HomeMy WebLinkAbout2002-P05708 - re-roof PERMIT
tCi-i Y OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Pos�og
Crystal Bay, Minnesota 55323 Pe►'mit Type: MinorAlterations
(952) 249-4600 Date Issued: lo�i�i2oo2
SITE ADDRESS: 4060 Dahl Rd
MOUND,MN 55364
PID: o�-ii�-23-ii-oo2o
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Pernut 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: $ 167.25 Valuation: $ 9,000.00
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 172.25
APPLICANT: Project Facilitators OWNER: 7&7 NEVE 7R
5057 Three Point Blvd 4060 DAHL RD
Mound, MN 55364 MOLTND MN 55364
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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APPLIC NT ERMITEE SIGNATURE 1 UED BY SIGNATURE
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Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthlv Reports. 1-Assessin�, 1-Finance Page 1
, � Total Fee: $ �o� • � S Date Received:/8- �-Oa
Entered By: Permit#: {�U 5�b 8"
CITY OF ORONO - BUILDING PERMIT APPLICATIOleT
1V, All information must be submitted in full before plan review will be started.
(please print all information)
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� ��� THE APPLICANT IS: (circle one) OWNER O CONTRACTOR �
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JOB SITE ADDRESS: `-��(�u 7/�}N L �-� �G V�ti'D ZIP: S S� � � ��
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NAME OF OWNER: �►`��S P. N� V� PHONE: (home) `�sa - �c�a - 3c� 7�
(work) 9 S� -s" �%l -! 7 �t y
MAILING ADDRESS: �c�l� � 7�/4'L�i-L �i2D CITY: /�'1 G �i� N'1� ZIP: SS 3� �/
CONTRACTOR: pR�J�-�.� �J4 C�L�1�+47"(� �'PHONE: 9 Sa - � 7 a --I/a l�
CONTACT PERSON: /�Lv4-N (� L N C,l�l,�r MOBILE/PAGER: `�Sa- .��.L -- O 7 36
MAILING ADDRESS:Sz�s 7 %N,eEE ,���ti�r��L,�ITY: /�'►C v Nls ZIP: �S 3 !� Y
STATE LICENSE: # c,7 D�;2.c� 9'� l 7
ARCHITE T NGINEER: PHONE:
MAILING DRESS: CITY: ZIP:
NAI�!IE; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
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PROPOSED WO ( es� d cribe in detai�: �'� �P�� p�i��r d F /�C,'G E� � C��
�S'�S� � Eti �,�
S�EE�KKIES:-- SQ:��'T'OFE-A��.-9Q�:
. . G _ TT. ----�T,
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��% �� �
I hereby apply for a building pernut and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the 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:_,`;:"_���� �c�:� l��G� �LC DATE: /L:�, l -7 - L� Z
NOTE! Parade�Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
. �
Sec.13.04 RIGHTS OF SLIB.TECTS OF D�1TA
Subd. i. 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 confidendal dara conceming himself shall
be informed of: (a)the purpose and intEnded use of the requested data within the collecting"state agency, poliacal subdivision,or sratewide system;
(b)whe[her he may refuse or is legally required to supply the requested data;(c)any known consequence arising fmm his supplying or refusing to supply
private or confidenrial data;and(d)the identiry of ocher persons or enricies authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieadve data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or property 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 whe[her it is classified as public, private or confidenaal. 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 hicn 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 Ihereafter unless a dispute or action pursuant to this seccion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies 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 accual cosu of making, certifying, and compiling the copies.
The responsible authoriry shall 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. If he cannot comply 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,exciuding 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 pm•ate
data concerning himself. To exercise this right,an individual shall notify in wriang the responsible auihority describing�he nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy 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 authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 pernut or license from the City of Orono or any of its departments may require you to fumish certain private or
confidential information.
You are notified that:
1, The information you furnish will be used to determine your qualification for the pemut 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 pernut or license.
4. If your requeste� 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.
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Signa re � ,:'�
✓ DATE TIME
CITY OF ORONO , ��CALLED IN
INSPECTION NOTICE � SCHEDULED �"b
PERMIT NO. ���� C MPLETED
ADDRESS 7 �(�� �� � �,.
OWNER CONTR.
TELEPHONE N0.
� DESCRIPTION v �i-' I�O
l� 01 FOOTING . 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
O 03 INSULATION 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z ALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
05 NAl 14 SEWER HOOK-UP 06 PROGRESS
� 07 OEMO-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 MEET YOU:_YES_NO
� COMMENTS:
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� �ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call forthe next i spection 24 hours in advance. (952� 249-4600
Owner/Contrac 't
Inspector. � �
White Copyllnspector's File Canary CopylSfte NoUce
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cinr oF oRONo �� �7���A�a o � ; _ -
INSPECTION NOTICE SCHEDULED ! / �� � �' �%�j
PERMIT N0. COMPLETED �
ADDRESS �`�
OWNER CONTR.
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TELEPHONE N0. — � ����-/l�7� ��
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� DESCRIPTION �� � —
� 01 FOOTING 11 MECHANICA RI 18 EXCAV RA ING/FILLIN �
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL �
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS �� •
� 07 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
� OWNERICONTRACTOHTOMEETYOU:�YES_NO
� COMMENTS: �� l,�i' ,✓'1 7'S 7 7� //f���-
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Cal1 for the next inspection 24 hours in advance. (g52) 249-46�0
OwnerlConUacto �e:
Inspector.
White Copy/lnspector's File Canary Copy/Site Notice
DATE TIME
CITY OF ORONO �:-�L' CALLED IN �'
INSPECTION NOTICE , �'�,? SCHEDULED al d s
�ERMIT NO. COM�LETED
ADDRESS �t(1�oO �t�,l �.�
OWNER CONTR.�iro ie�" �I i��o rs
TELEPHONE NO. Col���O—
� DESCRIPTION 'rl' —'�`OOT
� 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 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q�INAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENT
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� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (g52) 249-46��
OwnedContrac or��ite:
\1
Inspector v
White Copyllnspector's e Canary CopylSite Notice