HomeMy WebLinkAbout2014-01135 - roofing CITY OF ORONO * 2014 - 01135 *
2750 KELLEY PARKWAY DATE ISSUED: 10/03/2014
ORONO,MN 55356-
(952)249-4600 FAX: 952 249-4616
ADDRESS : 2540 OLD BEACH RD
PIN : 21-117-23-22-0009
LEGAL DESC : SHORE HILLS
: LOT 024 BLOCK 000
PERMIT TYPE MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION $ 3,045.00
NOTE: VALUATION OF PERMIT:$3045.00
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 103.25
BAC CONSTRUCTION SERVICES
STATE SURCHARGE(VALUATION) 1.52 3032 MINNEHAHA AVE. S. MAIL-1N FEE 2.00TOTAL 106.77
MINNEAPOLIS,MN 55406-
() Payment(s)
Minnesota State License#:BUIL-20192062 CREDIT CARD 1160 106.77
OWNER
LEAF,D SCHNEIDER&M
2540 OLD BEACH RD
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.Zpemay be
revoked at any time for due cau6
A
Applicant Pertnitee Signature I essu By Signature Date
Orono
Bufldfng Remit Appffcafi on I> '� I aintenaa'ce'-1 R®pincemant I Ranovatfon
No structural expanzion. 0n1windows boors, aid In re-roof, etc.
Melling Addr ow ,•; ';... :' t;
P-0 Ba 8e
Crystal PAY,MN 1515923-0088
F.
Street Adds I",
$tai,' RT^ ?.;d f�J' ''� `•L;.
' 2780 K II Peryway
Orono,IN 65366
Main:
b12-249-4aoo Feil:': -2 18 +
This application form must be•tem leted In full and all required Iftrmnitbon r>nust be subxini
Incomplete spp I*Mons will be returned. (Pleese pi lbn) e� / '�
GENERAL INFORMATION: (2
Job Site Address: (y Q ��Q��
INll I thiel lets.a Farads of Homes•Refoodsl� howcusO.Horri�s or other.Display Homs? es No
K yam;a spealal event pemnit is n*tquiusd f�DNCs.Lfa and ft Cd0d eppnava160 days pry fo Nie event .8huft bila;•sentb a99 bs
FW"d unless epplfGsnt darnonetr 02 t&mfte Pm%h d i*vwW9bls. Nay-parmOtad etronle wttl not ba alta4vad.
CONTRACTOR/APPLICANT INFORMATION:
Name; A'C �co..
State License iratlon Date: ) /
Lead Certification Number. - —I Explrtrtion•Date:
(for wo►k on honras that wan constructeat jpriori to 1#78
Phone: (call) -(office) ria r.Z - 7 JP & ..5500
Mailing Address: 303 4 CI . 5 ZIP: S 0
Contact Person: b Applicant Is: Cont Homeowner immia one)
Email and/or Fax:
el ge
PROPERTY OWNER INFORMA ON:
Nerve:
Phone(day): A)9- Q4`ar
Address; O 40 14 . City. rn n ZIP; S'S 1
Email and/or Fax
PROJECT-INFORMATION; Overall project d I sari tion: m ;
Typo of Projea�t; Any earth m ment may 'also
.+,quire
❑�Ka) CJ Remodel W Fire Damage MCWD ravlOw.&parmits:
Xwroof,asphalt ❑ Repair Storm Damage Mlnnehaha Greek Watershed-Dletrie (MCWD)
ia2m❑Re-roof,ceder ❑ Restoration Water Demes eeph v nrr MN 5 Blvd
Damage t)aepheven�,MW 55391
❑Re-roof,other(rpeoi y) ❑ Siding Other,(specify) Phone; 962.471-Woo
ow(s) Fax:.962.471.0882
WindEstimated Conoructicn valuation of project( cluding land) $ Al 4 M
,APPLICANT ACKNOWLEDGEMENT:
Agrees to provide all Inf nriallon required or req eaten! by the Building Department;
• Certlfles that the information supplied It true en j correct to the best of hiamer knowledge, The applicant.rempnlzes that they are
solely responsible for aubmift a complete api�hnatlon being Awive that upon failure to do so,the stiff has no sltemetive but to
reject It until It Is Complete;
N Some or at of the information tW..you are adl�vd to provide on this application Is claaslfied by State law as either private or
conildentlal. Private data is It'nfonnetion which'�nZy cannot be given to the public but can buy given to ft.subject of the data.
Confidential data Is tMbmlation vutdch generalire given to wither the.public.or the subject of the date, Our purpose and
Intended use of thee.Imam ation Is to annually te our re=de and records of other governmental agenoles required by low. If
YOU refuse to supoly the 1 rma on the OplicsAM,may not be issued.
Applicant's Signature: 0, Data:
Owner's Signature: per;
Last Updated:031 N013
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