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2017-00329 - roofing
� ,� CITY OF ORONO * 2 0 1 7 — 0 0 3 2 9 * 2750 KELLEY PARKWAY DATE ISSUED: 04/06/2017 ORONO, MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 2840 NORTH SHORE DR PIN : 09-117-23-24-0002 LEGAL DESC : LJNPLATTED 09 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-CEDAR ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 21,776.00 NOTE: VALUATION OF PERMIT:$21,776.00 ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICE,PRIOR TO WORK BEING STARTED) MUST PROVIDE COMPLETE SET OF PICTURES OR A FINAL INSPECTION MAY NOT BE ISSUED. SIGNS-ADVERTISING SIGNS MAY ONLY BE ON THE PROPERTY DURING THE TIME THE ROOF IS BEING DONE. ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED. APPLICANT PERMIT FEE SCHEDULE 387.20 STATE SURCHARGE(VALUATION) 10.89 SELA ROOFING&REMODELING,INC. TOTAL 398.09 4100 EXCESIOR BLVD Payment(s) ST.LOUIS PARK,MN 55416- CHECK 37768 398.09 (952)915-7227 Minnesota State License#:BUIL-BC1050 OW1�1ER Three Rivers Park District 3000 XENIUM LA N PLYMOUTH,MN 55441- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry approvals,and the State Building Code. This permit is for on►y the work described and dces 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 specified herein.This permit will expire and become null and void if construction suthorized 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 the State Building Code.This permit may be revoked at any time for use. -�-� , , I Applicant Permitee Signature ate Issued By Sign re Date � !� City of Orono Building Permit Application for Maintenance / Replacement / Remodel — Residential ONLY (i.e. windows, doors, siding, re-roof, etc.— NO STRUCTURAL EXPANSION) Mailing Address: Permit number: �-�-�O PO Box 66 Crystal Bay, MN 55323-0066 Date received: Sfreet Address: Received by: ��, ��' 2750 Kelley Parkway Plan review fee: � Orono,MN 55356 t`��ESHo4� 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 submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: a p Nnr�l� S�w�c riv Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus s rvice will be required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANvT I�NFORMATION: Name: �� �'KS a� ��^��«^�i State License# L IZ 8�I D 5 Expiration Date: 3/31�I�{ Lead Certification Number: N�}T-a5o3�{-01 Expiration Date: �aa�aa (for work on homes that were constructed prior to 1978 Phone: (cell) (office) �jSa- 915-7dd6 Mailing Address: y aa �(�;,� (31,, City:Sf. f.�.��s p�l� ZIP: SSy/(, Contact Person: {,^ Applicant is: Contractor / Homeowner (Circle One) Email and/or Fax: �(K,,�,� (� k 4r, ;,,,q.G,,.,� PROPERTY OWNER INFORMATION: Name: �3ra�( Cl�ouc Phone(day): `la-yyd- N57t Address: a$4D /Uo!'� S�.r� �r;✓e City: br�no ZIP: r�r3r� Email and/or Fax: PROJECT INFORMATION: Overall project description: Type of Project: Any earth movement may also require ❑Door(s) ❑Remodel ❑ Fire Damage MCWD review 8�permits: ❑ Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) 15320 Minnetonka Blvd ,�Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka,MN 55345 ❑Re-roof,other(specify) ❑Siding ❑Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.orq Estimated Construction Valuation of Project(excluding land) $ 'oil�776 =-' 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 required by law. If ou refuse to su I the information,the a lication ma not be issued. ApplicanYs Signature: '��`+� ��6��"�� Date: �/�G�17 Owner's Signature: Date: Last Updated:January 2016 :: . __._,i — ,.,_... . . � � - - - IC{ ; i t 6 � � � . • ;� � . . 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