HomeMy WebLinkAbout2003-P06280 - re-roof � *� PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po62so
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: s���2o03
SITE ADDRESS: 3080 Farview La
I.ong Lake,MN 55356
PID: 04-117-23-34-0012
DESCRIPTION:
Proposed Use: Residential
Buildin Census Code O/S-Building
Pernut Class: g
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 223•25 Valuation: $ 12,340.00
State Surcharge Fee: $ 6.70
TOTAL FEE: $ 229.95
APPLICANT: �'�'esturn Roofing OWNER: Daniel&Martha Lips
9700 13th Ave 3080 Farview La
Plymouth,MN 55441 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESI'S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
� /-� ������-
APPLICANT PERMITEE SIGNATURF, ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reoorts. 1-Assessine, 1-Finance Page 1
� 1�..
Total Fee: $ o� a Cl .�.S Date Received: S- �- D,3
Entered By: Permit#: PD�2$D
CITY OF ORONO - BUILDING PERMIT APPLICATIOl`+T
All information must be submitted in full before plan review will be started.
(please print all information)
----------------------------------------------------------------------------�----------------------------------------
�-
THE APPLICANT IS: (circle one) OWNER OR NTRACTOR
�,����
JOB SITE ADDRESS: ��c> � ��e ZIP:
13�•.��ucr
1�TAME OF GWNER: �a-+y"��5�� ��S� I`�� PHONE: (home) �
(work) �i �- 3��-�S`��
MAILING ADDRESS: �;�,,.,e CITY• �f�o ZIP:
CONTRACTOR: ���PS-fc.��t� 2oc��ro PHONE: ��Sf��-��'�
CONTACT PERSON: �,�,� MOBILE/PAGER: �ia ���-`/�s^S-
MAILING ADDRESS: R�� �3n �� �c/ CITY: /?��� ZIP: ssYy/
STATE LICENSE: # �c��5��,
ARCI�ITECT/ENGINEER: PHOivE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: � �-' �P�� �
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �ai �`��
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: S 7 ��
NOTE! Parade of 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.
.� a
Sec.13.04 RIGHTS OF SLJBJECTS OF DATA
Subd. 1. Type of data. The righu 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. M individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of che requested data within the collecting"state agency,polidcal subdivision,or statewide system;
(b)whether he may refuse ot is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply
priva[e or confidencial data;and(d)the idenriry of other persons or enrities au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invescigarive dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer.
The commissioner of r���enue mav place the noace required under this subdivision in the individual income tax or proper[v tax refund
instructions instzad of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals, and whecher i�is classified as public, private or confidenrial. Upon his further request, an individual who is the subject
of stored private or public data on individuals shali be shown the data without any charge to him and, if he desires, shall be informed of the content
and meaning of[hat data. Afrer an individu�l has been shown the private data and informed of its meaning, the data need not be disclosed to him for
six months[hereafrer unless a dispute or acrion pursuant to this secaon is pending or additionai 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 acrual cosu of making, cerafying, 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 Sa[urdays,Sundays and le¢al holidays,if immediate compliance is not possible. If he cannot comply with the request
within that tune,he shall so inform the individual,and may have an addirional 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 individua(may contest the accuracy or completeness of public or pri�•ate
data concerning himself. To exercise[his rieht,an individual shall notify in writing the responsible au[horiry describing rhe nature of the disagreement.
The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past tecipients of
inaccurate or incomplete data, including recipients named by[he 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 wi[h the disclosed data.
Ttie decerminarion of the responsible authority may be appealed pursuanc to the provisions of the administrarive 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 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 pernut or license.
4. If your requested permit or license requires Council action to approve, some informa[ion 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
Ciry State Zip Phone
I understand my rights as stated above.
i��/�7/�
—T
Signacure/