HomeMy WebLinkAbout2017-00097 (Re-roof) t
� • _ � := CITY OF ORONO * 2 0 1 7 - 0 0 0 9 7 *
2750 KELLEY PARKWAY DATE ISSUED: OU3U2017
ORONO, MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 1212 ARBOR ST
PIIv : 10-117-23-24-0022
LEGAL DESC : MAXWELLS ADDN CRYSTAL BAY LAKE
: LOT 000 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 16,600.00
NOTE: VALUATION OF PERMIT:$16,600.00
ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO
WORK BEMG STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED.
SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE.
ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED.
APPLICANT PERMIT FEE SCHEDULE 309.75
STATE SURCHARGE(VALUATION) 8.30
529 Indian Mound St Spydernt TOTAL 318.05
401 LAKE ST E Payment(s)
WAYZATA,MN 55391-
OWNER
529 Indian Mound St Spydernt
401 LAKE ST E
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 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 if construction authorized is not
commenced within l SO 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
revoked at any time for due cause.
�TU l l
Applicant Permitee Signature Date ssu d B ignature Date
�
. '
` � � City of Orono
Building Permit Application for Maintenance/ Replacement/Remodel— Residentiai ONLY
{i.e.windows, doors, siding� re-�oof, etc.—NO STRUCTURAL EXPANSION)
�O A' Maili O�8. Pemut number. 0�0�7 G�l'`
j vO
Crystal Bay,MN 55323-0066 Date received: � /
Street Address: Received by:
s `�` 2750 Kelby Parkway Plan roviewfee:
`� Orono,MN 55358
�1KESH0�`�' �-� (�1 �
Totai Fee:
Mein: 952-249-4800 Fax: 952-249-4816 www.ci.orono.r�m.us
This applicadon form must be completed in full and all required ir�formation must be submitted.
Incomplete applications wili be returned. (Please print)
GENERAL INFORMATION:
Job Site Addr�ess: a�
WIII this be a Parade of Homes,Remodelers howcase Home or other Dfsplay Home? Yea No
H yes,a specid event permit is required witA Pdice DapertmerN and C/ty Coundl approvei a0 daya p►ior to fhe evenf. Shu�tk Dus wii!be
required unbss epplicent demonsbetea sulPicient on-a�e perldng is aveile6le. Nan-permitted events wip not be al/owed.
CONTRACTOR/APPLICANT INFORMATION:
Name: _�hT�iv'n ,.�.i.,.,,.6L�,� s/�vi�r�Y�-:— LL o
State License# Expiration Date:
Lead Certiflcation Number. Expiration Date:
(f+w woih on harws Lh�t wMn corabuctad prior t�1978
Pnone: (ce�q � ��-- � �.i 6�� ? (otfice) ��j- L/7���7�, �
Mailing Address: City: ZIP:
�n��Pe��� r_NAQ1�s' fc/i o�nl Applicant is: Contractor Homeow �c+�a.a�.�
Email and/or Fax: �. A Mb �L,��.o p/��L.. c�.;,r�
PROPERTY OWNER INFORMATION:
Name: � s',, �.�.n �u r� S�,,,.��,�-n� �E.,� LG.G
Phone(day): q�S�-�-/ Z I ��_
Address: c..j�l L9-GCF S T E 1� C�ty� l,tf'3���1'l"/�' ZIP: .S S?�I /
Email and/or Fax: (,,�},�/� �Z..�p n�/!.�L_ �, M
PROJECT INFORMATION: Overall 'ect descri tion:
Typ�of Project: Any earth mowmer�t may also roquire
�.Door(a) f�Remodel ❑ Fire Damage ���nview d�pennits:
�Re-roof,asphalt ❑Repair ❑Stortn Damage Minnehaha Creek Watershed District(AACWD)
15320 Minnetonka Blvd
❑Re-roof,cedar ❑Restoration gj Water Damefle Minnetonka,MN 55345
❑Re-roof,other�sp«�ryr) ❑Sidinp ❑Other.(speciry) Phone: 952-471-0590
Fax: 952�71-0682
❑wndow(s) ' v�y�yv.minnehahacreek,oro
Estimated Conatruction Valuatlon of Project(exduding land) S�tv� �006�
APPLICANT ACKNOWLEDGEMENT:
• Aflreea to provide all information required or requeated by the Building DepaMiant;
• Certifies that the infoRnation wpplied ia true and coReat to the beat of hia/her knowledpe. The applicaM rocopnizes that thsy are
solely reaponsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to
reject it un�l ft is complete;
• Some or all of the inforrnation that you aro saked to provide on this application is Gasaifisd by Stab law as either private or
confidential. Private data is infortnation which generaly cannot be given to the public but can be qiven to the subject of the data.
Confidential data is infortnaaon which genereNy cannot be giv�en to either the pubNc or the subject of the data. Our purpose and
intended use of this information is to annualy updata our recorda and records of olher govemmental agenaes required by law. Ii
ou rofuse to su the information the a ication ma not be iasued.
ApplicanYs Signature: Date:
Owner's Signature: � ' .,,���,Date:�i/�,r/ �_3 •"�o/ 7
Last Updated:January 2016