HomeMy WebLinkAbout2009-00340 - windows CITY OF ORONO PERMIT NO.: 2009-00340
2750 KELLEY PARKWAY
' ORONO, MN 55356- DATE IssUEv: 06/23/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3060 SIXTH AVE N
PIIY : 28-118-23-32-0014
LEGAL DESC : LESLIE ADDN
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOWS
ACTIVITY : O/S BUILDING-LJNDEFINED
VALUATION : $ 43,854.00
NOTE: REPLACE 27 WINDOWS WITHIN EXISTING OPENINGS.
APPLICANT PERMIT FEE SCHEDULE 617.25
RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 21.93
1920 COUNTY RD C. WEST
ROSEVILLE, MN 55113 MAIL-IN FEE 2.00
(612)502-4777 TOTAL 641.18
Minnesota State License#:20130983
OWNER
KOSEK, CHRISTOPHER&HEATHER
3060 SIXTH AVE N
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 does
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 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. �� ��� ���
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Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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� Total Fee: $ DateRe�eived: 11�� -"� � � �
Entered By: �'�=1 � i r,�. (-l t%/ ��i j Permit#: -1� � C�'3i��
CITY �F ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan reyiew will be started.
(please prtnr all injor»u�tion)
THE APPLICANT IS: (circle one) OWI�TER OR CONTRACTOR
JOB SITE ADDRESS: �1�p O - _ _ � �D ZIP:
Will ttus be a Parade �f Homes, Remodelers Showcase Home or other Display Home?
❑ Yes ❑ NO If yes, a specia/event permit is requlred with Police.�lepartment and City Council appraval
6D days prior to the event. Shuttle bus service will be required unless applicant demonstrates
su�cieni on-site parking rs avnilable. Non permitted events wil!not be allowed
NAME OF OWNEit: �-efi��-�� �USr�Y�, PHONE: (horne o�' - tpw�p
(work)
MAILING ADDRESS: � CITY: ZIP:
CONTRACTOR: Renewal By Andersen pHONE:
CONTACT PERSON: 1920 County Road "C" W est -AGER:
MAtLING ADDRESS• Roseville, MN 55113 Z�.
' — License #20130983
STATE LICENSE; # 651-264-4777 DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CTTY: ZIP:
1tiAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits!
PROPOSED WORK(descrlbe in detai�: �p,��_QSQ a�- l�l11�U��S �,t>/i��,
_� � ,
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALL5: ATTACHED DETACHED_
Cl�
E5TIMATED CUNSTRUCTION VALUATION(excluding land): $ �
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[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: ��f`Q�
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Sec.13.W AIGHTS�R bUBJECTB OF DATA
Subd.]. Type ofdata. The rights of�dividual oe whom tAe data is stored or to be etored ahall be w eet fort6 in thia secti�•
3ubd.2. lnformntiun required to be given individusl. An indivtduel aslaed to saPP1Y Private or�°"fida'Nal date'conceming himaelf�ell be
informed of: (a)the purpose and inteeded use of the mquasoed dafa within�he oollecting state agency,political snbdivieion,or atatewide syeoem;(b)
whe�her he mey rcfuse or is lega)ly roquh�ed to supply the*equested data;(c)any known co�equence uieing fram his supplyiag oc retLsing oo eupply
private or confidenNal data;and(d)the identity ofother persons or entities authorized by atate ar fedetdl law to re.oeive fhe dan. Thia requirement ahell
not apply when an individusl ie esked ro supply inveatigative data,pursuant to section 13.82,subdivision 5,to a lew�fbrcemenl officer.
TAe rommLs!aner of revenue mav els�t�e n�?ic.,r�eite��nder ihia s�bdivision in he individLpl i���ome tax or oronertv Isx reRmd
Subd.3. Access to data by individual.Upon requeat to a teeponaible authorily,an lndividual shell be inforn�whether he is the subject of
stored data on individusls,and whcthcr it is classified as public,private or contldential. Upon Ris A�rther cequest,sn individuel who is du subjed oP
atw+ed private or pubUc dan on iedividuals shell be shown the data without sny cherge to him snd,itha deoirss,shell be informed of the oonront and
mesning of thu daM. After an individual hsa ban ahown the pri��abe data and informed of ils meaning,the d�ta need not 6e dieclosed to hirn for eix
montha thareafter ualess a dispute or nction purs�at to this section ia pending or addirional data on the individusl has been coll�e�ed�cteatcd. 7'he
responsible authority shnll provide oopies of the private or pubtk data upon roquest by the individual subJcct of the data. The rwponsible sutlsority
may require t6e requesting penon to pay the sctuel cosls of making,c.adFyinB+and comp��»B che roP�es.
The tesponsible autt►odiy shatl canply immediately,if posaible,with any requat rtuda pursue�M to this subdivision,or within ffve days of
thc dtu oftho requeat,excluding 9aturdaye.Sundaye and legal Aolidaya,if inrnedisce compiiance is eot possible.lihe cennot complywith tRe request
within t6at tirrK,he shnit so inform the individuel,and may have an sdditioesl tive days wid�in wBicA�to comply with the request,excludingSsiurdays,
Sundays and legsl holidOYs. ,
Subd.4. Proeedure when dala isnot rceurateor cort�plaa An individual m�y contes�the acc�acy a eemp�eo�eas ofpublie or privet�e data
conccming hirnaelf, Tn exercise d�id right,an individusl ehall irodty in writingihe mspomibk authodly deacribing tfie neturo of the dieagteement•'Che
responeible�nthoTity shall witbia 30 daya either. (a)correct t6e dua found oo be inaccucnte m incemplete and attemprt ro notify past reap�ents of
insccurste or incomplete data.including recipients named by the individual;or(b)notify the individual that tie belisvw the d�la to be oorrxt.Deta�
diepute ahall be di�closed only if the individ�uPa stalement of disegreement is inelud�witl►the dieelosed data.
The detertninstion of d�e r�ponaible authority may be appealed pursuant to tl►e provisions of the edministrative ptocBdure act relsting to
ooalated cases.
�ATA PRIVACY ADVISORY
In acco�dance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would fike to inform you that your requcat
for a pennit or license fmm the City ofOrono or any of its deparnnents rney requit+e you W fumiah certain private oc
confidentiai information ,
You are notified that:
1. The infarmption you furnish will be used to determine your qualiflcation for the permit or license
requested. �
2. You rnay refuse to supply dats,but refusal may reqnire that the City deny the permit or License.
3. The i�fotmation-may be shared with other local, state or federal agencies to the extent necessa�y to
process the permit or license.
4. 1f your iequested petmit or license requires Council action to approve,some infortnation may become
public.
5. Youhave certain rights under M.S. l3.04(available upon request)to review private data a�yourseif.
6. Yoar full name is required to prxess this application or pennit
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