HomeMy WebLinkAbout2003-P06822 - re-roof � ' PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po6s22
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 9�24i2oo3
SITE ADDRESS: 2475 Countryside Dr
LONG LAKE,MN 55356
P I D: 04-117-2 3-11-0006
DESCRI PTION:
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 40135 Valuation: $ 25,958.00
State Surcharge Fee: $ 13.50
TOTAL FEE: $ 414.85
APPLICANT: Sela Roofing&Remodeling,Inc. OWNER: Barbara Hite
4100 Excesior Blvd. 2475 Countryside Dr
St. Louis Park,MN 55146 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.
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APPLICA�+1 PERMITEE SIGNATURE I SUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance PaQe 1
Total Fee: $ Date Received:
Entered By: Peruut#:
CITY OF OIZONO - BUILDING PERMIT APPLICA.TZON
All informatiou must be subznitted in full before plau review �vill be started.
(please print all inforntation)
----------------------
THE APPLICA.NT IS: (circle one) OWNER OR CONTRACTOR ,
JOB SITE ADDRESS: �` � I ��
� �7� � ZIP: _� �~,� � �
��I
NAI�� OF Oti�NER: n i� �
��c� � r,�.����� ��r�-P PHONE: (home) �1Sa-���5 �
(work)
I�IAII.ING��.DDRESS: . CTI'Y: ZIP:
CONTRA.CTOR: � SE�ROOFING&REMODELING P�IONE: �'1,
��-�a��X�y��
CONTACT PERSON: SIOR BLVD. 7ZOBII.E/PAC'rER:
MAILING A.DDRFSS: -�#A�A��^ CIT`Y: ZTP:
STATE LICENSE: #
ARCHI'I'ECT/ENGliYEER: PHO\TE:
NIAILL�IG ADDRI;SS: CITY: ZIP:
�T��� ` REGISTRA.TION# �
TYPE OF tiVORK: Ne�v Addition Accessory Structure
Move Remodel/111teration Land Alteration
P�ZOPOSED tiVORK^(describe in detai�: - '� ��.,, '� �-� Q C�
--�'�`�-�- � `� `� /\�e , � � � �c " P S
STORIES: SQ. FEET OF EACII FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT�. � DET. � _ .- . .. .,
ESTIttiIATED COti'STRUCTION VALUATIO\ (exclucliug land): S �.�`��\
I hereby apply for a building pemut and I acknowled�e that the information above is complete and
accurate; that the work �vill be in conformance with the ordinances and codes of the City and with
the State Buildin� Code; that I understand this is not a perm.i[ and work is not to start without a
permit; and tha[ the work will be in accordance with the approved plan.
A.PPLICAN'I''S SIGNA'TUIZE: �� , - �
DATE: �_ �-- � - 1
14'OTE! ,Parade of HomeE events require separate pernrit c�pproval by Police Depgrfinent and
City Cou�tcil 60 days prior to the event. Non permitted events tivill not be allotived.
Scc.13.0-t RIGHTS OF SUEJECTS OF D.-1T,�
Subd. l. Ty�pe of data. "IZu righcs of individual oo whom�e dau is s�n:�or co be scorcd shall be�s sc�forth in this sccdoo.
Subd.?. Informatioo reqtrired to be given individual. �ir.c+i�idual ast�to supply private or confidendal da[a concerning himself sb�ll
be informcd of: (a) the purpose and in�ended use of the rcquestcd dam ai�in tbe collecang�tace agency, Polidcal subdivisioo,or scatewida ryscem;
(b)whe�her he mzy rcfuse oY is legally rcquircd to supply[he[equested dan;(c)any l�o•xn coasequeoce arising from his supplying or tefvsing to supply
priva�e or conndendal data;ar.d(d)the tdentiry of other persoat orearid:s z�c.horized by s�ate or fedecal law to rceive the data.,This requiremeot shall
not apply whtn an individual is asked to supply invesdgadve daa, purs�.c[o seccoa 13.82, subdivision 5, to a law cnforcement officer.
The comrrussioner of r��e�ue mav lace the norice rcwircd �r.Cer chis subdivision in tha individual ir:coma tax or oro em mz rcFund
instrvuions ins�esd of on ehose foRns.
