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Home My WebLink About2010-00917 - roofing '' y CITY OF ORONO PERMIT NO.: 2010-00917 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE �SSUEn: 09/30/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 635 FERNDALE RD N PIN : 36-118-23-11-0009 LEGAL DESC : LJNPLATTED 36 l l8 23 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING -ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 30,000.00 NO"I'E: TGAR OFF REROOF-ASPHALT SHINGLES APPLICANT PERMIT FEE SCHEDULE 466.75 ALLSTAR CONSTRUCTION STATE SURCHARGE(VALUATION) 15.00 5145 INDUSTRIAL ST SUITE 103 TOTAL 481.75 MAPLE PLAIN, MN 55359 (763)479-8700 Minnesota State License#:20631575 OWNER O'NEILL-JACOBSEN, LARRY JACOBSON&VICTORIA 635 FERNDALE RD N WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approvcd plans and spccifications,applicable City approvals,and the State[3uilding 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 type of work shall be compied with whether or not specified herein.This permit will expire and become null and void ifconstruction 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 co formance with the State E3uilding Code.This permit may be revoke t�ny 'm for u cause. � � / �" � �'� � npplicant Permitee Signature Datc �� Iss d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. � ' City of Orono �� '�� Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: /�,�. PO Box 66 Permit number: ��a�9� \ Crystal Bay, MN 55323-0066 Date received: ��U /(� i � m� 0 �� -� i Street Address: Received by: (�� `z ;�' F .�,t� G� 2750 Kelley Parkway Plan review fee: kESH04'� Orono, MN 55356 ��O�f �S Total Fee: O 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 INFORMATI - N: � r-- Job Site Address: l�� t-4��°�, � Q Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � 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/APPLICANT INFORMATION: � l Name: `��/C, ��>j�,J �d� State License# `Zo � Expiration Date: Phone: ')b' - 7 v � office cell Mailing Address: �iYS' �' ��qru�. 5�- �k�� Cit : `- (,}�Ll�.t ZIP: 53.=�` Contact Person: �� Applicant � . Contract � Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFOR ATIO^��S l Name: ` �J Phone (day): 6 r � - ��'I�{� -�, \ Address: ��,5��jL�;Q�� City: �,�►v t� ZIP: � S�5/ Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review 8� 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 Fax: 952-471-0682 �e-roof ❑ Fire Damage www.minnehahacreek.orq Overall Project Description: �� Estimated Construction Valuation of Project(excluding land) $ p �v�� 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 t su I the information,the a lication ma not be issued. ApplicanYs Signature: Date: � - J `� ^ � � LastUpdated: 05-04-2009