HomeMy WebLinkAbout2010-00221 - roofing CITY OF ORONO PERMIT NO.: 2010-00221
• 2750 KELLEY PARKWAY
r ORONO, MN 55356- �ATE IssuE�: 04/13/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1151 NORTH ARM DR
PIN : 07-117-23-14-0052
LEGAL DESC : SKARP&LINDQUISTS FERNHILL LA
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING- UNDEFINED
VALUAT[ON : $ 1,000.00
APPLICANT PERMIT FEE SCHEDULE 41.25
DAHM, TED STATE SURCHARGE(VALUATION) 0.50
1151 NORTH ARM DR
MOLJND, MN 55364- TOTAL 41.75
PAID WITH CASH 41.75
OWNER
DAHM,TED
1151 NORTH ARM DR
MOLIND, MN 55364-
AGREEMENT AIYD SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is for only thc 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 speciYied herein.This permit will
expire and become null and void if construction authorized is not
commenced within I 80 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 assurin equired inspections are
requested in conformance with the S te Buil �ng Code.This permit may be
revoked at any time for due cause. .
G �'r..� . `r �C'��'� y�� ,��'
Applicant Permitee Signature Date � �
Issued By ❑ature � Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED AB E.
# .
; .
-�- , . City of Orono
' Building Permit Application for Internal Work
= (windows, doors, siding, re-roof, etc.)
�
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; ' Mailing Address: Permit number:
�,L,�,� PO Box 66
�� � 0`� � Crystal Bay, MN 55323-0066 Date received:
�� � ���
� �il a � ��`4,���;� �. � Street Address: Received by:
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� �� � F"' �ti 2750 Kelley Parkway Plan review fee:
�" � �`�kEsxot''� Orono, MN 55356
Total Fee:
�"` Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us
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� This application form must be completed in full and all required information must be submitted. s
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
� � Job Site Address: I j S 1 ����nTt� ,�i-,�r� ��� �'�
�R Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
� If yes, a special event permif is required with Police Department and City Council approval 60 days prior fo the event. Shuttle bus service ill be
k- required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
��=, CONTRACTOR/APPLICANT FORMATION:
Name: ��'Tj ��U�;
" State License# Expiration Date:
�'�; Phone: " (� -0 �� office cell
`'' Mailin Address: <r � �
p�- 9 �U . -Iv;,v� (L_ Cit : ,�� ��c. ZIP: S"'( ,`;
6- Contact Person: Applicant is: Contractor / Homeowner (Circle One)
Email and/or Fax�
PROPERTY OWNER INFORMATION: y-
��` Name: I'�1� �;�-N'V'f
� Phone (day): - -��� —
���' Address: ��1�_ �2 � ,, ��� �i
i IS1 ,�- ��� City' �,�j�-� �J�� ZIP� �� ,�� �
Email and/or Fax
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^„;.; PROJECT INFORMATION:
� �` Type of Project: Any earth movement may require
F'
' ❑ Door(s) ❑ Remodel MCWD review& permits
❑Water Damage
�, Minnehaha Creek Watershed District(MCWD)
�,, ❑ Window(s) ❑ Repair ❑ Storm Damage 18202 Minnetonka Blvd -
t�,� Deephaven, MN 55391
��, ❑ Siding ❑ Restoration ❑ Other: (specify) Phone: 952-471-0590
'�' Fax: 952-471-0682
�' Re-roof ❑ Fire Dama e
, : 9 www.minnehahacreek.orq
�, Overall Project Description: y �Va;> 5�,, _ �,��:� �,,c� � - �� ��c,�t�v�� � � .- �4� ��. _ Lz�d-�
� ; - -
� X Estimated Construction Valuation of Project(excluding land) $�����1 �� � �(��,.,q�Pi- � /abor
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€��"i 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 th ' 'on,the a lication ma not be issued.
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Applicant's Signature: Date: �,3 f�
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`' Last Updated: 05-04-2009
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