HomeMy WebLinkAbout2004 - P07648 - minor alterations St
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: P07648
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 6/30/2004
SITE ADDRESS: 1770 West Farm Rd
Long Lake,MN 55356
PID: 27-118-23-44-0017
DESCRIPTION:
Proposed Use: Residential
Census Code 0/S-Building
Permit Class: Building
Permit Type: Minor Alterations Permit Sub-type(s): Building Undefined
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
r-----1 6Lietz,i - '------
FEE SUMMARY: Permit Fee: $ 421.55 Valuation: $ 27,406.00
State Surcharge Fee: $ 14.25
TOTAL FEE: $ 435.80
APPLICANT: Garlock-French Roofing Corporation OWNER: William&Margaret Bracken
2301 East 25th Street 1770 West Farm Rd
Minneapolis,MN 55406 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.
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signitures Required). 1-Applicant, 1-Monthly Reports, 1-Assessine, 1-Finance Page 1
JUN,.25',2004 12: 12 6127229754 _,p,QdGARLOCK FRENCH ROOFING #5245 P.002/006
61?S J p
Total. Fee: $_ Tag-Cr° Date Received: !�O/f
el
Entered.By: Mc Permit#: Ab7&4 Ll
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must he submitted in full before plan review will be started.
(please print all infnrrnation)
THE APPLICANT IS: (circle one) OWNER ORCONTRACTOR
JOB SITE ADDRESS: 111 0 Y' FGIYm fz.oaa ZIP: G;3 _7)1-40
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
17 Yes ISI No If yes, a special event permit i.' required with Police Department and City
Council approval 60 days prior to the event, Non-permitted events will riot
be allowed.
NAME OF OWNER: .5015Of M(' 1 Y1( PHONE: (home) 11D3'41�-- K3to
J (work)
MAILING ADDRESS: 111 O \N, FOIYrti1 EOO A CITY: byll 10 ZIP: 65'3S
CONTRACTOR: -cQIY1 ,- A Di PHONE: U l a-"1 113.1
CONTACT PERSON: 16,/ky\ vi 19.A.y • MOBILE/PAGER:
MAILING ADDRESS: A")b\ EA* G'}- CITY: 1 G1 S ZIP: 7ri4o
STATE LICENSE; # OQ('�14 a 3 EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure _ _
Addition _ Move Home _
Remodel/Alteration
PROPOSED WORT((describe in detail): yW t1 00/4042, Amyl r {s 1r
1 l t s� (AiKok. yume
STORIES: SQ. FEET OF EACH FLOOR:
NO.OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ a-L) O( .
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;a.nd that the work will be in accordance with
the approved plan.
APPLICANT'S SIGNATURE: 4,42 DATE: ( -2S oftf
JUN.25',2004 12:12 6127229754 GARLOCK FRENCH ROOFING #5245 P.003/006
Sec,13.04 RIGHTS OF SUBJECTS OF(IATA
Subs.I. Type of ditto. The rights of Individual on wise the dole is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given lndlvitlud. An lndividtud tusked to supply prIent.c or confidential dela concerning himself shall he
informed of: fa)the purpose unit intended use of the requested ditto within the eollecthig state agency,political subdivision,or statewide system;(h)
whether he may refuse or Is legally regtired to supply the requested dntn;fc)tiny known consequence arising from Itis supplying or refusing to supply
prlvnl.eor confidential dote;and(d)the Identity of other persons or entitles euthnrired by state or federal law to receive the data_This requlrementahall
net apply when an iltdividunl Is asked to supply Investigative data,pursuant to section 13,61,subdivision 5,to a law enforcement officer.
'nue rotitmiss1S11er of revet1lfer,tnay stone The entice rcnuj tp JjJis snhdlvtalnn In the.IndivldnnlllgiUc lout or nrottrrty tn>i.refund
instructions lnsteu i of on those.forms.
