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Home My WebLink About2015-01056 -reroof ` ! CITY OF ORONO * Z 0 1 S - 0 1 0 5 6 * 2750 KELLEY PARKWAY DATE ISSUED: 08/19/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 2476 DUNWOODY AVE PIIY : 20-117-23-21-0004 LEGAL DESC : REG. LAND SURVEY NO.0660 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 4,400.00 NOTE: VALUATION OF PERMIT:$4400.00 ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED. SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE. ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED. APPLICANT PERMIT FEE SCHEDULE 123.91 STATE SURCHARGE(VALUATION) 220 SELA ROOFING&REMODELING, INC. TOTAL 126.11 4100 EXCESIOR BLVD Payment(s) ST. LOUIS PARK,MN 55416- CHECK 36192 126.11 (952)915-7227 Minnesota State License#: BUIL-BC1050 OWNER NUEMAN,JERI 2476 DUNWOODY AVE WAYZATA,MN 55391- 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 sepazate permits. All provisions of laws and ordinances goveming 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 afrer work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance wi[h the State Building Code.This permit may be revoked at any time for due cause. J � � ' )`► • 15 ,� � - � �1�1��` icant Permit��gr�ure LJ Date Issued Signature Date � F City of Orono Building Permit Application for Maintenance / Replacement / Remodel (i.e. windows, doors, siding, re-roof, etc. — MO STRUCTURAL EXPANSION) �O�O Mailing Address: Permit number: �'�/ � � PO Box 66 Crystal Bay, MN 55323-0066 Date received: �—� �– Street Address: Received by: �i�, G� 2750 Kelley Parkway Plan review fee: lqkESH�� Orono, MN 55356 � Total Fee: 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) �-- �� Z l GENERAL INFORMATION: „ ^'� � �+/��D/"� � � Job Site Address: �i'`[ `� 1 (/�� Will this be a Parade of Homes, Remodelers Showcase Home or ot er Display Home? ❑Yes No !f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servic will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLIC1ANT I FORMATION: Name: Se1� � � State License# �b�� Expiration Date: ?�'3��-, Lead Certification Number: N �2,�D3 t�2 Expiration Date: 4�Z2�ZD (for work on homes fhat were constructed prior fo 9978 Phone: (r.� G��2 • Gj� -'� (office) �� . ' ��4'C� Mailing Address: o}/ City: 6},� 1,(,�S y� ZIP: :�G�l(D Contact Person: ��((, Applicant is: ontractor / Homeowner (Circle One) Email and/or Fax: CjZ.G1'ZZ. PROPERTY OWNER INF�ORMATIQN: Name: �� Phone(day): (�( . O� Address: �Z��t-1,1�P U,��4�G(,U DUV� c�ty: (�VI,() ziP: �Gj'�G� � Email and/or Fax: PROJECT INFORMATION: Overall project description:��,V1,1 �� '/V V� V WVl ��, Type of Project: Any earth movement may also require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review&permits: �e-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 Fax: 952-471-0682 ❑Window(s) w innehahacreek.or 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 gen rally cannot be given to the public but can be given to the subject of the data. . r rp se an intended use of this inf e ann al p ate our records and records of other governmental agencies required by law. If ou refuse to su pl e i rma the lica n ra �ot be issued. Applicant's Signature: �`! '� Date: Owner's Signature: Date: Last Updated:January 2015