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Home My WebLink About2007-P00405 - re-roof PERMIT CITY�OF ORONO 2750 K.elley Parkway- PO Box 66 Permit Number: p11405 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 9/6/2007 SITE ADDRESS: 765 Dickey Lake Dr Unit# Long Lake,MN 55356 P�� 34-118-23-22-0010 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minar Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved perresolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 139.25 Valuation: $ 6,713.00 State Surcharge Fee: $ 3.40 TOTAL FEE: $ 142.65 APPLICANT: Midwest Roofing OWNER: James Fenske 313 Jefferson Hwy 765 Dickey Lake Dr Champlin,MN 55316 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 REQU[REMENTS. � \ �G��2�!`� APPLICANT PERMITEE SIGNATURE S UL D RY SIGNATURE � Copies: 1-File(SignaturesRequired), 1-Appiicant, 1-MonthlyReports, 1-Assessing,(If Septic, 1-Septic) Page l � 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 O ONTRACTOR JOB SITE ADDRESS: �rpS Di c�PY � �e y��'vc ZIP: Witl this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �NO Ifyes, a special event permit is required with Police Department and City Council approval 60 days prior lo 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 OWNER: ��tf.,,¢s �.��S k e PHONE: (home)�s2 Y76 yOSf (work) MAILING ADDRESS: CITY: ZIP: CONTRACTOR:/��q�wPS� KoO�i�c d-.5��4,c PHONE: 763�YZ 7- 969� CONTACTPERSON: �Gf��-esQ /L14�,�tie.. MOBILE/PAGER: MAILING ADDRESS: �l:i �T�,�'�r�soH hlwv CITY: ��n /�� ZIP: SS3/(o STATE LICENSE: # 2 DO/D2'7'7 EXPIRATION DATE: 3 3 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 ay require MCWD review and permits ! PROPOSED WORK(describe in detain: `�'' O ef- �"�roo Glovse�4��cc� - y�ss ' v STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(exduding land): $� �13 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 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: �� DATE: � 4 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA � Subd. 1. 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 confidential dauconceming 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 private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shal 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 mav place the notice required under this subdivision in the individual income tax or propertv 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 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 shal l be shown the data without any charge to him and,if he desires,shal I 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 disdosed 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 ofthe private or public data upon request by the individual subject ofthe data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority 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 compl iance 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,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contestthe accuracy or completeness of public or private data conceming himsel£ 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 either (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[he data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data. The determination ofthe responsible authority may be appealed pursuant to the provisions ofthe 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 refusa]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 Middle Last Address City State Zip Phone I understand my rights as stated above. � � ignature � � � Reset Form 32 `/'- DATE TIME ✓ CITY OF ORONO � CALLED IN lD—� INSPECTION NO ICE SCHEDULED D� -D � PERMIT NO. d COMPLETED ADDRESS -Z � OWNER NTR. � I`--�'U TELEPHONENO. 76� �z-7 `� ��o � � DESCRIPTION ��n� ��' � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS � ❑ INSULATION 0 WOOD BURNER/FIREPLACE Q ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP r ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � � O �. � O � W � Q � Z W � W � j d W� ❑WORKSATISFACTORY:PROCEED �ROJECTCOMPLETE W ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Cal1 for the next inspection 24 hours in advance. (J52� 24J-4600 OwnedContractor on site: Inspector.� �,� �� White Copyllnspector's File Canary CopylSite Notice