HomeMy WebLinkAbout2008-00026 - siding � CITY OF ORONO PERMIT NO.: 2008-00026
� 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssuEn: 07/09/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 690 BROWN RD N
PIN : 34-118-23-12-0007
LEGAL DESC : LJNPLATTED 34 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : SIDING
ACTIVITY : O/S BUILDING-LTNDEFINED
VALUATION : $ 63,860.00
APPLICANT PERMIT FEE SCHEDULE 786.75
ALLSTAR CONSTRUCTION STATE SURCHARGE(VALUATION) 31.93
5145 INDUSTRIAL ST.
SUITE 103 TOTAL 818.68
MAPLE PLAIN, MN 55359
(763)479-8700
Minnesota State License#: 3247
OW1vER
LARSON, ERIC&ANDREA
690 BROWN RD N
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
I�he work Yor 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 governing 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 c formance with the State Building Code.This permit may be
re�oked at a�ime for�due cause.
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Applicant P mitee Sign' Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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 a[l inforrriation)
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THE APPLICANT IS: (circle one) OWNER CONTRACTOR�
JOB SITE ADDRESS: (Q�j� �ra;�.. ���. N�. ZIP: �.�3 J(r(�
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes � No If yes, a special event permil is required with Police Department and Ciry Council approval
60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates
su�cient on-site parking is available. Non-permitted events will not be allowed.
NAME OF OWNER: �v�t�aTe,e-. Lcw'Sv� PHONE: (home)
Q (work)
MAILING ADDRESS: _�J�j(� Dti^v�•�,� �1 . CITY: � �h �� � r, ZIP: SS3SCv
CONTRACTOR: �`1S`t�=� C_�c�,-���vvc.\3-��.� PHONE: ��3 ��7`t �^70U
CONTACTPERSON: C�,�,,, �,J.;,,��- MOBILE/PAGER: C.c/Z -3fc -�L��
MAILING ADDRESS: S �-IS` :���l�s�I,�,�� S� . '�G CITY: � �e Y�ct���, ZIP: S j S"`�
STATE LICENSE: # '� 7 EXPIRATION DATE: '3 - ���
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows) L�
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detai�: �� , �,�,
STORIES: J- SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ (��� i�(�
1 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 ordinanees and eodes of the City and with the State Building
Code;that I understand this is not a perm�t and wark is not to start without a permit;and that the work will be
in accordance with the approved plan, � �
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APPLICANT'S SIGNATURE: � � �� DATE: �- `� C C
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
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. Information required to be given individual. An individual asked to supply private or confidential dataconceming himselfshall be
informed of (a)the purpose and intended use ofthe requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to suppl}'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 mav place the notice required under this subdivision in the individual income tax or propertv 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 ofthe 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 ofthe request,excluding Saturdays,Sundays and legal holidays,ifimmediate compliance is not possible. Ifhe cannotcomply 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,exduding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness ofpublic or private data
conceming himself To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature ofthe disagreemenL The
responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to noti£y past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual[hat 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 ofthe administrative procedure act relating to
contested cases.
DATA PRNACY 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 to process this application or permit.
First Middle Last
Address
City State Zip Phone
I uqderstand my rights as stated above.
f � _
Signature
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