HomeMy WebLinkAbout2009-00123 - roofing CITY OF ORONO PERMIT NO.: 20o9-ooi23
� - 2750 KELLEY PARKWAY
` ORONO,MN 55356- DATE ISSUED: 03/26/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3533 LIVINGSTON AVE
PIN : 17-117-23-43-0045
LEGAL DESC : NAVARRE HEIGHTS
: LOT 004 BLOCK 004
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 3,800.00
NOTE: RE ROOF
APPLICANT pERMIT FEE SCHEDULE 103.25
MARK OSBORNE CONSTRUCTION STATE SURCHARGE(VALUATION) 1.90
1211 OLIVER AVE.N. MISC FEE 0.00
MINNEAPOLIS,MN 55411-
(612)250-5060 TOTAL 105.15
Minnesota State License#:20143166
OWNER
SANDLER,STEVEN&KATHRYN
3533 LIVINGSTON AVE
WAYZATA,MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this pertnit is issued shall be performed according to
the approved plans and specifications,applicable Ciry 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 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 State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
City of Orono
Buildin Permit Ap lication
O���O ��PO 8aa 66� Parmik numbsr.
Cryeoal 9ay, MN 09323-0066 Osts roeeivsa;
" Stnart Addrosa: ReosNed by:
� � 2T50 Kdley ParltwaY Plan revlew�ee:
'�a� Orono,MN 55358
_ = Totel Fee:
Maln: 932-248�4800 Pax: 852•249�4818 www.d.orona.mn.us
hie applfcation form must be compleled In full and all reQulred irnormation must e suDmtttea.
Incomplebe appllcatlon�wlll Ae returned. (PI9As9 pl�nq
GENERAL INFORMATION:
Job Slte Address: 3S S' 3 j L;�; s kw f��•t OITw+ >►-,,�•S 5 3Gy
Will this be a Parade of Homes, Remodelers Showpse Home or other Display Mome? � Yes No
Hyss.a apselN s►bM oennl!la�epdrsd wYlh Adios Cspsrhnenf end Cib�Coundl�paroNeJ 60 Qeys prlor te the erv�nt Shufds bun bwvtm wip he
/�GUN'ed unlass AGDIf�It doYnansbaaas atAlici�t on-el(91�8/IdnC It eValleDle, Non•OSRnlflltl 6VAnts►WA not be aYowed.
CONTRACTOR/AP UCMIT INFURNATION:
Neme: 1CIC �S!3C/i /JE QuK,�`�f s'u.1-'F�a,L'
8tale Llcense# �C l iI.7/�.E� EXplratlon Date: 3- �•-/�
phone: I t� 'o c` ofAce) � (cell)
Malling Address: i t t�S Y�'. ,�,�,+ r-._. City: /!�v+ti.s�� 21P: S'���r L
Contact Person: :-n �� Applieent Is: Contra or ! Homeowne� �cra.on.�
�mail and/or Fax: �,�,,d� �t►LR1 c«s ,N�r�
PROPERTY OWNER INFOIZMATION:
Nema: S' . � a...l •. �R s
Phone(da�: i— I - G Z
Address; 3 f �. ��' v�= Clt : � d ZIP: S.3'4.S/
Email andlor�ax
PROJECT INFORMATION:
� � Aror anh mw�m�t msy nquln
MCWD rwi�w i p�m�ib
Q Door(s) �Remodel ❑Waea►�amsge
� MinneNaha Greek Wacerehed Distric[(MCWO)
D Window(s) Q Repair . , • �Stenr+Demape 4A202 Mim.bonlo.61vd
Daephave�,MN 55381
�3iding �Restoration �Othar.(apecity) Phone: 9�2-4T1-0580
Fex: 952�71-0882
R�root 0�Ire Damage w�w�w.minnshahpereak.ora
Orcra�l ProJoet�asorlptlon:
Estlmated Constructlon Valuatlon of ProJect(oxeluding land) i 3��•b°'
APPLICANT ACKNO DOEMENT:
+ A9rees b pre�ride all in(omwNon requirod or roquoatod by tho Buildina Departrnent
• Cenifles Utet fhe irifOmiatlOfl supplieC Is true s�oOfisCt lo tl1e DeSt of hlslll�k1aNAadga. The�pplieant rar�gnizas tl�a!Ihay
aro aolsly rosponsible for auhmitiing a oomplets Applioddal being awere that upo�failur.to do 90,tha sis1T haa no altsrhA�iVs
but eo r'ejeot it until i!is oo►nplate;
• Some or all of the Mametlon tl�af you ara ask�d In previds on lhis 6�ppflcad4f'I i�d6leslfied by SEate law ae afher privabe or
corrfide�mial. Prlva[e dafa is iMorrnstlon which pansfaily cannot ba 91ven lo Ihe Dubllc but can be giwn to me sue�eet of the
daM, CoMidential daW is iMonnetlon whiolt generolly aannot bo giv.n to sifher the publia or Ihs subjeet e1!he dafa. Ou�
puqwsa end intended use ef fhis IM�nnnetlen ia 6o annually updrti.our r+.00rd+c and reoonla aT olher qovemmeMal agencles
required by law. It you refuse to supply tAe iMorrnation,ths applir,Ation may not bs issuod.
AppQc�nt's 3igna[ure: _ _"_ _ Z� � � -�� " ^ Da�te: 3��Z 5 '—�`l
�Fa�l
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