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Home My WebLink About2009-00692 - roofing CITY OF ORONO PERMIT NO.: 2009-00692 *� 2750 KELLEY PARKWAY '` ORONO, MN 55356- DATE ISSUED: 10/14/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 180 LEAF ST PIN : 04-117-23-22-0025 LEGAL DESC : SWAN LAKE 2ND ADDN : LOT 001 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 4,144.00 NOTE: TEAR OFF AND REROOF APPLICANT pERMIT FEE SCHEDULE 118.00 GARLOCK-FRENCH ROOFING CORP STATE SURCHARGE(VALUATION) 2.07 2301 EAST 25TH STREET MINNEAPOLIS,MN 55406- MAIL-IN FEE 2.00 (612)722-7129 TOTAL 122.07 Minnesota State License#:0001423 OWNER HEALEY,THOMAS 180 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 dces not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or�ot 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�lie State Building Code.This permit may be revoked at any time for due cause. ` �, / / / / Applicant Permit�ture Date Issued a y ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER N DESCRIBED AB V . . - � City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailing Address: Perrnit number: ' O��,�.0 PO Box 66 ,: y Crystal Bay, MN 55323-0066 ,aate'.reCeiVed;' , a �, Street Address: ��4��bY� r �'�, Gtiti 2750 Kelley Parkway Plan revi�vv fe8: ��ESHO�`'� Orono, MN 55356 ��t8��: � 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: Job Site Address: �� ,��Q� ��-�� /� �� ,�5�S!f Will this be a Parade of Homes, Remodelers Showcase H e or other Display Home? Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required un/ess applicant demonstrates s�cient on-site parking is available. Non-permitted events wili not be allowed. CONTRACTOR/APPLICANT INf�ORMATION; Name: /"� /�- r �! State License# Expiration Date: p Phone: -o? � - office cell Mailing Address: Cit : ,- ZIP: � Contact Person: Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: t - ' PROPERTY OWNER FORMATION: Name: �tl� � . Q ,C Phone(day): ( - -. S Address: �p '�� Cit : � .c ZIP: ,s�,.s"� 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 Fax: 952-471-0682 Re-roof ❑ Fire Damage www.minnehahacreek.orq Overall Pro'ect Description: ar YC- � Estimated Construction Valuation of Project(excluding land) $ , " - OQ 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 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: / /7/� -T Last Updated: 05-04-2009