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Home My WebLink About2011-00540 - roofing CITY OF ORONO PERMIT NO.: 20��-oos4o � 2750 KELLEY PARKWAY � ORONO, MN 55356- DATE ISSUED: 06/28/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 550 PARK LA PIN : 06-117-23-41-0099 LEGAL DESC : MINNETONKA SUMMIT PARK : LOT 000 BLOCK 007 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT VALUATION : $ 12,837.00 APPLICANT pERMIT FEE SCHEDULE 233.59 HOME DEPOT AT HOME SERVICES STATE SURCHARGE(VALUATION) 6.42 2690 CUMBERLAND PKWY SUITE 30 ATLANTA,GA 30339- MISC FEE 0.00 Minnesota State License#:20268257 TOTAL 240.01 OWNER DUENOW,KAREN �nn�S 550 PARK LA LONG LAKE,MN 55356 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 dces not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if consWction 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 aRer 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. �l��.� GYL l l l l Applicant Permitee Signature Date I s s u e d B y n a t u r e D a t e SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . � City of Orono Building Permit Application for Internal Work (windows, doors, siding, re-roof, etc.) —` Mailing Address: Permit number: /,�L,Q J►� PO Box 66 y �V Crystal Bay, MN 55323-0066 Date received: � :.. 0 �" ,� Received by: �� Street Address: a r�� ?._ a. ,� , l�',�+. �� G� 2750 Kelley Parkway Plan review fee: �t�xtiEx;i�ilo�v Orono, MN 55356 , SH ./ ---__-- 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:55 O PQ r � �Q /� Q Job Site Address: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No /f yes,a specia/event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuttfe bus service wi//be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not 6e allowed. CONTRACTOR/APPLICANT INFORMATION: Name: THD At- Home Services, Inc. od� m F��t� Jo�l�s State License# 2690 Cumberland Pkwy, Ste 300 �'s a 9 y • G oy� Phone: (cell) Mailing Address: Cumberland Office Park ZIP: Contact Person: Atlanta, GA 30339-3913 lomeowne� (Circte One) Email and/or Fax: Lic#20268257 Ph. 763/ 542-8826 PROPERTY OWNER INFORMATION: Name: (�P n 1? �r� Q Phone(day): C Q /1 Address: 5 i a � 7�!� �?q� �� Ciry: � �� A �l ziP: 5S 3 5 4 Email and/or Fax PROJECT INFORMATION: Type of Project: Any earth movement may require MCWD review&permits ❑ Door(s) ❑ Remodel ❑Water Damage Minnehaha Creek Watershed District(MCWD) ❑Window(s) Repair ❑Storm Damage 18202 Minnetonka Blvd Deephaven, MN 55391 ❑Siding ❑ Restoration ❑ Other:(specify) Phone: 952-471-0590 Fax: 952-471-0682 e-roof ❑ Fire Damage www.minnehahacreek.or Overall Project Description: � -�`o 0 0 u 4 o F r� s i Estimated Construction Valuation of Project(excluding land) $ o�, 3 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 re uired b law. If ou refuse to su I the informati n,the a lication ma not be issued. ApplicanYs Signature: .� Date: �` �� // � Last Updated: 05-04-2009 Construct�on Codes and Llcenslnp DWisfon "'v' MINNESOTq DEPARTMENT OF Pl�one: (651)294-503�I �• :l Email; dli.license _9tate.mn�d5 �,� l..AE30R 8e �NDUSTRY websKe; www.dll.mn.qovicci�� ' CON97'RUCTION CODE9 ANo LICENSrNG Po eox 6aa�� 9T.Pq.UL.