HomeMy WebLinkAbout2010-01025 - roofing . • CITY OF ORONO PERMIT NO.: 2010-01025
� 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 10/19/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1865 LAKEVIEW TER
PIN : 27-118-23-42-0015
LEGAL DESC : LONG LAKE COUNTRY CLUB ADDN
: LOT 003 BLOCK 002
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATTON : $ 8,400.00
NOTE: TEAR OFF REROOF-ASPHALT
WORK STARTED WITHOUT PERMIT-DOUBLE FEE
INSPECTOR REQUIRING PICTURES OF THE ICE AND WATER SHIELD ON SITE AT TIME OF FINAL.
APPLICANT pERMIT FEE SCHEDULE 177.00
S J ROOFING LLC STATE SURCHARGE(VALUATION) 5.00
99 CHERRY AVE S
ANNANDALE, MN 55302- MISC FEE 177.00
(320)2747663 TOTAL 359.00
Minnesota State License#:20628701
OWNER
ASKE-REMICK, SHARILLYN
1865 LAKEVIEW TER
LONG LAKE,MN 55356-
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 sepazate
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 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 St te Bui(ding Code.This permit may be
revoked at time for du ause.
l��J �1v � �
Applicant Permitee Si nature Date Issued By nature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO
• . City of �rono
..
' Building Permit Application for Internal Work
(windows''doors, siding, re-roof, etc.j
,._._�_ Mailing Address� Perrnit raumber. �� �
/O .(�\\ PO Box 88
O 'O\; Crystal Bay, MN 55323-4066 Date received: �� � �
� 1 Received by:
� � � Streef Address:
� 2750 Kelley Parkway Plan reviewfee:
�� ag�° Orono, MN 55356 �( �
��H 7otal Fee: ,I,D���`
Main: 952-249-0600 Fax: �52-249-4616 www.ci.orono.r�n.us `f�
This apptication form must be completed in tull and all required iniormativn must be submitted.
Incamptete applicationa will be returned_ (P/ease prirrt)
GENERAL INFORMATION:
Job Site Acfdress: ��(P � �Ci �� �'�� �
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No
1f yes,a specia!event pemxt 7s requir�d with Police Depertment and City Council approval BQ days prinr to the evenk Shuttle bus servioe wiU 6e
required unlass applicant demonsbates suff'icienF on-site parkrng is available. Non-permitted events wiU rrot be allotirred.
CONTRACTOR f APPLICANT IN ORMATION:
Narne: ' b��� '�'t'�
State License# � � ', Exp' tion Date: 3�i— !/
Phone: .. .,I office cell
MailingAddress: �� � � �� �P� �
Contact Person: + � Applicant is: Contractor ! Homeowner 1c��e��1
Email and/or Fax: '7 —
PROPERTY OWNER I�IF�RMATION: `-
Name: �4.�,r1 �1! 1� � S I�e
Phone (day): 1 - `-�31�
Address: � ►�'' � � �� �, �.-�j'.,�t�ft� f(, �<<y: ��-,��� Z�P: �-�-��r,�
Email and/or Fax
PROJECT INFORMATION:
Type of Project: Arry earth movemerit may require
�ACWD revtew 8�permits
��oor(s) ❑ Remodel ❑Water Damage
Minnehaha Creek Watershed District(MCWD)
❑Window(s) ❑ Repair �;Storm Damage 18202 Minnetanka Blvd
, Deephaven, MN 55391 !
❑ Siding ❑ Restoratian �G]Other. (specify) Phone: 952-471-0590
, Fax: 952-471-Q662
Re-roof Q Fre Damage www.m+nnehahacreek.ora
Overall Prvject Description:
Estimated Constructian Valuation of Project(excEuding land) S �� a �
APPLICANT ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
. Certifies tt�at lhe information supplied is true and correct to the �est of hisJher knowledge. The applicant recognizes that they
are solely responsibte for submitting a complete application being aware that upon failure to do so, the staff has no altemative
but to rejeet it un�l it is eomplete;
. Some or ali af the informatlo�that you are asked io provide on this applicedan is dassified by State law as eitfier private or
con6de�aE. Private data Es ir�formation which generally cannot be glve� to tl�e publiC but can be given to tl�e subject of tt�e
data. Confidential data is infnrmation which generally cannot be given to either the pub(ic or the subject of the data. Our
purpose and intended use af this �r�ormation is to annually update our records and re�ords of other govemmer�tat agencies
uired b law. lf u re�use to su I the information the licatiom m �ot t�e issued.
licant's Si nature: �i'-•�L� ' date: / �/✓L �`�/�/
�PP 9
E i ,
LastUpdated: 05-04-20D9 '
6'd b869bLZOZ£ ��� 6ui�ooy �S e95�6 6 06 66��0