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Home My WebLink About2010-00782 - roofing � * . CITY OF ORONO PERMIT NO.: 2010-00782 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 08/30/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 1265 ELMWOOD AVE PIN : 07-117-23-41-0017 LEGAL DESC : SAGA HILL REVISED : LOT 002 BLOCK 005 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENT[AL COI�ISTRUCT[ON TYPE : ROOFING- RUBBER ACTIVITY : O/S BU[LDING - UNDEFINED VALUATION : $ 10,000.00 NOTE: RUI3I3ER ROOF[NG APPLICANT PERMIT FEE SCHEDULE 191.75 PERKINS,JOHN STATE SURCHARGE(VALUATION) 5.00 1265 ELMWOOD AVE MOUND, MN 55364 TOTAL 196J5 PAID WITH CC# 7308 OWNER PERKINS,JOHN 1265 ELMWOOD AVE MOUND, MN 55364 AGREEMENT AND SWORIY STATEMENT The work for which this pennit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the State Buildin�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 goveming this typc of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construc[ion au[horized is not commenced within 180,days of the date of issuance,or if construction is suspended for a period of I 80 days at any time after work has commenced. The applicant is responsible forassuring all required inspections are requested in conformance with he State Building Code.This permit may be revoked at any time � ' `_� .__ _ r! / / � � �.0�/� lV Applicant Pern�itce S'gnatu e Date Issu By Signa re Date - S ARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � . City of Orono 73 0 � Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Permit number: /��('7�O`� 4v�� PO Box 66 R � 'Q� Crystal Bay, MN 55323-0066 Date received: U� ''\� \ �� s a �'� ��;` s. � Street Address: Received by: �'� ° `" ��' 2750 Kelley Parkway Plan review fee: ��kESH04�' Orono, MN 55356 �: Total Fee: l9��7�� 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: ' � ' � ��v�� c- Will this be a Parade of Homes, R modelers Showcase Home or other Display Home? ❑ Yes �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-permrtted events will not be allowed. CONTRACTOR/APPL�IC T IN�OR ATIO� , Name: � ,� � � �, State License# Expiration Date: Phone: ( �{t� — (p office cell Mailing Address: � —� Cit : - ZIP: — Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: � Name: �p�o-U L Phone (day): ' ` Address: Cit : ZIP: Email and/or Fax s PROJECT INFORMATION: ' Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel MCWD review&permits ❑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 Damage www.minnehahacreek.orp verall Project Description: Estimated Construction Valuation of Project(excluding land) $ t (3 �� — �1 k 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 gene�ally cannot be given to either the public or the subject of the data. Our � purpose and intended use of this information is to �nnually update our records and records of other governmental agencies re uired b law. If ou refuse to su I the informati n, the a lication ma not be issued. -. Applicant's Signature: - -""��— Date: -��-� r 7 LastUpdated: 05-04-2009 I