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Home My WebLink About2007-P10901 - re-roof PERMIT CITY OF ORONO 275C Kelley Parkway - PO Box 66 Permit Number: P10901 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 4/19/2007 SITE ADDRESS: 470 Big Island Unit# Excelsior,MN 55331 P�� 22-117-23-41-0002 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: $ 391.25 Valuation: $ 24,500.00 State Surcharge Fee: $ 12.25 TOTAL FEE: $ 403.50 APPLICANT: A1 Hirsch&Sons OWNER: Christopher Bollis PO Box 633 220 Stubbs Bay Rd Dealano,MN 55328 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. �' �� ;� '�--�� -�-- C�'�� /'I �� APPLICANT PERMII'EE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) 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 OR�CONTRACTO�R� JOB SITE ADDRESS: 47C� P�I E, 15LJ11�t� ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes, a specral event per•»�it is r•equired with Police Departrnent and City Coamcil approval 60 days prior to the event. Shuttle bus ser�vice rvill be reqz�ired unless applicant demonstrates su�cient on-site parking is available. Non-per•niitted events lvill not be allowec�. NAME OF OWNER:C+�P�S � C�hiL BOL.I.�S PHONE: (home)g5Z-4�3-5Z89 (work)9 5 2- 935-�►3 1 MAILING ADDRESS: 220 5Tu3B5 t3�+Y 1Z�. CITY: L�rit� �-.q►Z�. ZIP: 55 35Co CONTRACTOR: ��- t�1�2�sGH �;�►�t�� +.�C• PHONE:�co3-97Z-z�tf.o CONTACT PERSON: �v,4�E t{ i2 sc}-� MOBILE/PAGER: (v►Z- 7 59-aZ3 5 MAILING ADDRESS: P,O, gc�� (�33 CITY: DEI..�No ZIP: 55 28 � STATE LICENSE: # (Z�{c� EXPIRATION DATE: Z ob � ARCHITECT/ENGINEER: ��/� PHONE: �- MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WOR�: New Home Addition Accessory Structure . Move Home RemodellAlteration (ie: Siding, Wi�dows) `� - Any earth movement may require MCWD review and permits ! PROPOSED WORK(describe iii detain:_� �...i V,QM, K R�� A'�'� W�*►flow5� T��-e. oC� � Q��F STORIES: I SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: Z GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 2�, 5UU�� I hereby apply for a building permit and I acknowledge that the infonnation above is complete and acciu-ate; that the�vork��ill be in conform3nce��it}:the ordinances and codes of the City and��ith the State Buifdin� 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: t Z c3 O �l . Sec.13.0�1 RIGHTS OF SUBJECTS OF DATA Subd. l. Type of data. The ri�hu of individual on whom the data is stored or to be stored shall be as set foRh in this section. Subd.2. InFormation required to be given individual. An individual asked to supply private or contidential dataconcerning himselfshall 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 priva[e or confidential data;and(d)the identiry of other persons or entities authorized by state or tiederal law ro receive the data. This requirement shai I 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�lace the notice required under this subdivision in the individual income tax or vropercv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shaU be infonned whether he is the subject of stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shoevn the data widiout any charge to him and,if he desires,shall be informed of the content and meaning of[hat data. After an individual lias been sho�vn the private data and informed of its meaning,the data need not be disdosed to him for six months thereafter unless a dispute or action pursuant to this secfion 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 shal I 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 comply with the request �vithin that time,he shall so inform the individual,and may have an additional tive days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. 3ubd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming 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 tbund to be inaccurate or incomplete and attempt to notity 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 induded�vilh the disclosed data. The determination of the responsible authonty may be appealed pursuant to the provisions of the administrative procedure act relating[o 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: l. 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 �liddlc . Last � Address Citv State Zip Phonc I understand my rights as stated above. Signaturc Reset Form .i