HomeMy WebLinkAbout2010-00573 - roofing \
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CITY OF ORONO PERMIT NO.: 2oiaoos�3
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 07/19/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3745 JACOBS MILL RD
PIN : 32-118-23-24-0011
LEGAL DESC : JACOBS MILL
: LOT 001 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-CEDAR
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 76,000.00
NOTE: REMOVE ALL STUCCO,FIX SHEATHING AS NEEDED,REPLACE WITH SHAKES AND HARDIE.
APPLICANT pERMIT FEE SCHEDULE 876J5
SLJNDANCE EXT�R7�RS" � �-" � '� --- --� STATE SURCHARGE(VALUATION) 38.00
105 W.23RD ST. � � �
HASTINGS,�MN�55033'- - . . ,... . MAIL-IN FEE 2.00
(612)419-1085 TOTAL 916.75
Minnesota StateLicerise�:20383035��--- - �-� --,- ..
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OWNER" - .. __._ _._. _
ADAMS,BRADL�Y&LYNN
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3745 JACOBS MILL RD - �
_. , . . .
LONG LAKE,IVIN,55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicabie City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission fo[-additional or related.work which requires separate
permits. All provisions of laws and ordinances governing 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 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 conformance with the State Building Code.This permit may be
revoked at any time for due cause.'
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Appiicant Permitee Signature Date Issued By Si ture Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED ABO .
, �
City of Orono
sw Building Permit Application for Internal Work
��� (windows, doors, siding, re-roof, etc.)
Mailing Address: permit number:
0•�,��,�.0 PO Box 66
Crystal Bay, MN 55323-0066 Date received:
,� �, Street Address: Received by:
'�, � G� 2750 Kelley Parkway Plan review fee:
��g�o�� 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: e�
Job Site Address: �f 4'� ��(iICA(pS 1"`� �� �•
Will this be a Parade of Fiomes, Remodelers Showcase Home or other Display Home? Yes No
It yes,a special event permit is required with Police Department and City Council approval 60 days pr'ror to the event. Shuttle bus service will be
required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR/APPLICA T INFORMATION:
Name: I�t Gtn e X ✓i�rs Z�h�i�O( ►�c
State License# 20.�$303 S'- Expiration Date:
Phone: - 0� o0 office - �N2- cell
Mailing Address: O '� Ci : Q fih ZIP: S—S'0
Contact Person: v i � �o or+ Applicant is: Homeowner �cir�i.o�e1
Email and/or Fax: y i; Y, S't� �x ✓i�s• ��m
PROPERTY OWNE INFORMATION:
Name: r� �/�ah2S
Phone(day): Le IL-g( 0 8� �Z$7
Address: Ci : ZIP:
Email and/or Fax a,r+-�s i-h' (�n I •Co�
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
❑Re-roof ❑ Fire Damage www.minnehahacreek.om
Overall Project Description: ov (l a. '� �'1e��+ a.s t �d YC c S � � ��
Estimated Construction Valuation of Project(excluding land) �(.!,pOb
APPLICANT ACKNOWLEDGEMENT:
. Agrees to provide all information required or requested by the Building DepaRment;
• 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: 7T/2��(�
Last Updated: OS-04-2009