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Home My WebLink About2009-00531 - roofing CITY OF ORONO PERMIT NO.: 20o�-oos31 , '� 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 08/26/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 1220 LYMAN AVE PIN : 35-118-23-34-0016 LEGAL DESC : LYMAN WOODS : LOT 003 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 8,000.00 NOTE: TEAR OFF AND RE-ROOF APPLICANT pERMIT FEE SCHEDULE 162.25 ROOF COMPANY NA INC. STATE SURCHARGE(VALUATION) 4.00 3560 KILKENNY LN MEDINA,MN 55340 TOTAL 166.25 (763)550-0444 Minnesota State License#:20172153 OWNER BENSON, SEAN&ALISA 1220 LYMAN AVE WAYZATA,MN 55391 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 w� e State Buildin :This permit may be revoke t any time fo e cause. � � ' 7c '6 � /..e.. 8'�a� � Applicant Permitee Signature Date ued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ; .}.:: � � .��s�; '�" .+"- �.1C -�;, �- '�"� r s� .r a,,�"r�.g� � 9-�,', ;:� �F"`€�� r� �� . , . . g , s_„ � �, r�i �' r Y�'-. Y'��` � n° t ,�.z i ' {r�7 3�F`� � � �� 4�r� �_ . City of Orono `�� - � � ,� � � , 2. ' � Building Permit Application for Internal Work �� r� � : (windows, doors, siding, re-roof, etc.) � � �'= Mailing Address: , f� �, �,i,�,��\ PO Box 66 Permit number. �(��✓�_ ,j� � #w7: 0 k� Q .\ Crystal Bay, MN 55323-0066 Date received: � �l,.�U�1 �� e;_;� �� Street Address: Received by: ' � a = �' '''"� �ti r 2750 Kelley Parkway Plan review fee: � � .4 ,. ��3'� �`�gESHo4.� Orono, MN 55356 � � � ' Total Fee: ��p�p,�LJ-J ��' 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: 1 '? 2 v L `/�r-r.Q.-�- ;/�li �%/Zc?,�- cf �� Will this be a Parade of Homes Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No � �s lf 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 unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. � �;. � CONTRACTOR/APPLICANT INFORMATION: �.� �. Name: /�vvf C�.1,�r��-L-`l /�� Z-�z � .- State License# _ �p��7 •z r�-� Expiration Date: 3� :��= 2 0 (b d r �� Phone: J��S�c� -G�/<�N/ (office) cell F� �':� Mailing Address: 1�� l>..�- �i <<-- Cit : ,.vi�r,v�-� ZIP: ��( ) �,; Contact Person: f0 6�1i� '702 • 2 ��- 7 Applicant is: ract / Homeowner (CircleOne) Email and/or Fax: 76 S- �;�''7 �%U 9'� _,, PROPERTY OWNER INFORMATION: �°� Name: � € Phone (day): �� Address: ��z � ��r�,�� ,/,�G-� � Cit : c�Iz�.-z-c� ZIP: �� Email and/or Fax `��s �� ° PROJECT INFORMATION: � � � T e of Pro'ect: � �� YP 1 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 ',i Deephaven, MN 55391 �. � ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590 ;a- g Re-roof Fax: 952-471-0682 ❑ Fire Damage www.minnehahacreek.orq � Overall Project Description: - � Estimated Construction Valuation of Project(excluding land) $ �-> "� �1 Y^ P� �.� APPLICANT ACKNOWLEDGEMENT: ` � • Agrees to provide all information required or requested by the Building Department; � e , • 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 a�ternative � � ,' 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 �ication ma not be issued. � , ;- ��._.--''",_ ! � ��'J :I'.__. l4�i ApplicanYs Signature: ` �j'�� `,��-/�/"�J�f Date: � �6� � � ,� :� Last Updated: 05-04-2009 k; ry '�. �'�. ? . - l ��yi" n „r �',{ i +�x�^k�- Y�'.h. � 'x.Y � , i G. ,. - � e,,. �.,wt!t ...ma+�^'.",��s.A . . ,,.��f-v.��r.��: 'E� h. ,. er+>. ..... f:� ��c�+l.z�'�F .,w�..,s.n.. .. . .�.. .,��, .s �,.:ti�: