HomeMy WebLinkAbout2003-P06728 (Re-roof) � s
PERMIT
CITY OF ORONO Permit Number:
2750 Keliey Parkway- PO Box 66 P06728
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249,4600 Date Issued: 9/11/2003
SITE ADDRESS: l lss Arbor st
Wayzata,NIN 55391
PID: 10-117-23-24-0031
DESCRIPTION:
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS: �--�
FEE SUMMARY: PermitFee: $ 125.25 Valuation: $ 5,994.00
State Surcharge Fee: $ 3.50
TOTAL FEE: $ 128.75
APPLICANT' Les Jones Roofing Inc. OWNER: Steve&Randi Carlson
� 941 W 80th Street 1185 Arbor St
Bloomington,MN 55420 Wayzata MN 55391
THE UNDERSIGNID HEREBY REQUEST5 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 BUII,DING CODE REQUIREMII�iTS.
��� a ����
PE E SIGNATURE ISS[JED BY SIGNATURE
Copies: 1-File(SiQnitures Recrui�ed),1-Aunlicant,1-Monthlv Renorts, 1-A�essin�, 1-Finance Page 1
. ` * '
Ju1-18-2001 11:48am From-CITY OF ORONO +9622484616 T-436 P.�O1/002 F-870
Total Fee: � Date Received:
Entered By: Permit�:
CYTY OF ORONO - BU]LDING PERMYT A,PPLICA'I'�ON
. All information nausf be submttte�.ia full before plan review will Toe started.
(ptease print all inforrnanon) .
� �..-.--------------- - , ' -- ----------�-� .
TI� AI'PLICANT IS: (circle one) OWNER 0 ONTRACT012 •
aoB srr��nnnr�ss: I l �� C�f�o � �. z�aP: ��.��� �
N� o�o�R:�a�� �- (� �P$o�: �m��_�/s� _ �s- o���
(work)
1�tAII�NCr AJ]Y3RESS: � � g`�� ��v� S-t CITY• -z.ce� :�,_�� �
C41�1'TRA.CTOR� ��-e s Ko o� � P�ONE: �1 S� -g �( - a a�-1 (
CON"Y`ACT PERSO�T: ° �iOBII�E/PAG�ER: (�1 a -3 c�3 -� � ��
IYSA�II�CC ADDI2ESS: �l� � l,r' - �b .S� _C��_��°L�'�.` 5 O
STA�'E LICENSE: # �� � D
ARCY�'!'ECTlENGIY�ER: ��� -PT3411E:
MAIL�IG A7�DItFSS: CITY: ZrP;�
� N�; R�G�,STItAT�01�#� •
�"YP� QF�irORF�: New Addi[ion Accessory Suucture
Move • ReaiodeUAlteration� Land Alteration�
P OP4SED�'V' (describe in detai�:� G-� �% s�.-� ����� 6�
- � " —
STORIES: � SQ.FEET OF EACH FLOOR: •
N0. OF B�DROOviS:• GARAGE STA,LIS: ATT: • DE�. ��• �-L �-••�••.�•., � •
EST�YIATED CO`TSTRU'CZ'YON`VALYJATIO� (excludin�land): �a �v�
I hereby apply for a building permit and I acknowled;e that the iafotmation above is complete and
accurate; tha�the work will be in conformance with�ne ordivances aad cades of the Gity and with
the State�uilding Code; that T un,derstand this is n.ot a permit a.ad work is not to stazt without a
permic; and that the work will be in accordaac 'ch the approved plas. .
APPY.ICA.��"T'S SYCNATLTRE 1 DA,'I'E: �-�-O�
,
NO.TEd P r�.d_e a.f Aames events require separa#e permit approval by Police Depgrtment and
� City Council 60 days pr�or to the event. Nnn permitted events wilt not be allowed.
Ju1-18-2001 11:49am From-CITY OF ORONO +9522494616 T-436 P.002/002 F-�TO
' Scc.I3.01,RIC�'S OF SLBJEC?S OF�A�A
Subd. l. Type of daw. 11►e righ�s oF iadividaall oa wha�rke dam i�stor�or w be sw�ed sball be as sec fonh�Tn rhis secdon,
Subd,2. IaPocmntton requdred to be givea iadtvqdial, r1n ir.�i�idpal�s1cr.1 po supplY privace or cot�fideadal dsa�oaaecniag himeelf shsll
be iAFormed oF: (s)the pur�osa aad iatanded use oF�ha cequesuxl daa w:atn�e eoUettiag*�Ata ageocy,poi[desL sul�division,or statewide sygrem;
Ib)�he�ar he n�y esPuse oti is tngally�qu�rcd m supply tha�equested dsa:(a)anY Icoaa eoosequeace acisiag from his supply'mg er re[using m suFP�Y
p��ace or eonndendal dan;a�d(�ehe ideacry of orherpersoes or anricaa ucsorized by smto or tadersl law m r�eiva ttto da�a.,�'h,is tcq¢tremen�shal�
ao�apply whan an ir.dlv�cu�lls asl:ed m snBP(y invesrigadve dac�,pu�c r�saedon 13.8..subdivisioa 5.�o a law cs�forcemeo�offteer. '
Tt►e eor�missioner oP rgvenuo mav atsce ehe noCxe reattEnd erd-r this ,ubdiL+ision in the individual ineome taz er nreoeRv sx�efund
insnvacions�scead of on�hvfe�s. '
Su6d.3. Aiceess co data by iadividual. LTpon reqnesc ta a txans�ta aut�oriq�an iadfv�dual sball be inFo�ted wl�ethcr ae is dtie subJcec
oF smred dara on wdividuJs,snd whechec i�is eL�ssiF�ed as public,pt�+a�oe cenRdar.dal. Upoa his fiuih��sequesL aa indlvidusA who is cha sLbJeca
nP seoecd privsce or publie daa oes iadivtdnals shaJl 1x showa she dara w-i�oue aay cnsrge ta hfud aad;iP!►t desiras,stiaU be iaQoruud of cbo concenc
ar�d mesnir+g o��►c dacz Afur an i�dividual b�bean shewa�he pdvas-�and ie�araud of ics meaniug.dsa dam,Qaed uoc be diseiosed oo ti�m for
six monrhs rharesnec onless a dispuce or zcaon parsusee w�is seedon is�eadi�g oc addtdansl da�,oe�he individuat h�s boen eaUec�ed or ereaed.
'rhe t�sponsibl�auehoriry shali prov�de copias af�he prlvace or pu6lic daca�ran raq�ses:by tbe individust subjecc oF cha dan. The rasponsibt��s�kadry
_ may requir�rhe requesdng pecson m psy�tu acrosl coscs of maki�ig,eo�j�ing.nnd eompd[ag�he copfes.
7he cesponsible su�heriry shsl[wmplg inunedi�ccly.�f poss�ete,wi�h any i-.�ues�mado puesuant w�his subdRvision.or wi�in five dsys oF
�he dsu:oE�u�cquesc,aceluding 5aatrdays.Srsadays snd legal holfdays,i�ir..cnedi�c:compl�a is nac possibte. IF he cuwat eam.ply w'nc�he nquesc
wid►in thac ame,ho sball so inPorna ehe iudivfdual,and raay have en addi�o�l Cve da;s wirltia wbicb W comply witls thc requost,exaludiag Sapudays,
Sundays and kgal holidays.
Subd.4. Proeedure whea data is aot aceuraee or complete. ,�iadivitu-1 may ca,ues��he ueucscy or eemple�ne$s oF pubtic or pri��a�e
dsa conceming himselP. To exe�ise�his righ�,an individual shaU noaly�wddeg n�respoas�'ble au�hodry dascribiag rho aaa�ce o!nc�disagr:smeac.
