HomeMy WebLinkAbout2003-P06625 - re-roof CITY OF ORONO PERMIT
permit Number:
! 2750 Kelley Parkway- PO Box 66 P06625
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 8/6/2003
SITE ADDRESS: 2640 Watertown Rd
Long Lake,MN 55356
PID: 33-118-2343-0004
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:
FEE SUMMARY: Permit Fee: $ 125.25 Valuation: $ 5,845.00
State Surcharge Fee: $ 3.45
TOTAL FEE: $ 128.70
APPLICANT: Sela Roofing&Remodeling,Inc. OWNER: Sharon Ehlen
4100 Excesior Blvd. 2640 Watertown Rd
St.Louis Park,MN 55146 Long Lake MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
L�iYI�C
APPLIC PERMITEE S TURF ISSUED BY SIGNATURE
Cosies: 1-File(Sienitures Required).1-Applicant. 1-Monthly Reports, 1-Assessine. 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 O CONTRACTOR
JOB SITE ADDRESS: 4%}k taw n ZIP:
NAME OF OWNER: -��,c,��� . ��Q n PHONE: (home)_9s z-
(work)
MAIMING ADDRESS: /N, CITY: ZIP: ,
^^N
CONTRACTOR: * 9EIA800FlNG&REMODELING, IN PHOYE: G IZ- 8Z3' �v�6
4100 EXCELSIOR BL
CONTACT PERSON: �I�IOBILE/PAGER: ry
MAILING ADDRESS: -tOU5416j, Y: ZIP:
SSTATE LICENSE: # CIT
ARCHITECT/ENGLNEER: PHO\TE:
IYIA.ILI tG ADDRESS: CITY: ZIP:
NAME: = REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration A Land Alteration
PROPOSED WORK(describe in detail): c �� r��1" l, c
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. .
ESTIMATED CONSTRUCTION VA.LUATIO\ (excluding land): 5 shy 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 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:
NOTE! grade of Homes events require separate permit approval by Police Depgrtment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall
be informed of: (a) the purpose and intended use of the requested data wi?dn the collecting trate agency,political subdivision,or statewide system;
(b)whether he may refuse or is legally required to supply the requested data;(c)any Down consequence arising from his supplying or refusing to supply
private or conndendal data;and(d)the identity of other persons or eaddes authorized by state or federal law to receive the data. This requirement shall
not apply when an Individual is asked to supply investigative dam,pursue c to section. 13.82,subdivision S,to a law enforcement officer.
The commissioner of revenue may lace the no reouired under this subdivision in the individual income tax or ra erty tax refund
instructions instead of on those forms.
Subd.3. Access to data by indi-vidual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of 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 dam on individuals shall be shown the dam Mahout any e'natge to him and;if he desires,shall be informed of the content
and meaning of that data. After an Individual has been shown the private dam and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this section is Finding or additional data on the Individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of snaking,ce^.ling,and compiling the copies.
The responsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of
the dato of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he carwot comply with the r.quest
within chat time,he shall so inform the individual,and may have an addicacal 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 notify a writing tae responsible authority describing the nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the dam fcund to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data, including recipients named by the individual;or(b) eotify the individual that he believes the data to be correct Data
in dispute shall be disclosed only if the individual's statement of disagree tent is ktcluded with the disclosed data.
The determination of the responsible authority may bre appeased pursuant to the provisions of the administrative procedure act reladng 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 iB departments may require you to furnish certain private or
confidential information.
You are notified that:
I. The information you furnish will be used to determine}our 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 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.
First Middle
Last
Address
City State
Zip Phone
I derstand my right stated above.
`Signature