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Home My WebLink About2011-01155 - roofing (� CITY OF ORONO PERMIT NO.: 2011-01155 � 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE iss[1ED: 09/29/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 35 HACKBERRY HILL PIN : 33-118-23-44-0018 LEGAL DESC : DANIELS LONG LAKE HE[GHTS : LOT 012 BLOCK 002 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING -ASPHALT ACTIVITY : O/S BUILDING -LJNDEF[NED VALUATION : $ 3,800.00 NOTE: VALUATION OF PERMIT:$3800.00 ROOFING PERMI'I'S ISSUED WITHOUT ENOUGf l NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO WORK BEING S1'ARTED) MUST PKOVIDE COMPLETE SET OF PIC"I'URES OR A FINAL INSPECTION MAY NOT BE ISSUED. SIGNS-ADVERTISING SIGNS MAY ONLY 13E ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE. ONCE W012K IS COMYLI;TED THG SIGNS MUS7'BE REMOVED. APPLICANT pERMIT FEE SCHEDULE ]03.25 ETAL, R WAGMAN STATE SURCHARGE(VALUATION) 1.90 35 HACKBERRY HILL LONG LAKE, MN 55356 TOTAL ]05.15 OWNER ETAL, R WAGMAN 35 HACKBERRY HILL LONG LAKE, MN 55356 AGREEMENT AND SWORN STATEMENT The work for which Ihis permit is issued shall be performed according to the approved plans and specitica[ions,applicable City approvals,and the State[3uilding Code. This permit is for only the work describcd and does not grant permission for additional or rclated work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not spccitied herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date oY issuance,or if�construction is suspended for a period of 180 days at any time after work has commenced. I'he applicant is responsible for assuring all required inspections are requested in conformance with the Sta[e Building Code.This permit may be revoked at any time for due cause. �,�sl�� ``'�`.7�`_ y l 3° l 2�" � l l Applicant Permitee Signature Date Issued By Si ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABO . � City of Orono t Building Permit Application for Maintenance / Renovation (windows, doors, siding, re-roof, etc.) Mailing Address: ��,�. PO Box 66 Permit number. 0 �. � Crystal Bay, MN 55323-0066 Date received: `�`' �"l � � Received by: ,� � �, ; Street Address: � � r;?'._,-> �'.�c,� �; 'a� �ti 2750 Kelley Parkway Plan review fee: '1'• �v Orono, MN 55356 9kEsxo� 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: �� 1 C��r I� �� C � � Job Site Address: �� Will this be a Parade of Homes, Remodelers Showcase H e or other Display Home? ❑ Yes �No lf yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wip be required unless applicant demonstrates sufficient on-site parking is avaifable. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: _J c RI2�' c �-,�r i� State License# Expiration Date: Lead Certification Number: Expiration Date: (for work on homes that were constructed prior to 1978 Phone: C, ( Z_C � y. �(i � y (office) (cell) Mailing Address: City: ZIP: Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: PROPERTY OWNER INFORMATION: Name: � }2� c �-�,�R� �t ;-.��c, r; r�, Phone (day): `�S Z .-1�� —5 S zt Address: �5 i�:'�crc�riz l��c �-�; .c City:l�N�— �-�� ZIP: 5 5�fc Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require ❑ Door(s) ❑ Remodel ❑ Fire Damage MCWD review& permits: Minnehaha Creek Watershed District(MCWD) �'Re-roof, asphalt ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd ❑ Re-roof, cedar ❑ Restoration ❑Water Damage Deephaven, MN 55391 Phone: 952-471-0590 ❑ Re-roof, other(specify) ❑ Siding ❑ Other: (specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Overall Project Description: Estimated Construction Valuation of Project (excluding land) $ , � C:°��' ��- ��r�- `� 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 alternafive 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 fication ma not be issued. czy/�,(,'' � �' 2 • Zo/ ApplicanYs Signature: �,�,�f -�-2f Date: f `7 � Last Updated: 08-09-2011