Subd. 7. Access to data by tndir-iduat. Upon requcs�to a r_staasible a��oriry,an individual shall be informed whether he is[he subject
oF s�or:d data on individuals, and whe�her it is classificd as pubiic, priva4 or confider.rial. Upon his funhec rzquest, an individual who Is the subjecc
o[scored privace or public daca on individuals shall be shown ehe daraµi.^ou�any eiurgo to him and,'if he desires, shall be informed of�he concenc
ar.d mcaning of that daca. Aftar an individual hu bcen shown the priva��ac�and 'tc:ormed of its mcaning, the data peed not be disclosed to hirn for
si.c mon�hs thereaft�r unless a dispute or acdon pursuant to this secdon is F:nding or additioaal data on the individual has been collected or cr:aced.
Tie responsible authoriry shall provido copies of�he private or public dau�:on reques;by�he individu�l subjecc of�he data. The responsible au�horiry
ray requirt [he «quesring person to pay the ac�ual cosu of makin¢, ce_:;ing, and compiling the copies.
The responsible authoriry shall comply immediacely, if possibla, wi�h any r.quest made pursuant to this subdivision, or wi[hin five days of
the dac�of the request,e.tcluding Saturdays,Sundays and legal holidays,ii is.media[_compliance is not possible. If he cannot comply with�he r:ques�
wi�hin�hac dme,he shall so inform�he individual,and may have an addice�i five da��s wi�hin w6ich to comply wi�h[ho request,exciuding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when d�ta ts not accurate or complete. �n individuzl may contest the accuracy or completeness of public or pri�•ate
dac3 conceming himself. To exercise�his rieht,an individual shall noriFj u wridng ce rsponsible authoriry describing�he nature oF the disagre:meoc.
Thc responsible au�horiry shill wi�hin 30 days ciiher: (a)comct the dae[cund to�e inaccuratc or incomplece and attempt to nodfy pas[recipienes of
inaccurste or incomplete da�i, including recipiencs named by the individ�J; or(b) rodfy the individual tha[he btlieves [he data to be correcL Da�a
in dispuce shill be disclosed only if the individual's statement of disagre:�ent is �.cl�ded with the disclosed data.
Tiu decerminadon of the responsible authoriry may be appta:e� pursuar.c to the provisions of tha adminis[rarive procedure act reladng to
conees:ed cases.
DATA PFtI�'�CY AD�ZSORY
In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of da�a", we would like to inforui you thac your reauest
for a permit or license from the Ciry of Orono or any of is depac-;�Leacs rr�ay require you to furnish certain privace or
confidential information.
You are notified that:
1. "I�e informa�ion you fumish will be used to de:ermine ��our qualiftcation for the permic or license requesred.
2. You may refuse to supply data, bu[ refusal nay require that the City deny che permic or licease.
3. The information may be shared with oeher loczl, state or federal a;eacies to the extent necessary to process
the permit or license.
4. If your requested pemut or license requires Council action to approve, some information ruav become
. public. . "
�. You have certain riehts under Nt.S. 13.04 (a•:ailable upon request) to review private data on yourself.
6. Your full name is required to-process this zpalicatio❑ or permi�,
Firsc �(iddle
Last
Address
Ciry Stam ZiP Phone
I underscand my ri;hts ed above.
� _ _
Signacure
�s��� .�
DATE TIME
CITY OF ORONO CALLED IN ��'Z-�'�
INSPECTION TI SCHEDULED l��Z3-Q3 3�vo
PERMIT N0. �Z2- COMPLEfED
ADDRESS �-� S f1v
OWNER C NTR. ��P�il-�
TELEPHONE N0. �l� Z�� ���7 �N����
� DESCRIPTION �J'�'Q .�._, _ �I1SOT�'ELY'D�� I
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z J04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q/OB�INAL 14 SEWER HOOK-UP O6 PROGRESS
� �fI,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
� OWNER/CONTRACTOR TO MEEf YOU:_YES_NO
� COMMENTS:
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W� ORK SATISFACTORY:PROCEED . PROJECT COMPLEfE
W ❑CORRECT WORK&PROCEED O ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WlLL RETURN
❑STOP OR�ER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARFiANGE ACCESS.
Call forthe next i pection 24 hours in advance. (952� 249-46��
OwnerlConU it :
Inspector. �'�'��--
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