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Home My WebLink About2010-01111 - roofing . . CITY OF ORONO PERMIT NO.: 2010-01111 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 1 U16/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 1090 LOMA LINDA AVE PIN : 08-117-23-23-0010 LEGAL DESC : LOMA LINDA : LOT 009 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 5,025.00 NOTE: TEAR OFF REROOF-ASPHALT SHINGLES APPLICANT pERMIT FEE SCHEDULE 132.75 CMR CONSTRUCTION STATE SURCHARGE(VALUATION) 5.00 8400 NORMANDALE BLVD#920 TOTAL 137.75 BLOOMINGTON,MN 55437- (763)39&7663 Minnesota State License#:20635871 OWNER ICLOCEK,RICHARD&KIM 1090 LOMA LINDA AVE MOUND,MN 55364 AGREEMENT A1vD SWORN STATEMENT The work for which this permit is issued shail 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 are reque�, orrrtazt�e�wrE4�.ille State Building Code.This permit may be rev6�ke t� e for due e.��` � - _ _ i/ � /6 � /a � � l� Applicant Permitee Signature Date Is e By Sig ure Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �.1,'1�,_2010 11:17 5156616336 PAGE 01/01 � City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) Mailinq Addr�ss: Permit number� f�ld—b/� � � ��Q�\ PO 6ox 66 L.. >,•� Crystal Bay, MN 55323-�066 Date received: I b D il �i'�;p�:,:,., �, Received by: i �'� �,, Str�et Address: �� nsr,;,. � `�,� ti l 2750 Kelley Parkway Plan review fee: `�C�yJ �s�'�" °�� Orono, MN 55356 � 9kE$IIOg� /�� ✓ __ . 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 submiited. Incomplete applications will be returned. (Please print) GENERAL INFORMATION� Job Site Address: 0 0 LOm4 l,indct-- - � ound /� 5s3� Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Home? ❑ Yes No If yes,�Spec�al event permit is required with Police DepaRment 9nd City CounCll approve/60 days prloY fo the event. Shuftle bus service Wrll be required unless applicant demonstr�tes sufficient on-site par'king is available. Non•permitted events will not be allowed. CON7RACTOR/APPLICANT INFORMATION: Name: G7�� Cd t A�'tM df' 7�)11Q State License# Z�S / Expirahon Date� �1_ 0 Phone: - - office cell Mailing Address: v 0 Cit : ZIP: ContaCt Person: Applicant is: Contractor Homeowner (Clrcle One) Email andlor Fax: c1�s .L�tc r��3'�Y'G �1S " � " PROPERTY OWNER I�N 1�MATION: Name: Phone (day}� - / a Address� D 0 � ��t : �'1 hd z1P: 553 Email and/or Fax PROJECT IN�ORMATIQN: Type of Projsct: Any earth movement may require MCWD review 8 permits ❑Door(s) ❑ Remodel ❑ Water Damage Minnehaha Creek Watershed District(MCWD) ❑Windo�v(s) ❑ Repai� ❑Storm Damage 1$202 Minnetonka Blvd Deephaven, MN 55391 ❑Siding ❑ Restoration ❑Other: (specify) Phone: 952-471-0590 Fax: 952-471-0682 Re-roof ❑ Fire Damage ___________________.. www.minnehahacreek.orca Overall Project Description: f /'.�e lat.e . .$ Estimated Construction Valuation of Project(excluding land) $ aS APPLICANT ACKNOWLEDGEMENT: .. . Agrees to provide all information required or requested by 4he 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 rejecl it unlil it is complete; . Some or a�l of�he information thal you are asked to provide on this application is classlfied by State law as either private o� � confidential. Privat� data is information which generally cannot be given �o the public bu� can be given to Ihe subject of the 1 da�a. Confideniie� data is informetion which pgnerally cannot be given io either the public or the subjec[ of the daSa. OUr purpose and inlended use of this information is to annually update our records and records of other governmenial agencies re uired b law. If ou refuse to su I the information, the a lication ma not be issued. Applicant's Signature; Date: ^�I f D�� LaslUpdated; 05-Oa-2009 �� J�`y�� DATE TIME ✓ CITY OF ORONO CA�kED IN �I�f�'I� INSPECTION NOT C� SCHEDULED �1-1�1� '___� PERMIT NO. c'.��I �� I � connP�E1Eo ADDRESS � �GII�> � t�r"Y�� 1�['��' � U'�.. OWNER TELEPHONE NO. �7�� 7�'�(�,� CONTRACTOR C G"�� ---��F • v �; DESCRIPTION ' 1 �� `��Ci� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS 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 ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FIN ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES�NO � COMMENTS: � W a � J O ? � � y.- . C ��-C-,'J'< � �-- .,�, 0 � i -� W � _ �� _ - Q � z W � W � � d � ❑WORKSATISFACTORY:PROCEED -�1 PROJECTCOMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CAII INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor on site: " f Inspector. 1 � / `� � � _..� White Copyllnspector's File Canary Copy/Site Notice