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Home My WebLink About2005-P08945 - re-roof PERMIT CITY OF ORONO Permit ►vumber: 2750 Kelley Parkway - PO Box 66 P08945 Crystal Bay�Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 7/11/2005 SITE ADDRESS' 4215 Forest Lake Dr Unit# MOUND,MN 55364 P�� 07-117-23-12-0026 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: 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: $ g3.25 valuation: $ 3,000.00 State Surcharge Fee: $ 1.50 TOTAL FEE: $ 84.75 APPLICANT: Owner/Self OWNER: 70HN&RUTH LOUGLIN MN 4215 FOREST LAKE DR MOUND MN 55364 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE W[TH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �� . ,� ` h-� <<�l'�� C_c ,�-� f�f� APPLICANT PERMITEE SIGNA RE ISSUED BY S[GNATURE Copies: 1-File(SignaturesRequired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1 Total Fee: $ Date Received: �:ntered By: Permit#: CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all inforna�rtion) --------------------------------------------------------- ----- -- ---------------------------------------------------- THE APPLICANT IS: (circle one) OWNER ¢R CONTRACTOR JOB SITE ADDRESS: y ;� ��' �=v�e �= .� ; ��<� r��,ziP: .s� a—.� � % Will this be a Pa►•ade of Homes, Remodelers Showcase Home or other Display Home? ❑ YeS �No If�-es, a special eve�at pe�niit is re�uir•ed witli Police Depaf-trnent and Citv Co�incil approval 60 dats pr•ior to the event. Shuttle btrs se�vice tivill be reqTiired tniless applicant dernonstrates s�r�cient orz-site parking is available. Norr pern�iitted events will��ot be allowecl. NAME OF OWNER: -_lc�� ,7 C1. �c�c,I cr� f;x-r PHONE: (home) r s"� - �' ��. �,3_;�,z�� (work) MAILING ADDRESS: y�Zi� rv ;�� %�,A�C� ,v,�..CITY: U�o�v� ZIP: _;'�'".I c y CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home Remodel/Alteration PROPOSED WORK(dese�•ibe in cletai�: f2 +,_ - �c:-c';;= � ) v a ,�.re,. ,/� 5'I'ORIES: � SQ.FEET OF EACH FI.00R: NO. OF BEDROOMS: �_ GARAGE STALLS: ATTACHED � I)ETACHEI)_ h <:�, ESTIIVIA'I'EI)CONST1tUCTI01�i VALIIATION(excluding land): $ �C3 c�� — I hereby apply for a building permit and I acknowledge that the inforniation 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 perniit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: � �� C� � � � DATE: J- (/- c� � � �, 5ec.13.04 RIGHTS OF SUBJECTS OF DATA • l Subd. L 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. Infonnation required to be given individual. An individual asked to supply piivate or confidential data concerning himself shall be infoimed of: (a)the purpose and intended use of the requested data within the cotlecting state a�ency,political subdivision,or statewide system;(b) whe[her he may refuse or is legally required to supply[he 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. "fhis requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.8Z,subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or pronertv tax refund instructions instead of on those fonns. Subd.3. Access ro data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is[he subject of stored data on individuals,and whether it is classitied 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 withou[any charge to him and,if he desires,shall be infonned of the content and meaning of that data. After an individual has been shown the private data and infonned 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[he individual has been collected or created. The responsible authority shall provide copies of the p�ivate or public data upon request by the individual subject of the data. The responsible authority�nay require[he requestin�person to pay the actual costs of making,cettifying,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. [f he cannot comp(y with the request within that time,he shall so infonn the individual,and may have an additional tive days within which to comply with the request,exduding 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 piivate data concerning himself. To exercise this tight,an individual shall notify in writing the responsible authoiity 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 recipien[s of inaccurate or incomplete data,including recipients named by the individual;or(b)notity the individual that he believes the data to be con�ect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detennination of the responsible authority may be appealed pursuant to the provisions of the administiative proceclure 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 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 extent necessary to process the permit or license. 4. If your requested pennit or license requires Council action to approve, some infonnation 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. ,� � h �� o w �;�i� �. v u S�i /;�� First Middle C,as '7�� 1S� i~U�c S f � /� 1< � /) ,�' ; Address �� v N�� ✓�-+ N .�'�;�6 '� ��s�� /��- ._��S-:�'s� Citv Statc Zip �honc I understand my rights as stated above. � � C/ , Signature � �� . � ,� DATE TIME �ITY OF ORONO CALLED IN ��I/�� INSPECTION NOTICE t/ SCHEDULED �""�'' .:il��c�� - Q`� PERMIT NO. ��-'�� 7 � COMPLETED � - ADDRESS `'f�� l `'� �'�rf' � �- �--�` /�,� OWNER ��-'�-�� C�'�.;�';h fi Yl CONTR. TELEPHONE NO. �� '�� DESCRIPTION �--e�� `�� l� 01 FOOTING 11 MECHANICAL RI T/18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP i09 PLUMBING RI 23 SEPTI F AL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL ` 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU: YES�NO � COMMENTS: � W � � J O � � O � ti � Q � Z W � W � � d W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK 8,PROCEED '� ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. �� pHOTOTAKEN INSPECTOR WILL RETURN �7 CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next i spection 24 hours in advance. (952� 249-4600 OwnerlContract Inspector. White Copyllnspector's File Canary CopylSite Notice V DATE TIME CITY OF ORONO CALLED IN INSPECTION �I� �/ SCHEDULED PERMIT N0. J COMPLETED ADDRESS Y-��S �4/�S't L� ,�L� OWNER �6� L CONTR. TELEPHONE NO. 9S2 - �70� —35�� DESCRIPTION �"""! l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP ? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � � O � � O � W � Q � 2 W � W � j d W WORK SATISFACTORY:PROCEED PROJECT COMPLETE � ❑ CORRECT WORK 8 PROCEED � W ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDlTIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN 7 CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR ❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS. Call for the next'nspection 24 hours in advance. �952� 249-46QQ OwnerlContra r n it : Inspector. White Copyllnspector's File Canary CopylSite Notice