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Home My WebLink About2007-P11665 - re-roof . PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p11665 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date issued: 11/7/2007 SITE ADDRESS: 736 Dickey Lake Dr Unit# Long Lake, MN 55356 PID: 27_118-23-33-0006 DESCRIPTION: Proposed Use: Residenrial Census Code O/S-Building Pcrmit Class: Building Permit Typc: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 139.25 vaivation: $ 6,900.00 State Surcharge Fee: $ 3.45 TOTAL FEE: $ 142.70 APPLICANT: Incline Enterprises Inc OWNER: Marian Hoyt 26175 Birch Bluff Rd 736 Dickey Lake Dr Shorewood, MN 55331 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 B�ILDING�ODE RERUIREMENTS. �, �, � i � i i i R� ` ; '� �i/YY .�-� AP _l NT PERMITEE SIGNATURE S UED BY SIGNAT[.'RE Copies: 1-File(Srgr:atirres Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, I-Septic) Page I 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�ONTRACTOR � JOB SITE ADDRESS: �7�� C- � � ,:,��'' ZIP: Will this be a arade of Homes, Remodelers Showcase Home or other Display Home? ❑ YeS NO /f yes, a special event permit is reguired ivith Police Department and City Council approval 60 days prior to the event. Shu[tle bu.r service will be requir�ed unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed NAME OF OWNER: �J'/i-l� �7�y7 PHONE: (home) i�� - ��'� (work) MAILING ADDRESS: CITY: ZIP: CONTRACTOR: -�lsl c:..-/� `r�;y ,��-�-i�. �. PHONE: 5'S%� y�� - �O�(.� CONTACT PERSON: , � OBILE/PAGER ��Z -..� �/-�'y 77 MAILING ADDRESS: ��G�l 7 5 �,� �/�'�CITY: -S,�i c}�ti.,�ck; ZIP: S�' "� / STATE LICENSE: # ,��f;� 3 I EXPIRATION DATE: %'� ' � � �; ARCffiTECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding, Windows) Any earth movement may require MCWD review and permits! PROPOSED WORK(describe in detain: i��c�` �� ..i�,� ��j"v,�� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED �- ESTIMATED CONSTRUCTION VALUATION(excluding land): $ �� ! I 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 ord}pances,and code�of the CiTy and with the State Building Code;that I understand this is not a permit and w.6rk is nctt to start:�vithout a permit;and that the work will be in accordance with the approved plan./" ��' �'', % / ) APPLICANT'S SIGNATURE: � DATE: !/�� 31 Sec.13.04 RIGHTS OF SLJB.IECTS OF DATA Subd. 1. Type of data. The righu 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 confidential data concerning himself shal I be informed of. (a)the purpose and intended use of the requested data within the collecting state aeency,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 refusin�to supply private or confidential data;and(d)the identity ol�other persons or en[ities 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 mav place the notice reauired under this subdivision in the individual income tax o�roperty 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 subjectof 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 ofthat 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 thereafter 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 copies of the priva[e or public data upon request by the individual subject ofthe data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shalt 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 compl iance is not possible. Ifhe 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,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 authoriry describing the nature ofthe disagreement. The responsible authority shall within 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: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to suppiy 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. y��l; � �... � � � �� First Mi dle � Last z � � ��,��, �� ,,� - �. Address � �� ' 0 C�tY i ��" .8`tate Zip Phone I understand my rights as state'cJ.above. ,�� ' ' '/ / ' , % "�� J Signature Reset�Forn� 32