' The r�sponsibk auehoriry shsll wiusia 30 daya e'ulu�; (a)co�c�che dae rcnnd�o�a i:ueestnte or incoa►plere ead auemp�ta nodFy past ceaipten�s nF
ir►aceunca or incomplem ds�.,tncludi,ns recipPen�s eamed by che iadivir!�1;or(b)aodfy tha indivfdual thac he 6alievn��ho dsn ro be eorraG Dac�
in dispuce sha11 ba disclosed o�ly iP rhe individual's Sracemoni of disagrs�enc is i�elcded widt d�e discloscd da�a, �
Tlie dtcarminadon of�he respensble authoc�ry rsiay bc appss'w pursuscc ro ehe provisions of�e sd�ialsaadve proeeduK ac�relaaag�o
� cantesud cases. . • � � . .
nA"Ta PRt��aCY AD�TSORY
� Ia acco�dance wirh M.S. 13.0��Subd.2, °Rig�.cs of su�jects oi da�a".we would Iike to iziforut yoa thac yaur rzquest
for a permit or license fcouz the Ciry af Orono or any or is deparWen�s may require you to futnisL�certain privarz or
conFdeat�al Ynforma�Ion.
You are no�ified that:
1, Zhe infermauon you Fumish will be used to de:ermizte 1 our qualif'ieacioa for rhe pecmic or Iicense reques�ed.
2. You may refuse t4 supply data, bac refusaL may require Lhat the Ciry deay rhe permit or Zicease.
3, '1'he informacion may be shared wfch acher loc�t,s�a�e ar federal a,oaaies to the extenc aecessary co process
� che permit or Jicense.
�.. IE your requested. permit or liceose requires Couz►cil acuon �o spprove, some i.nformaaon may beeoaae
. , public. . �
5. You have ceaaizi ri�hts under M.S. 13.0� (z:ailable upou reqnest) �o review�priva�e data oa yoursetf.
6. Your iull name is required ra process chis aopllcaciaa or permit. ' .
' Eicst tifiddlt Las�
r
!
Add�cu
Ciry Sace Zip p�ano ,
I uudecscaad my ri�hcs as s�ated e, '
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Signacure
� Sev•. 4, 2003 10:41AM LES JONES ROOFING No.9294 P� 1
Jui-18-Y001 11:4eam Prom-cir� OF oRo�lo +e6zx4e461e T-d86 P ooifoo2 F-e7o
�otal Fee: � �o"Z�a 7 D�Received:, �-��3
. ��fy
F.ater�d SY: . �"✓,�„�L-,'..,� Permu�: �Dl�
I� cY� oF oRONo -��nv���r�c.A.�e�cA�or�
�� ,03 -
�j-� A11 information m�us�be snbmitted iu�u.11 bePare pl�t r��vfew wrill'�e started.
. . (pleQs�prtiu ali ir�fornr�'on) .
. . � ------------= •
TI�E�'pLICANT IS: (circle one) O�R O QNTRAC'TO �
JOS SITE A�DDI�ESS: � � g 5 Q-r'�jo� �'. ZZ�; ���r'1 I
NAME OF��:��-��.a �-a^ �� �PHONE= (lzome) �1 s� - 7S"- O/D�
14jAILTNG A.DD1�I'SS: f � g`� �—�cs r S-t CITY:`�, z..cc�+-�IP:_��'�,�oi /
. . _..�,
CON1'RACTOR:�s �oxe. s o o� .��PHONE: �5�- cY�(- a��-1 (
CONTACTPEF.SOiv: ` �IOSIIrE A�R:_ !? -.3Co3 � ' "j'
iVI�,�TG A])DiZESS: �l�! r.�.. �� � CT�'iY: o " ��:,��o
ss��r�aErrs�: � r,�.5�0
����,���: �1�. � ___ _p�o�:
M�L�tG a�nDREss: crrY: �:_____�
��; REGxSfiRAr�'T�ON� �
TYPE OF�rORS: ATew Addition_ Ac�essory S¢uctu�re
Move� Remodel/Alterazion„L, Land Alr�erafaon�
PROPOSED�'Y' (desc�be irt detu��:�.�-r G�F �i s�`;...� �'ff6 I�•�-Q C5�_
STO�TES: �.._ SQ.FEET OF�ACSFLOOR •
N0. OF S1tDROOV�9:� G�RAGE STALLS: ATT: - DE'�. .:. .-= =.-_.•�a.. �
EST�i1�iATED CO�TSTR'CJCTION'irALUATIO�(excludiag lan�: � 5�'GI'� .�G _..�
Y heceby apply for a buiiding penmi,t aad I acknowl��e tbac the iufozma$on above�S complet�and.
