HomeMy WebLinkAbout2003-P06283 - re-roof CITY OF ORON PERMIT
� Permit Number:
2750 Kelley Parkway- PO Box 66 P06283
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 2�9-�600 Date Issued: s���2o03
SITE ADDRESS: 4340 Sixth Ave N
LONG LAKE,MN 55356
PID: 31-118-23-12-0010
DESCRIPTION:
Proposed Use: Residential
Pernut Class: Building Census Code O/S-Building
Pernut Type: Minor Alterarions Pernut Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 153.25 Valuation• $ 7,389.05
State Surcharge Fee: $ 4.20
Misc.Fee: $ 153.25
TOTAL FEE: $ 310.70
APPLICANT: Elite Remodeling OWNER: C S WILLIAMS&E R WILLIAMS
5510 Three Points Blvd. 4340 SIXTH AVE N
Mound,MN 55364 LONG LAKE MN 55356
THE UNDERSIGNED HEREBY REQUEST'S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT CO IANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIRE S.
�_ C9m�,
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Couies: 1-File(SiQnitures Required), 1-Anpl cant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
Tota�,Fee: $ Date Received:
E*�tered By: Permit#:
.
CITY OF ORONO - BI.TII�DING PERNIIT APPLICATIOleT
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �� / � �� �U� �� ZIP: �S3�S�o
NAME OF OWNER: �V// ((CC�t S PHONE: (home)9`SZ ��� �Z�Z
(work)
MAILING ADDRESS: �t'� '�S CITY� ZIP:
CONTRACTOR: �l�;� j�"/�'? + C� PHONE: ��Z r ��� �S Z��
CONTACT PERSON: l OBILE/PAGER:
MAILING ADDRESS: /�8 � CITY• Ovl6' ZIP: �� y
STATE LICENSE: # 2O 3�5�5��(' .3 /3i/��
/
3/3i/a�{
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
rJAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: ���'� 7��� C�`i�l�
�� D�Q cr�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
�j 4�
E TIMATED CONSTRUCTION VALUATION (excluding land): $ �� 'f`'
S
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 u rstand this is not a permit and work is not to start without a
permit; and that the work will e ' accordance with the a • plan.
APPLICANT'S SIGNATURE: at- D.�TE: �� � � 6 �J
NOTE! Parade o�'Homes events require sepa e permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be aZlowed.
�
Sec.13.04 RIGHTS OF S[TBJECTS OF DATA
Subd. 1. Type of data. The righcs of individua!on whom the data is stored or to be stored shall be as set forth in this secdon. •
Subd.2. Information reqtrired to be given individual. An individual asked to supply privau or confidenaal data conceming himself shall
be informed of: (a)the pucpose and intended use of the requesied data within the collecting�tate agency,poliucal subdivision,or sratewide rysum;
(b)whether he may refuse oti is legally required to supply the requested data;(c)any Imown consequence arising from lus supplying or refusing to supply
private or confidenaal data;and(d)the idenury of other penoas or enuues authorized by state or fede�al law to receive the data. This requiremenc shall
not apply when an individual is asked to supply investigarive data,pursuant to secdon 13.82,subdivision 5,to a law enforcement officer.
The commissioner of re�enue mav place the nodce rewired under this subdivision in ihe individua( income tax or oroDertv taz refund
instructions inscead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of swred data on individuals,and whether it is class�ed as pubiic,private or confidential. Upon his further request,an individua!who is the subject
of stored private or pubiic data on individuals shall be shown the data wi[hout any charge to him and;if he desires,shall be informed of the content
and meaning of[hat data. After an individual has been shown[he private data and informed of iu meaning,the data need not be disclosed w him for
six months thereafter unless a dispute or acdon pursuant to chis secrion is pending or addidoaal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the da[a. The responsible authoriry
may require the requesting person to pay the actual cosu of making,cerdfying,and compiling the copies.
The responsible authority shail comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,excluding Sarurdays,Sundays and legal6olidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing rhe namro of the disagreement.
The responsible authoriry shal(within 30 days either: (a)correct the data found m be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data,including recipients named by che individual;or(b)notify the individual that he believes the data to be correct. Data
in dispuu shali be disclosed only if the individuat's statement of disagreement is included with the disclosed data.
The determination of the responsible au[hority may be appealed pursuant to the provisions of the administrarive procedure act reladag to
contesud 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 fumish 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 eztent necessary to process
the pemut 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.
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First Middle Last
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un rstand my rights as stated above.
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