HomeMy WebLinkAbout2002-P05071 - re-roof � ,
PERMIT
CITY ',�F ORONO Permit Number:
2750 Kellt y Parkway PO Box 66 Poso�i
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 4�23�2002
SITE ADDRESS: 2943 Farview La
L.ong Lake,MN 55356
P I D: 04-117-23-34-0008
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Pernut Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 195.25 Valuation• $ 10,300.00
State Surcharge Fee: $ 5.15
TOTAL FEE: $ 200.40
APPLICANT: Sela Roofing&Remodeling Inc. OWNER: Joseph&Kay Deckman
4100 Excesior Blvd. 2943 Farview La
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 CO E REQUIREMENTS.
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APPLIC P RMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Aoplicant. 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
#
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Total Fee: $ Date Received: � ��'
Entered By: Permit#:
CITY OF ORONO - BUILDING PERNIIT APPLICATIOl�
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 OR CONTRACTOR
JOB SITE ADDRESS: aC��I� ��Y 1i'�' G W �. c�►�L ZIP: 5�3 S�
NAME OF OWNER: �q y ��C �w«�n PHONE: (home)y5�,_ y��/-ys !3
� (work)
MAILING ADDRESS: ����3 E-�.r V.`� i,✓ �. 1�1 CITY: �r 6►il p ZIP: .5�35�
CONTRACTOR: S � ��, l�o o���� r PHONE: �1�� ��3' ���16
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: ��!b0 f�x�c�ls�or I�/c�c� CITY:S�-�.o�,�s I�r If ZIP: SS�//d
STATE LICENSE: # I �S�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: , �a r o �.� /�c�rr��+ f�o u5�
,/� .��,C h�,�� G c, rc� �'
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �'��, 3��
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 t permit and work is not to start without a
permit; and that the work will be in c rdance i the approved plan.
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APPLICANT'S SIGNATURE: � DATE:
NOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
♦ �I
Sec.13.04 RIGHTS OF SUB.TECTS OF D�TA
Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecang"state agency,polidcal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply
privace or confidenrial data;and(d)the idenriry of o[her pecsons or enriaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigadve dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data b�individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, privace or confidendal. Upon his further request, an individual who is the subject
of stoted private or public data on individuals shall be shown the data wi[hout 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,che data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant[o this seccion is pending or additional data on the individual has been collected or created.
The responsible authority shall provide copies of the private or public data upon request by the individual subject of che data. The responsible authority
may require the requesdng person to pay the actual costs of makine, cercifying,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 compliance is not possible. If he cannot comply with the request
wi[hin[hat time,he shall so inform the individual,and may have an additional five days within wtuch to comply with[he 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 conceming himself. To exercise this right,an individual shali notify in wriang the responsible authority describing[he narure of the disagreement.
The responsiblz authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be cocrect. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the adminisuarive procedure act relating to
contesred 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 Ciry 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 pemut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut 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.
j. 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.
Se 1 �12o a�'��
First �' ) dd/le Last
`I'GO l�1CC'�'l 5'�O� �lUi.�
Address �
.�-� Z a v,5 �� r I� Vv� n �S'�/�� � I���.�.3 -��'`�� _
Ciry State Zip Phone
I underst d rights as t d above.
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Signature
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOT CE / SCHEDULED �`�,,Z
PERMIT NO. 3��� �( COMPLETED
ADDRESS •���,� Y��IL�� ����- LCc ti-c..
OWNER CONTR. �.- /c-r �
TELEPHONE N0. �S� �1�� ��3c� � �
� DESCRIPTION �' G��--� ���2 �� �
� Ot FOOTING �,/ 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING G 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATIGN 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER NOOK-UP 17 SITE INSPECTION
Q FINAL 14 SEWER HOOK-UP 06 PROGRESS
� O-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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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W� ❑WORKSATISFACTORY:PROCEED ROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
OwnerlCo or a�site: .
Insp or.
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