 6�lance�0 6e Pald ln FuM Upon ComoIBtlOn hY ChYt'0�5 ��A � �ii ma�arfai is guaranaed ro ee ea epeclt{ed.AI�WOAK ta 69 g;tims�Cd 3teR pa�e: S�._ Q camD'eled in ra�ra+hrnanike mam3ra.^:ordinalc slantlard prctix6. yYeSthe��ermlttlnB "F � I5pOcineC�ik end quoted priae eubjeCi to Chan�B upotl tl19eCVCry ��r� � al hidden delecs.Ali egreeMea�ls cO�GnqS�l t,�►o�6trSk�i,7ioeke�� q��hori29d or delays beyond o.r contro�,owngr b ca.-ryt�rc,tamada snd aiher 8l0noture - nee9.:3ry insu�n.e.O�r wo•keca ere fulty covere�6y LVorkere' Compensatien Ineu.dnca.P.vducta ead melerlale mey be Subctltutetl �te:TMe Propoeel mApl CE F.0 equlvale^t prxJucls tlue tn avaiiabiU(y wRhdrewn by us�P nct a t�d wRMn daYg� We haraby submii xceallc�tions snd e9tlmate6 tar: Paga No. C ol � Pe9� ' • ��/r?C1-��l J /Gr� °�n�✓"� �� . � ��/n6 c�� .,-.6-� (a.c.4a ��' Ci`'�'Y �«,[i dt21-.1' . � � � ' , /f� �(,�S`m�-y �°f7��7-re- !� (B��- F�'� +�lr�►e.,a ' ' r . • ��'b�� t�J-C��,.�.�,C'r�,�, c,�.� 729 ��-��zr f�`�� . � � � . (��- n�J � �►c(�� . e ��r� ��p �-�C,�w-��S �=��`��9- , ;r� ��-�. a( �,n�1 �r-�e..�- c� _r.r�� C�q.� �o�� E�` d �c'�1�-^�. � ��c� o�.t,,� �3--,�l� � C'l�ce � �� . f rJ ��`' NOTE3t Scc REVEA��41DEfOR IRIPORTANT NOTICE. A1�o5eaz:ehelWeCo�ew^oV�eh:e+mli0npb3�� Acaep��nee of Contract , Cart4cl�f.e utl�sll�omru srte app6esh�leses, Co-t'eela Ic dwn v�f.rr.now alf tl��hom cnUre yerd, The BDOV9 p�,=�aiY�e��pne and m�lle a•e sallsfectG�y MO a��heretry een�•eeiu a ma�r,e�ss yvd d.a�ewa��. aeeep�ad.Ya+ars auhoRaoC t�do e specNied.Peimenl wpl bt Canl;aebrnot ceeporetle fr deneqe lo{r*ee,bu:hs:or shf�e tlu�M+g��m+m mede ee ouMned aba�o. 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