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Home My WebLink About2004-P08012 - re-roof PERMIT C�T�iI'' OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 Posoi2 Crystal Bay, Minnesota 55323 Permit Type: Mi�or aiteranon� (952) 249-4600 Date Issued: 9i3oi2ooa SITE ADDRESS: 2055 Salem Ct I.ong Lake,MN 55356 P I D: 27-118-23-34-0008 DESCRIPTION: Proposed Use: Residential Permit Class: Building Census Code O/S-Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: T__"./1CC=::1 T_T::1` FEE SUMMARY: Pernut Fee: $ 237.25 Valuation: $ 13,700.00 State Surcharge Fee: $ 7.35 TOTAL FEE: $ 244.60 APPLICANT: Foss Extrer�' r�s OWNER: Robert&Jane Beach 1891 ��'b2i Circle 2055 Salem Ct Waconia,MN--33339' Long Lake MN 55356 $53FS7 THE UNDERSIGNED HEREBY REQUESf S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �� APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Couies: 1-File(Si�nitures Required), 1-Avplicant, 1-Monthlv Reports, 1-Assessin¢, 1-Finance Page 1 � � Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: �` OS S ��.� ��V rL ZIP: S S 3��-P Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: ,�C�'F'' �-c.S"17iJ� PHONE: (home) ��3-� �S� �;3-�Z� (work) �l'SML - �'17�0 '�2-'l� MAILING ADDRESS: �- s�r� C�,,�,� CITY: � ZIP: �S 3 5'� CONTRACTOR: 5� ��u-�v�.5- PHONE: �17� Z��°I—Su�9 CONTACT PERSON: �u-.�� ss MOBILE/PAGER: C��..L2g-�G�4 MAILING ADDRESS: /8al 5w,r��,oc_ G� CITY: li✓!�►c.�,�.,,� ZIP: i1l 5 S�'� STATE LICENSE: # ?��y38 Dy2 ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration� Land Alteration PROPOSED WORK(describe in detai�: T'E1q�,-�,�p- � �'c�'�� STORIES: �� SQ. FEET OF EACH FLOOR: /SJJ� NO. OF BEDROOMS: � GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �,�d v � I hereby apply for a building permit and I aclrnowledge 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 a permit and work is not to start without a permit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: GI�3o�v�J � * Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. Type of data. The rights of individual on whom the data is stored or to be stored ahall be as set forth in this section. Subd.2. [nformation required to be given individual. An individual asked to supply private or rnnfidential data concerning himself shall be informed of: (a)the purpose and Intended use of the requested data within the collecting state agency,political subdivlsion,or statewlde system;(b) �vhether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confdential data;and(d)the identity otother persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement oft�cer. The rnmmissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or aro�ertv tax refund instructioas instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be inCormed whether he is the subJect ot stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public dsta on individuals shall be shown the data without any charge to him and,if he desires,shsil be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to thls section is pending or additional data on the individual has becn collected or created. The responsible authority shall provide rnpies of the private or public data upon request by the individual subject of the data.The responsible authoriry may require the requesting person to pay the actual rnsts ot making,certifying,and compiling the copies. The responsible authorlty shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the reques[,excluding Sa[urdays,Sundays and legal holidays,if immediate rnmpliance is not possible.[f he cannot rnmpiy with the request wlthin that time,he shall so inform the lndlviduul,and may have an additianal five days within which to comply with the request,exciuding Saturdays,Sundays and legal holidays. 5ubd.4. Procedure when data is not accurate or rnmplete. An individuei may contest the accuracy or completeness of publie or private data concerning himself. To exercisc this right,an individual shail notify in writing the responsible authority describing the nature of the disagrcemenG The responsible authority shall within 30 days either: (a)rnrrect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or inrnmplete data,including recipients named by the indivldual;or(b)notity the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individusl's statement ot disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. 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. Z. 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(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. /�cv�� S+'r,,�.,...� �s s. First Middle Last ,/ A�i 1 S►�.�,�u,,a�� '� � � Address (�,/��.,u�� 1'�� .��u� lo�� -�� -8l0 l� City State Zip Phone I understand my r' s as stated above. Signature