HomeMy WebLinkAbout2011-01166 - roofing CITY OF ORONO PERMIT NO.: 2011-01166
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 10/04/2011
(952)249-4600 FAX: (952)249-4616
ADDRESS : 360 ORONO ORCHARD RD S
PIN : 02-117-23-24-0006
LEGAL DESC : REG.LAND SURVEY NO. 1349
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-OTHER
VALUATION : $ 9,490.00
NOTE: TEAR OFF AND REPLACE EPDM ROOF SYSTEM
VALUATION$9490.00
APPLICANT PERMIT FEE SCHEDULE 191.75
OARLOCK-FRENCH ROOFING CORP STATE SURCHARGE(VALUATION) 4.75
2301 EAST 25TH STREET
MINNEAPOLIS,MN 55406- MAIL-IN FEE 2.00
(612)722-7129 TOTAL 198.50
Minnesota State License#:0001423
OWNER
OSBORNE, STEELE B
360 ORONO ORCHARD RD S
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
71/t 421,t
Applicant Permitee Signature Date Issue. .y S' ature 11 ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER t •N DESCRIBED AB tr .
City of Orono
Building Permit Application for Maintenance / Renovation
(windows, doors, siding, re-roof, etc.)
Mailing Address: Permit number:
,�o PO Box 66
/ (3.4
Crystal Bay, MN 55323-0066 Date received:
`, - Received by:
A P v Or ' ti Street Address:
�t ' +;�.�1� �Gti 2750 Kelley Parkway Plan review fee:
t9gE$H�� Orono, MN 55356
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: Alps
/�
Job Site Address: 3/00 Oroj'O O4C/ i ( jO ?t2 (iro, 'o 2"770
Will this be a Parade of Homes, Remodelers Showcase Home Or other Display Home? E Yes D3I No
If 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/APPLICANT INFORMATION:
Name: ("7/ e l / ./4C-A /irr
State License# C _ , Expiration Date: 3- �r-Z
Lead Certification Number: 4 v't ' '-- Expiration Date:
(for work on homes that were constructed prior to 1978
Phone: / -7?) -'7/?? (office) (cell)
Mailing Address: 3o/ F T-f'h 571-, City ,,,,i„( ,/S ZIP: > 4/64.
Contact Person: 7.22/ v �atAdN Applicant is: ontracto / Homeowner (Circle One)
Email and/or Fax: , l ar/O G1C—-rr(NCi - C vm
PROPERTY OWNE NFORMATION:
Name: Qhf- Os hour#e
Phone (day): /02- 50f— 0/3a G
Address: 3/:00 Or o Orcli,rd /�iDa�( City: OrONCj ZIP: 5-535)/
Email and/or Fax
PROJECT INFORMATION:
l Type of Project: Any earth movement may require
❑ Door(s) 0 Remodel ❑ Fire Damage MCWD review&permits:
Minnehaha Creek Watershed District(MCWD)
❑ Re-roof, asphalt ,Repair ❑ Storm Damage 18202 Minnetonka Blvd
El Re-roof, cedar ElRestoration ❑Water Damage Deephaven, MN 55391
s ecif (specify) Phone: 952-471-0590
Re roof, other
(specify) 0 Siding 0 Other: Fax: 952-471-0682
EP.2ii'7 ❑Windows) www.minnehahacreek.orq
Overall Project Description: •14cf�1(h (;e, E.P YI1 ',
Estimated Construction Valuation of P'r`oject(exclu� land) $ (/ ��J CU
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,tiJthe application may not be issued.
Applicant's Signature: el 4' -/' 2�'/1�; - Date: � /�
Last Updated: 08-09-2011 I