HomeMy WebLinkAbout2011-00392 - roofing � CITY OF ORONO PERMIT NO.: 2011-00392
� � 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE [Ssu�n: OS/25/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1755 FOX ST
PIN : 03-117-23-44-0008
LEGAL DESC : FOX ISLAND
: LOT 4 � BLOCK 1
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOF[NG -ASPHALT
ACTIVITY : O/S BUILDING - LJNDEFINED
VALUATION : $ 5,275.00
APPLICANT PERMIT FEE SCHEDULE 132.75
ERNST ENTERPRISES LLC STATE SURCHARGE(VALUATION) 2.64
PO BOX 457
WATERTOWN, MN 55388- M[SC FEE 0.00
(612)210-7891 TOTAL 135.39
Minnesota State License#: 20630424 PAID WITH CC# 7292
OWNER
ABUKHADRA, HASHEM
1745 FOX ST
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work Yor which this permit is issued shall be performed according[o
the approved plans and specitications,applicable City approvals,and the
State I3uilding Coda 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[his type of�i�ork
shall be compied with whether or no[specitied 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 after work has conunenced.
The applicant is responsible for assuring all required inspections are
requested in confonnance with the State Building Code.This permit may be
revoked at any time fo e cause.
� �(.�/� �� � � �
Applicant Permitee Signature Date Issued By i nature �
! SEPARATE PERMITS REQUIRED FOR WORK OTHE HAN DESCR[BED A O
i �
1 '
, •.�
City of Orono
Building Permit Application for Internal Work
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
O�,L,�,�0 PO Box 66
Crystal Bay, MN 55323-0066 Date received:
� �'���:�;�:i_ �, Street Address: Received by:
�'�t ' �� �Gti�' 2750 Kelley Parkway Plan review fee:
`�Esxo4' Orono, MN 55356
Total Fee:
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 � 7 SS � ,S�.
Will this be a Parade of Homes, Remodelers 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-sife parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICANT INFORMATION:
Name: �,��,i �,�f��,,�.,;��; �LC d�c. f����r� ���•ha�,
State License# �� j(j y� t� Expiration Date:
5 - �/ � �v/,�
Lead Certification Number: Expiration Date:
(for work on homes fhat were consfructed prior to 1978
Phone: �a - a �U -7 ``� j (office) (cell)
Mailing Address: ,U, City: , /z�;� ZIP: �5 �;'�'
Contact Person: r�,� y�'��5�- Applicant is: ontractorJ / Homeowner (Circle One)
Email and/or Fax: �
PROPERTY OWNE INFORMATION:
Name: /��1G5 �b�l�l�t�rc�
Phone (day):
Address: � 7S'S � �`�. Cit : , ZIP: �5��'�
Y (%r�n�
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Any earth movement may require
❑ Door(s) ❑ Remodel ❑Water Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd
❑ Siding ❑ Restoration ❑ Other: (specify) Deephaven, MN 55391
Phone: 952-471-0590
�Re-roof ❑ Fire Damage Fax: 952-471-0682
www.min nehahacreek.orq
Overall Project Description: %; �1.� �' �c'-S�� �ry(� l��.� ,
Estimated Construction Valuation of Pro�ect(excluding land) $ 5f � 75- `��
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: .� ✓� �l
Last Updated: 03-01-2011