HomeMy WebLinkAbout2017-00343 - roofing 1'i'I'I!'I!L!I'I''Ili II II ICI II I L!II!I!
CITY OF ORONO * 2 0 1 7 — 0 0 3 4 3
2750 KELLEY PARKWAY DATE ISSUED: 04/11/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 825 OLD CRYSTAL BAY RD S
PIN : 09-117-23-21-0001
LEGAL DESC : UNPLATTED 09 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-CEDAR
ACTIVITY : 0/S BUILDING-UNDEFINED
VALUATION : $ 5,530.00
NOTE: VALUATION OF PERMIT:$5530.00
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 139.36
STATE SURCHARGE(VALUATION) 2.77
LES JONES ROOFING INC. MAIL-IN FEE 2.00
941 W 80TH STREET
BLOOMINGTON,MN 55420- TOTAL 144.13
(612)881-2241 Payment(s)
Minnesota State License#: BUIL-6560 CREDIT CARD 2821 144.13
OWNER
DAYTON,JUDSON&ELIZABETH
121 S 8TH STREET#860
MINNEAPOLIS,MN 55402-
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.
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Applicant Permitee Signature Date Issued y Signature Date
04!,10/2017 12:56 Les Jones Roofing, Inc. (FAX)9528817009 P.003/003
City of Orono
Building Permit Application for Maintenance/ Replacement/ Remodel -- Residential ONLY
(i.e.windows, doors, siding, re-roof, etc. —NO STRUCTURAL EXPANSION) #25789
A, Mailing Address: Permit number: -20/ j ( '
{VO PO Box 68
Crystal Bay, MN 55323-0066 Date received: 4'—/1_` 7
Street Address: Received by:
y 2750 Kelley Parkway Plan review fee:
'�t �� Orono, MN 55358 ,
1k@S hi 40. Total Fee:
Main: 952-249-4600 Fax: 952-249-4818 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: 825 Old Crystal Bay Road
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes ❑ No
If yes,a special event pemtit 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 parting is available. Non-permitted events will not be allowed.
CONTRACTOR l APPLICANT INFORMATION:
Name: les Jones Ronfinn inn
State License# 6560 Expiration Date: 3/31/18
Lead Certification Number: NAT-4n177-2 T Expiration Date: 5/28/20
(for work on homes that were constructed prior to 1978
Phone: (cell) 612-237-1988 (office) 952-881-2241
Mailing Address: 941 W. 80th Street Cgton, MN ZIP: 55420
Contact Person: Christy Anderson Applicant is: Contractor / Homeowner (circ/.one)
Email and/or Fax rhriAmelfissjnngAmnfino rnm
PROPERTY OWNER INFORMATION:
Name: Judd Dayton
Phone (day): R12-FIR7-4427
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Overall project description:, Re-roof gazebo only.
Type of Project: Any earth movement may also require
ElDoor(s) ElRemodel ❑Fire Damage MCWD review&permits:
ElRe roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD)
15320 Minnetonka Blvd
2 Re-roof,cedar ❑Restoration D Water Damage Minnetonka, MN 55345
❑Re-roof,other(specify) LI siding ❑Other: (specify) Phone: 952 71-0580
Fax: 952-471-0862
❑Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $ 5.530,10
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
you refuse to supply the information,the application may not be issued.
Applicant's Signature: ��...cQH �s Date: 411n117
Owner's Signature: _ Date:
Lest Updated:January 2016