HomeMy WebLinkAbout2015-00219 - roofing CITY OF ORONO1 1
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2750 KELLEY PARKWAY * 2 0 1 5 - 0 0 2 1 9
DATE ISSUED: 02/24/2015
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 450 OLD LONG LAKE RD
PIN : 36-118-23-34-0014
LEGAL DESC : SUMMIT STATION
: LOT 007 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
VALUATION : $ 35,000.00
NOTE: VALUATION OF PERMIT:$35,000.00
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 546.55
STATE SURCHARGE(VALUATION) 17.50
ANCHOR ROOFING&EXTERIORS TOTAL 564.05
7197 MONTROSE RD Payment(s)
WOODBURY,MN 55125- CHECK 3004 564.05
Minnesota State License#: BUIL-689351
OWNER
POLICINSKI,CHRISTOPHER&ANNE
450 OLD LONG LAKE 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 assurin all required inspections are
requested in confo ce with e S Building Code.This permit may be
revoked at+ yti for due ca e.
212,6' ,�
Permitee Signature Date Iss d Signature Date
ApFRc. gn By Sm
1 a,
City of Orono
Building Permit Application for Maintenance / Replacement / Remodel
V.e. vifirndoves, rocas, sod6m;, re-Fool, etc. — NO STRUCTURAL 1RAL E PANS Pi)
�O A: Mailing Address: Permit number. I rU-0021
. 1 k 1 V1 PO Box 66
(-1-74
Crystal Bay,MN,55323-0066 Date received: 219311C‹
M Street Address: Received by:
� 2750 Kelley Parkway Plan review fee:
4Orono,MN 55356
Total Fee: DU4c ° 1
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: ,l�� 4( LDn l p L_- n /'
Job Site Address: ,�L rl✓ L /� K�.
Will this be a Parade of Homes, Remodelers Show se Home or other Display Home? 0 Yes No
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus seg
wrll be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR I APPLICANT INFORM 1ON:,
Name: 110044J5 eletMzeS
State License# gd_ t7 5. 1 Expiration Date: .3-3/ZO/(o
Lead Certification Number: A 7 _ /ZZ i Expiration Date:
(for work on homes that were constructed prior to 1978 1 P �w 7— ZO /
Phone: (cell) (P fZ —36,3 - 7 yy3 (office) c if--
Mailing
Mailing Address: 7/97 MOA)77205e 1-)- Ci • etix,/ ZIP: j /ZS
Contact Person: jf� 1 f)DadA-3 Applicant is: ontracto)I Homeowner (Circle once)
Email and/or Fax: Si,6 amch,c„,, `oo 5 thrL.(O A4
PROPERTY OWNER INFORMATION: / '/ ` ,O
Name: I(JgrS i IA AJIAIE Poiieinskr ( �(.IJQt i�GAu ice ) (�/2-3 6 J4L 3
Phone(day):
Address: j'j d .s al Ca • 11 - City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Overall pro'ect description: k'e —e
Type of Project: Any earth movement may also require
ElDoor(s) ❑Remodel 0 Fire Damage MCWD review&permits:
❑Re-roof,asphalt ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD)
18202 MinneBlvd
121/Re-roof,cedar 0 Restoration ❑Water Damage Deephaven,MNka 55391
❑Re-roof, other(specify) ❑Siding 0 Other: (specify) Phone: 952-471-0590
Fax 952-471-0682
0 Window(s) www.minnehahacreek.orq
Estimated Construction Valuation of Project(excluding land) $
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 p ation,the agplition may not be issued.
Applicant's Signature: ...4,<- r...L Date: c3-/6- 201.5
Owner's Signature: Date:
Last Updated:January 2015
Z.d LZTv-£617-699 uoweal