� MN� 5516d.OQ 17 NOTICES LICENSE IS NOT TRANSFERABL� THD AT HOME SERVICES INC CHANGE OF BUSINESS STRUCTURE HOME DEPOT/1T HOME SERVICES THE YOU MUST GET A N�W LICENSE 2690 CUMBERL.AND PKWY STE 300 ATLANTA, GA 30339 A CHANGE IN INSURANCE pOLICY REQUIRES A NEW C�RTIFICATE OF INSURANCE TO BE FI4ED YOU MUST�11�O�TIFY THE dEPARTMENT O�CHANGES IN Yt�UR UG�I�f,S�p BUSIN�SS :;:`: F��i��,10 dq sCi,sudje+�ts'you�to admihlstrative penalties of up ta��1d,ffi30 � 15-bav`NotCllca�ion Re�:ulf`ement. LlcensAd contrectors must notf'ty LJLI)I�W[�ing Wi�hln'15;days of tfie tlate that any of the rollowing chahgbs to tha�ticense oc"�i��dunng the license perlod_ Information an�i�brlms to melKe charlg�s to the'ffCense are available online at ww�t�r.dli.mn.qov/c�Jd/LlcUpdatQ,,asa. . - • Licensed busin4g�"physi��l street�lddi�'��s�phona liumber, and mailing address. • Change In lice�r��d"ctsntrt��Mr'�tb�lfin(,:pwtt�eeshjp�offlce�s ar directors. • Change In licens�ed:conCr�ctqr's;::leg�l name arti�1ld�assumed name. • Loss of or thang�;ifi`Qualify�ng`Peir�on. . _ Judqmcent D�bkor Notice. �irensed controcbors must notlfy DLI in wkitih�with��C�,days>Of.th'e;,findinA that t�he contractor is found to ; , be a•Ju�gmenk debtqr bas�d:r�pon conduct requiriny licensure per Minn SCat.§�3ZHE'�b0�;f�'�6�:885 ., �ankrWp�cv f��tltion Filin�Notice, �icensed coMractors must noM"y�I�L{>in`wrltln�vi►N�m 1S�days o�fllirtig a petition for bankruptcy. .. . � .. . �onvictlon Notice. Licensed contractors must nohfy DLI in writing Wlthin 10 days if the Ifcensee has been found gui(ty oF a Felony, gross misdemeanor,misdertt��tta� dr a�ry�otnparabl�offA�l�relat�d to residentfal cortitracting,includih��cor�riations of Frdlud misrApreseMation,misuse tS�funds,theft;erilly�nal.sex��f coh�tlCl.Ct��`assauft,burglary,conversion of funds,+br'�th�ff otprpcaeds m thls'or any othe�state or any othef.lJi�it�3�tes JurfSdi�tio�t; ' . , t . ' _ , _ Your�license c�rtifcatR Is�telow the perforation. Show Ifcense ce�t�Tlcate fo when oE�tainfng;.buildittg permlts `'' `"'' Ctrnst(�;rCttan �odes aridLicensing Division �` � MiNNRl07A oEPi►RTMEM'ov �� T�1� I��OIYEr�''. GCJ� 284`�ti3c1 , ; . : :: P � ) , , LdBO�t&IfYDUSTRY , co.+eneucnon coveg�Mo uccNe�No E-ma�l address: dli.license�state.mn.us no wox 6e.z» • :�;> ar.rw��,MN, ss�e�,a�» Wekisite address. itiww dh:i�nri:aovlc�cld"as� . Y . _ ,,;. ... ..,: . . .:. , _ --:;. . _ <, : � ��(3ESI��EN't`�AL REIVIODELER LICENSE � , Legal Nai�tie> XHD AT HOME SERVICES INC ' �us'Iness SErU�ture: DBA: HOME DEPOT QT HOM�SERVICES THE � CORPORATION Address� 2690 CUMBERI.AND PT�WY S'fE�0�0: ATLANTA, G�R 3U339 '" _:, ,: .... .;: „ . _ ,. . , Licen9e Identiflca6on Numbar. 20268257 Licertse Expira�tlon':I]ate • :.b3/31/2p13 Qualifymg Persan:" ;gOYD A UPHAM , � �, HDME DEPOT r^''t C'`' u' �1/�4/2811 16: 11 76354_8_^_7 coo��t �uioi •� J. � � �+ I �+I 7'�11�` �•4 � -�,�A". I�1 � � • t �'�{ u � .. C . 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'�'� ' C' f U W � �...,,'(�� . Q � z W � W � � GW ❑WORKSATISFACTORY:PROCEED �OJECTCOMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDIT�ONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ iNSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site• Inspector. � �, S White Copylinspector's File Canary CopylSite Notice