HomeMy WebLinkAbout2009-00375 - roofing J
, CITY OF ORONO PERMIT NO.: 2009-00375
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 07/06/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 1185 FERNDALE RD W
PIN : 02-117-23-43-0025
LEGAL DESC : REG. LAND SURVEY NO. 0397
: LOT 000 BLOCK 000
PERMIT TYPE : M[NOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CO1�ISTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 14,000.00
NOTE:
TGAR OFF AND REROOF-ASPHALT SHINGLES
APPLICANT PERMIT FEE SCHEDULE 250J5
WHY WAIT ROOFING LLC STATE SURCHARGE(VALUATION) 7.00
972 BAVARIAN HIL.LS CT
CHASKA, MN 55318- TOTAL 257.75
(952)443-9957
Minnesota State License#: 20156835
OWNER
WYMAN, JAMES&KATHLYN
ll85 FERNDALE RD W
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 Yor additional or related work which requires separa[e
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permi[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 aze
requested in conformance with the State Building Code.This permit may be
revo at any time for due cause.
�' - ' � " � �-�'� .,� 7� � � o
App ' a ermitee Signature Date Iss By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
J
City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
�� Mailing Address: QO _DQ�7
,�\� PO Box 66 Permit number:
�� ,,�, Q��, Crystal Bay, MN 55323-0066 Date received: ��
�I �,,� _ ��
i1� t � � � s, � Street Address: Received by:
��' � q�, �,ti�' 2750 Kelley Parkway Plan review fe
��'�gESH�''``�/ Orono, MN 55356 �
Total Fee: � c�, 7s
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:
�. . ,, r
Job Site Address: i � � r r;�.-,�, �� L-.l
Wi�l this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
!f yes, a specia/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 wil/not be allowed.
CONTRACTOR/APPLICANT INFORMsATION:
Name: l.//►�. �r�,t a�tl�r L�-
State License# `� �C � � Expiration Date: � '
Phone: �' _�{ � --��tr (office) 2-2 ,:--���� cell
Mailing Address �Z �--� ;�1� h Cit .. ZIP: �� � --
Contact Person: ��„ Applicant is: ontractor / Homeowner �c���ie One)
Email and/or Fax: �
PROPERTY OWNER INFORMATION:
Name: r, .,� �,, �
Phone (day): Z� _ _�-����
Address: ���,C, ��},.,��� �� City: �/�,TR� ZIP: s���
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door s MCWD review&permits
( ) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair i ❑ Storm Damage 18202 Minnetonka Blvd
Deephaven, MN 55391
❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
�Re-roof Fax: 952-471-0682
❑ Fire Damage www.minnehahacreek.or4
Overall Project Description: '(';,f�,� �-{.E �.. � rc���
Estimated Construction Valuation of Project(excluding land) $ l�{� ���►. eTo
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.
ApplicanYs Signature: � Date: ���,�nG}'
--�
Last Updated: 05-04-2009