HomeMy WebLinkAbout2017-01316 - roofing CITY OF ORONO I 11 II 11111111111
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2750 KELLEY PARKWAY DATE ISSUED: 10/13/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 3466 IVY PL
PIN : 20-117-23-43-0006
LEGAL DESC : SPRING PARK
: LOT 010 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 11,807.48
NOTE: VALUATION OF PERMIT:$11,807.48 ASPHALT REROOF
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 232.30
GATES GENERAL CONTRACTORS STATE SURCHARGE(VALUATION) 5.90
3500 VICKSBURG LANE N TOTAL 238.20
SUITE 400-351 Payment(s)
PLYMOUTH,MN 55447- CHECK 42309 238.20
(612)723-6345
Minnesota State License#: BUIL-BC006793
OWNER
TUCKER,GARY
3466 IVY PL
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 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 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
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. j
e 1-k1'
Applicant Permitee Signature Date Issued By gnature Date
City of Orono
Building Permit Application for Maintenance/Replacement/Remodel — Residential ONLY
(i.e. windows, doors, siding, re-roof, etc. — NO STRUCTURAL EXPANSION)
��!V Mailing Address: / k
DI 3/,
PO Box 66 Permit number:
Crystal Bay, MN 55323-0066 Date received: �� �j'��O
Street Address: Received by:
y� G� 2750 Kelley Parkway Plan review fee:
t k Orono, MN 55356
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Total Fee:
AaP\DMain: 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: ( G ✓ p/ ,
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 1:1446-
If
N6If 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/APP N'eA.OR�p.":),x0r444� s ' /Name: /V� G • -,),c1-
State
/
State License# C 0-0 Expiration Date: 3 o
Lead Certification umber: 5/z3 5-p-/ Expiration Date: � Z0
(for work on homes that were constructed prior to 1978 J
Phone: (cell) A/2„,_.72.3__6,3 teir (office) t f
Mailing Address3S00 Ui7/ i3v L / fv,;` 1"04-35/ City: moi/974 ZIP: 7
Contact Person: % c_,___ Applicant is: rac r Homeowner (circle One)
Email and/or Fax: -t(,- -to q f--- 77/0
PROPERTY OWNER INFORM TION:
Name: —1.--V
Phone(day): to/Z 5-7S --6 ( 9'.
Address: 7?'f''1'1`' /�i�I(2,1,1 City: ZIP: _ 3,q
Email and/or Fax:
PROJECT INFORMATION: Overall project description:
Type of Project: Any earth movement may also require
❑ Door ❑ Remodel ❑ Fire Da MCWD review&permits:
e roof,asphalt ❑ Repair orm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
❑ Re-roof,cedar ❑ Restoration ❑Water Damage Minnetonka, MN 55345
❑ Re-roof,other(specify) 0 Siding ❑Other: (specify) Phone: 952-471-0590
Fax: 952-471-0682
0 Window(s) www.minnehahacreek.org
Estimated Construction Valuation of Project(excluding land) $ // iiiO .------,----y-y
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 inf. ••: ••.n is to annual) update our records and records of other governmental agencies required by law. If
you refuse to su•• • - in .rmation,the ap./atio ma not be issued.
Applicant's Signature: Date: /0 L3_42___
Owner's Signature: Date:
Last Updated:January 2016