Siam.3. Assess to dole by Individual. Upon requital to a responsible a uthority.en Individual shah he informed whether he is the subject of
stored data on Indivitivals,and whether It Is classified ns public,private nr confidential, Upon lila further request,an Individual who is the subject of
stared private or public deco on lndividunls shall be shown the darn without tiny ammo to him end,if he desires,ahnll he informed of the content and
meaning of that dein, Allier on Individual hes been shown rhe prhvnle Ilnta and informed orb*meaning,the dole need not lie disclosed to him for els
months Ihcrenfhcr unless n dispute or nction pursuant In this section is pending or additional data on the Individual has been collected or eroded. The
responsible nntbnrfty shell provide copies of the private or public'hue upon request by theindivldunl sebjeet atilt;dote.The responsible npthorirymay
require the requesting person to pay the actual costs of molting,certlfying,,ied compiling the copies.
The responsible authority shall comply Immediately,If possible,with nuy request made pursuant to this subdivision,or within five days of die
date ofthe request.excluding Saturdays,Sunda.ya nod legal holidays,if Immediate compliance la not:possible,Ube cannot comply with the request within
tint time,he shall so Inform the Individual,and may have en additional five days within which to comply with the request,exrh,ding Sonrrdeys,Sundays
and legal holidays.
saw,4. Procedure when data it not accurate or complete, An Individual may contest the accuracy or completeness of male nr prfvaredate
concerning himself.To exercise this right,an Individual shall notify In writing the responsible anthority describing the nanireof thedisngreement_The
respnnalble authority shall.within 30 days either: fa)correct the date found to be hMaccnrate or Incomplete and attempt to notify post recipients of
Inaccurate or incomplete data.Including recipients named by the Individual:or(Ir)nntil, the individual HIM he believes the dein to he correct. Dote in
dispute shout be auscins:d only If the IndivldmUas statement of disagreement Is included with the disclosed dela.
'Thr,delerminntion of the responsible aulhority may be nppenlcd porsunnt to the provisions of the administrative procedure eel relating to
contested cases,
DMA PRIVACY ADVf.SRY
O
in accordance with M.S. 13,04,Suhd.2,"Rights of sitbjtcts of data",we would like 1:o 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.
2. You may refuse to supply data,but refusal may require that the City deny the permit or license.
3. The informal:Ion may be shared with other local,stoic 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 favallable upon request)to review private data on yourself.
6, Your fail name is required to process this application or permit,
4i 4.r l 'Da V3 a fir`t 1,ii.)r
First Middle Last
3 y5-*( Ave, 5-,Q
Address
M ,',... Ke.� � I 1 5 tr1Ai _ 5-s--90 E 6IP- ' '?6-940$
City State Zlp Phone
1 und.erstand my rights as stated above.
• . 1 +
Signature
.!i i,..+', .';i'R sot Form
, •
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: 1110 \N VIAVYY1 Rocky ZIP: 3CaLv
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
E 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: -5060Y-1 PHONE: (home)1407-4161- IS3t0
(work)
MAILING ADDRESS: t11 0 uN e Rkv rYl Ku RA CITY: by-01 D ZIP: 6S"3cs 10
CONTRACTOR: (s Yl()(,1; \reAnc h 12..boTlV1j tap PHONE: 'I -1 11 . -`471
CONTACT PERSON: 1 i y\ Unlit vi pay MOBILE/PAGER:
MAILING ADDRESS: 3?( \ E14St- QC)I-K CAY1....e ' CITY: At a b�1 S ZIP: 5S40(4,STATE LICENSE: # OO 4 a 3 EXPIRATION DATE OS
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure _ _
Addition _ Move Home _
Remodel/Alteration 7d
PROPOSED WORK(describe in detail): \W>\-All " ' i) AL'Wrl'eol-c Ain(/t (51/1' ZY
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 9 7)LA 0 (�b
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: V w.iL�• ' L, DATE: 6 '2�
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 within the collecting state agency,political subdivision,or statewide system;(b)
whether 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 confidential data;and(d)the identity of other 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 officer.
The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. 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 data on individuals shall be shown the data without any charge 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 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 this section is pending 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 making,certifying,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
date of the request,excluding Saturdays,Sundays and legal holidays,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 notify in writing the responsible authority describing the nature of the disagreement.The
responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's statement of 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.
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
^toopprocess this application or permit.
First Middle Last
3oY3 ysAve. So.
Address
e•tpo 1;5 /")/1/ ,s5`v06 6th- 2�6-y�Og
City State Zip Phone
I understand my rights as stated above.
Ls 0
Signature