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Home My WebLink About2009-00520 - windows CITY OF ORONO PERMIT NO.: 2009-00520 t � 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE �ssuEn: 08/27/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 160 CYGNET PL PIN : 04-117-23-22-0020 LEGAL DESC : SWAN LAKE ADDN : LOT 003 BLOCK 003 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENT[AL CONSTRUCTION TYPE : WINDOWS ACTIVITY : O/S BUILDING -UNDEFINED VALUATION : $ 11,823.00 NOTE: REPLACE 4 WINDOWS&2 PATIO DOORS IN EXISTING OPENINGS APPLICANT PERMIT FEE SCHEDULE 221.25 RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 5.91 1920 COUNTY RD C. WEST ROSEVILLE, MN 551 13 MAIL-IN FEE 2.00 (612)502-4777 TOTAL 229.16 Minnesota State License#: 20130983 OWNER DEBERNARD[, OLSON& PAUL 160 CYGNET PL LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for 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 no[gran[permission for additional or related work which requires separate permits. All provisions ot�laws and ordinances governing this type of work shall be compied with whether or not specitied 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 I 80 days at any timc afrer work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. � / / / / Applicant Permitee Signature Date Issued By 'gnature te SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . �_ ��/ �`° ` �� , � � , � � • �� Total Fee: $ _ � Date Recerved: Entered By: \� permit#: "\ / CITY �OF ORONO - BUILDING PERMIT APPLICATION �- J v \ �� All mformahon must be submitted in full before plan review will be started. ��y (please print all irtformation) -------------------------•----------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: �� C u �Y��" �GL.C�Q„ ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No lfyes, a special event permit 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 OWNEI[t: �(x,� , �, b-Q,(��('O'� PHONE: (home)IG(��'Q'�[/l'" J�� (work) MAILING ADDRF:SS: CITY: ZIP: Renewal By Andersen CONTRACTOR: 1920 County Road "C" West PHONE: CONTACTPERSON: Roseville, MN 5�113 AGER: MAILING ADDRESS: _ License #20130983 ZIP: STATE LICENSE: # 651-264-4777 DATE: ARCHITECT/ENC.INEER: PHONE: MAILING ADDRF;SS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding, Windows) Any earth moveme t may require MCWD review and permits ! PROPOSED WORK(describe in detain: ' . � . STORIES: _ SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED CaU ESTIMATED COI�(STRUCTION VALUATION(excluding land): $ �', ga 3 `— 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 ordinances and codes ofthe City and with the State Building 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: ATE: �� 31 Sec.13.04 RIGHTS OF SL"EJECTS OF DATA Subd. 1. Type of data. Thc rights of individual on whom the data is stored or ro be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private orconfidential data concerning himselfshall be inYormed 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 private or confidential data;and(d)the identiry 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 may place the notice required under this subdivision in the individual income tax or prooertv tax refund instructions instead of on those f'orms. Subd.3. Access to data by individuaL Upon request ro a responsible authoriry,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 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 be disclosed to him for six months thereafier 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 wpies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible au[hority shall comply immediately,ifpossible,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 possibie. If he cannot comply with the request within that time,he shal I so inform the individual,and may have an additional five days within which to comply with the request,excluding 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 private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement. The responsible authoriry shall wichin 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt to notify 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 included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure 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: 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. '� �Q�Yl.sdl'1 First �.I ,� '1liddl Last ,= �.�,� A dress o�-�, cc�� rnrv s��`2� � �-(��y- C�4' State Zip Phone �� 1 understand my rights a stated above. Signature Reset Fotm 32 L r 5-��-- '� , D TE TIME CITY OF O ONO �D IN z INSPECTION N „ „sCHEDULED �1 �� PERMIT NO. � ��v OMPLETED � �j , ADDRESS �-- OWNER CONTR. TELEPHONE NO. �a--l�` /��" a�v�` �O�ls ` � �� DESCRIPTION ��I_-�I/t'�L� v�i.. � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z �WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL � ❑ PLUMBI ❑ FOUNDATION/REMOVAL � OW RICONTRACTOR TO ET U: YES_NO � COMMENTS: � W C � j1��c,� Qo� �,c7 �c�v � ��cs � �� .� � �r( S L�• U� � �1 �� 1 M �� r'� � 42 C�r'��o�J Q � ('—f c.�A4 � 1 � W Q /�� c� n �I �r ��c�l �'�c. S t��f�� G a9 �t �� t3 a.,e �l �C�� w�„ �o� W � %�- � J('o.ti,"T' � a W ❑WORK SATISFACTORY:PROCEED fl PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CEATIFICATE OF OCCUPANCY W RRECT WORK,CALL FOR REINSPECTION TEMPORARY V FORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR W4LL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor on site: Inspector. C � _ ___ White Copyllnspector's File Canary CopylSite Notice r��', � � � � DATE TIME CITY OF ORONO CALLED IN �� '� /�� INSPECTIO NOTICE � SCHEDULED ��I�-� _j�L PERMIT N� ��C COMPLETED ADDRESS � (.G'��}''��_f f-� ��-C _ OWNER CONTR. l�� G'�I �� TELEPHONENO. � ( ��'�—�GOt�S �?�I.CYC(`,�� aJ � � DESCRIPTION T r�-�" "k-� 1�� I�-� ��C�=•� � ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING �, Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETIANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE O ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION�Y�-�I Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS 1, ` � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT V" ��'�S Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP � n�u"Z i ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL � ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:�YES_NO � COMMENTS: � W a � J O �. � O � W � Q ti Z W � W � � GW ' ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE ❑�CORRECT WORK&PROCEED 1- ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PNOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-4600 Owner/Contractor on site: Inspector. r "` White Copyllnspector's File Canary CopylSite Notice