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� , CITY OF ORONO PERMIT NO.: 2011-01129 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUEn: 09/28/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4160 FOREST LAKE DR <br /> PIN : 07-117-23-11-0003 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : ROOF[NG -ASPHALT <br /> ACTNITY : O/S BU[LDING-UNDEFINED <br /> VALUATION : $ 8,000.00 <br /> NOTE: VALUATION OF PERMIT: $8000.00 <br /> ROOFING PERMITS ISSUED WITHOUT ENOUGH NOTICE FOR TEAR OFF INSPECTIONS. (WE REQUIRE 24-48 NOTICG, PRIOR TO <br /> WOKK BGING STARTGD) MUST PROVIDE COMPLETE SET OF PICTURES OR A PINAL INSPECTION MAY NOT[3E ISSUED. <br /> SIGNS-ADVERTISING S[GNS MAY ONLY BE ON THE PROPERTY DUR[NG THE TIME THE ROOF IS BEING DONE. <br /> ONCE WORK IS COMPLETED THE SIGNS MUST BE REMOVED. <br /> APPLICANT PERMIT FEE SCHEDULE 162.25 <br /> JENSEN CONSTRUCTION SERVICES LLC STATE SURCHARGE(VALUATION) 4.00 <br /> 2620 GRANGER LN TOTAL 166.25 <br /> MOUND, MN 55364- <br /> (952)472-7223 PAID W[TH CC# 3589 <br /> Minnesota State License#: 20639601 <br /> OWNER <br /> GOLDEN, LYNN &TIMOTHY <br /> 4160 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AIVD SWORN STATEMENT <br /> I�he work for which this pennit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. "This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> pennits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuancc,or if construction is <br /> suspended for a period o1�I 80 days at any time at[er work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked t any time for due cause. <br /> V� � � � 2 `3�'����/ �/ <br /> Applicant Permitee Signature Date Issued y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />