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Home My WebLink About2010-00385 - roofing , ~ CITY OF ORONO PERMIT NO.: 2010-00385 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ►SSUED: OS/26/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 110 LEAF ST PIN : 04-117-23-22-0005 LEGAL DESC : REG. LAND SURVEY NO. 0744 : LOT 000 BLOCK 000 PERMIT TYPE : M1NOR ALTERAT[ONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING -UNDEFINED VALUATION : $ 11,000.00 NOTE: [EAR OFF AND REROOF HOUSE AND GARAGE APPLICANT PERMIT FEE SCHEDULE 206.50 MARK T SEASHORE CONSTRUCTION STATE SURCHARGE(VALUATION) 5.50 1523 LAKE PULASKI ROAD BUFFALO, MN 55313- TOTAL 212.00 (763)232-2316 Minnesota State License#:20386373 OWNER GRONBERG,MR. & MRS. MARK 110 LEAF ST 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 separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not 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 commenced. The appiicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at ny time for due cause. �� S� S / Z6 � (t� l'1�6V Jr/0��7 /!> Applicant Permitee Signature Date Issue Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � ��- ;� �.. ; � - � " City of Orono �� , � ��,�� ,x� u;.� ��j'.; . Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) `` � Mailing Address: Permit number: /O—��3 4v�,� PO Box 66 ' �,;�y Q Crystal Bay, MN 55323-0066 Date received: �.��P�o ' `�s,�� . �' a �' ��" a Street Address: Received by: �� 4 AG.,.:';y �'�,n � A" G� 2750 Kelley Parkway Plan review fee: � L`�gESKo�`'� Orono, MN 55356 � — Total Fee: a`a� „A� 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. (P/ease print) �� GENERAL INFORMATION: �; � Job Site Address: 1\6 �ti-� ST � � 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 approva160 days prior to the event. Shuttle bus service will be � required unless applicant demonstrates sufficienf on-site parking is available. Non-permitted events will not be allowed. ;� � CONTRACTOR/APPLICA T INFORMATION: ��' Name: �r C' S��SI�c�C C�ns�- State License# �Zn 3� 6 37 3 Expiration Date: - "3 �I � i 1 ` Phone: �6 3, 23Z- 2`�1 office �6�- 2,3 L- 231-C cell � �;,; Mailing Address: �523 �'�-l�s �: Y . Cit : -f-f ti(o rn Z�P: S ��3!3 Contact Person: �y,pr � Applicant is: �� Contracto / Homeowner (Circle One) Email and/or Fax: � PROPERTY OWNER INFORMATION: � Name: i�e G�v.� c�ba��s ` Phone (day): Address: �l v (�., S T- City: � i �n �, ZIP: �� Email and/or Fax :,� PROJECT INFORMATION: �`.� Type of Project: Any earth movement may require � MCWD review&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 � E ` Fax: 952-471-0682 � �Re-roof ❑ Fire Damage www.minnehahacreek.orq Overall Project Description: '1 e�� -{-f- hv,s�,�. G�f{y� ( i (�.,{; -� �.�sl�, �� a Estimated Construction Valuation of Project(excluding land) $ 11 �p�C, �; �� APPLICANT ACKNOWLEDGEMENT: � • Agrees to provide all information required or requested by the Building Department; t� • 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 altemative .� 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. ':� :� A , �z` Applicant's Signature: �� Date: S �Z� � � � x �.` ;,� � :,- >ti. Last Updated: 05-04-2009 '�� ;. : � � �,'�, �—�'4 � : L y i _ .., _ . .. .., .��-�§._. s .wt�3s.zu ax,tE v= ..x �,�.,,�,4§.:xY'E4.y��"1`�.�[:3„.,.Se. � � /V� � r� �`�V DAT TIME CITY OF OR NO CALLED IN l� INSPECTION NOTICE SCHEDULED -� PERMIT NOD�0l4- DGL3SS COMPLETED ADDRESS ��0 i� 7� OWNER T LEPHONE N07 3 �� CONTRACTOR - �; DESCRIPTION �.�.�OL� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICALRI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO ��., COMMENTS: � W a � � O a � O � W � Q � Z W � W � � ��►WORKSATISFACTORY:PflOCEED ❑ PROJECTCOMPLEfE W O�ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFOREC�IERING PERMANENT ❑CORRECT UNSAFE CONDITION WITNIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ IIVSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on site: � Inspector. � White Copyllnspector's File Canary CopylSite Notice