accurate; tha�the work�+ill be in conformaace wiih�ordiaances a�ad wdes of the Citq�d.with
the St�,te$ailclis� Code; Thac I tr�ttderstand t�is�aoc a permtt aad work is aot to star�wlrhouC a
p2cm�,�; and that the work wi11 be 3n ac o ` the approved plas4
,
APPLICAa�t�'S SYCNATLTR� DA,TE: ��-O�
�
Np�'sd F ad� Z�Qmes everr.�require seParQt'e permit approval by �Parrce Depgr�eerr�w�td
City Ceuncit 60 days pr�or to �he event. Na�-pernaitted events will not be a�ox�ed.
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J . 0 �
Sec.13.04 RIGHTS OF S[JBJECTS OF DATA
Subd. 1. Type of data. The rights of individual oa whom the data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information required to be givea indivIdual, pn iadividual asked to supply privace or co�dential data conceming bimseYf
shall be informed of: (a)the purpose and intended use of the tequested data within the collecting s[ate agency,polidcal subdivision,or statewide
system:(b)whether he may refnse or is legally required to supply the requested data;(c)any Irnown consequence arising from his supplyiag or
refiuing ro supply private or confidenaal data;and(d)the identiry of ocher persons or eaaaes auchorized by state or federal(aw to receive the data.
T6is requi�ement shall not apply when an individual is asked to supply invesrigative data,pursuant to secdon 13.82, subdivision 5, to a law
enforeement officer.
� The commissi ner of revenue ma tace the noace re ire unde this bdivision in e individual inc me tax or ro tax refu
insnvcaons instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individua!shall be informed whether he is the
subject of stored data on individuals,and whether it is class�ed as public,private or canfidential. Upon his further request,an individual who
is the subjecc oP swred private or public data on individuals sha11 be shown the data without any charge ro him and,ff 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 bc
disclosed w him for six moad�s thereafter unless a dispute or acdon pursuanc to this secdon is pending or addidonal data on the individual has been
collzcted or created. TEie respa�ible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data.
The respoasible authority may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
Zhe resporuible authority shatl camply irnmediately,if possible,widt any requesc made pursuan�to this sub��uion,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 widi
the request widun thac time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,
excluding Saturdays,Sundays and legal hoiidays.
Subd.4. Procedure when data is not accurate or camplete. An individual may contest che accuracy or completeness of public or
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority descn'bing the�nature of ehe
disagreemenc. The respo�sible authoriry shall within 30 days either. (a)correct the data faund ro be inaccurate or incomplete and aaempt to noafy
past recipiencs of inaccurace or incomplete da1a,including recipienu named by the individuai;or(b)nodfy the individual that he believes the data
• to be coaect. Data in dispuce sha11 be disclosed only if the individual's statement of disagreement is included with the disclosed data,
The determinaaon of the responsible authoriry may be appealed pursuant to che provisions of the administradve procedure act relating
to con[ested cases.
pATA PRIVACY ADVISORY � .
In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of data", we would like to inform you that your
request for a permit or license from the �ity of Orono or any of its dPT�,�rrr�ents may reo���re yon m fi,m_�� ��-*�:,,
private or�uniiaential inrormauon. ' .
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 Counc::,:;,;ion to approve, some i..:ol�.ia�ion 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 Middla ��
Address
Ciry Srate Zip Phone
I understand my ri�hts as stated above.
.
Signature
6 . .