HomeMy WebLinkAbout1993-005705 - tear off PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway • P.O. Box 815Permit Number: i..)i LU I NG
Orono, Minnesota 55356-0815 Date Issued: r
(612) 473-7357 1 `'��'/�'�'
SITE ADDRESS:
500 ORONO ORCHARD RD S
JB
P . . N.. . 02-117-23-31-0049
DESCRIPTION:
TEAR OFF
Building Permiit. Type SF-ADD/REMODEL
Building Work Type RE-ROOF
CITY OF ARM
FINANCE OFFICE
1313100000 #
01 GEN 54.00
12«00004 #
01 GEN 1.40
CHECK Ti 55.40
RECEIPT-THAW YOU
#290.60 0001 R01 713.3
REMARKS: . 11/02'93
I'i FEE SUMMARY:
VALUATION $2,:300
Base Fee $54 . 00
Surcharge $I.-4Q
Total Fee $55 . 40
CONTRACTOR: - App 1 i cant. - ST . LIC- .OWNER:
RIGHT GHT WAY ROOFING 15578678 3999 LA I NG _FAME'S; 1
11304)4 RED FOX DR 50t) ORONO ORCHARD RD '
MAPLE GROVE MN 5536 WAYZATA MN 65391
(61 2) 557-8675
THS UNDERSIGNED HEREBY RE U ;TS PERMISSION TO MAKE . THE REAL I�ROVEMENTS
ECS, QED AND 4A ,. ',.....::",j'",16:-'00LL WORK IN STRICT CONK-IANCCE WITH ALL CITY OF
- it "',i N1 _ r DI ES ` : , TE MINNESOTABUILDING CODE REQUIREMENTS
APPLICANT/PERMITEE S`ATURE ISSUED BY:SIGNATURE
• ;A CITY OF ORONO - BUILDING PERMIT APPLICATION
Total Fee: $ Date Received:
Date Approved:
Entered By:
Permit#:
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
(See Check-off List Enclosed)
'ME APPLICANT IS: (circle one) OWNER - CONTRACTOR
JOB SITE ADDRESS: S vv 0rDA-3 6 i ZIP.
(work)
NAME OF OWNER: La.:1A1-‘2- PHONE: (home)
MAILING ADDRESS: (,16- CITY: ZIP:
TOR: 1 ezi.4,/, PHONE: �3- ) - Y`,6r) 7CONTRAC QN ADDRESS: � 3LI q ��--e--r. Y()l CITY: I2 4,/, (J /" ZIP: `3S ),-6.57
MAILING
STATE LICENSE: # . 9.‘c7 1
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration
PROPOSED WORK (describe in detail) : �� Ye �D d r
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land) : $(.2 8D(
vm,
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not - perm ' t and ork is not to start without a permit; and
that the work will be n .cco dance ith the appr, ed plan.
APPLICANT'S SIGNATURE:,�� �' ,, .I DATE:
CITY of ORONO
(+[y Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
OF-CIFIONCE On the North Shore of Lake Minnetonka
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of
data", we would like to inform you that your request for a permit or
license from the City of Orono or any of its departments may require
you to furnish certain private or confidential information.
You are notified that:
1. The information you furnish will be used to determine your
qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or license.
3. The information may be shared with other local , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review private
data on yourself.
6. Your full name is required to process this application or
permit. r
1p l Y� v�� v' .,-.42-trk-'FirstGMddlek1(-4
Last
pe,
I r.2) D (-( r, ,,,,,_
D r -
Add s
G.- (1:r6")J-k--- 4)
i iA4 Zip
City State
1)-5- *) — <64 7 r
Phone
derst d my , fights as stated above.
I .
c
Signatfre
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358
• PUBLIC WORKS—473-7359
ASSESSING