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Home My WebLink About2008-00105 - roofing � � CITY OF ORONO PERMIT NO.: 20o�-ooios 2750 KELLEY PARKWAY ORONO, MN 55356- DATE [SSUEn: 08/06/2008 952 249-4600 FAX: 952 249-4616 ADDRESS : 865 FERNDALE RD W PIN : 02-117-23-44-0006 LEGAL DESC : AUDITOR'S SUBD.NO. 184 : LOT 104 BLOCK 000 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING -ASPHALT ACTIVITY : O/S BUILDING-LJNDEFINED VALUATION : $ 62,850.00 NOTE: TEAR OFF EXISITING ROOF(NOT INCLUDING NEWER AREA)AND INSTALL SLATE ROOF. APPLICANT PERMIT FEE SCHEDULE 779.25 LES JONES ROOFING INC. STATE SURCHARGE(VALUATION) 31.43 941 W 80TH STREET TOTAL 810.68 BLOOMINGTON, MN 55420- (612)881-2241 Minnesota State License#: 6560 OWNER CONSTABLE,TRACY 19455 CEDAR HURST DEEPHAVEN, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if cons[ruction authorized is no[ commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is respon8 ble for assuring all required inspections are requested in co an with e State Building Code.This permit may be revoked a(�a i e or ue ca �e. % ,j -- � ;� . ;�� - � �'� C�� 0 � D� Applic nt Permitee gnature Date Issu d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � , . Total Fee: $ � �� p� Date Received:��10� Entered By: `y�t._.e� Permit#: �2D0 �-C��05 CITY OF ORONO - BUILDING PERNIIT 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�ONTRACT_„_O� _` JOB SITE ADDRESS: u�'S ��7��'�.�z� }�--� �'� ZIP: `� `� -� �� I Will this be a Paxade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes ��TB If yes,a special event permit is required witn Police Department and City Council approvai / 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. NAME OF OWNER: �%�`� � �-�n��- PHONE: (home) (work) MAILINGADDRESS: �� t�'',�-c'�l-� CITY: �l�'�`'`'' ZIP• S � -� �� l CONTRACTOR %-�.� _ ,.�c�.�_� j�"u,>��,, - .'.�.�- PHONE: r�`�.�- `�'SYr _� � `-�� CONTACT PERSON: �� t %`:�__�<�� ,�-�..--` MOBIL�/PAGER: t�� - 3'Y/—.�.�-�/l MAILING ADDRESS:� � �' �i'`� �`�- CITY:t"� �,f;��„ �^.��ZIP: 5 � �j STATE LICENSE: # 6�r�(,F.� EXPIRATION DATE: � - :�1 — G� ARCHITECT/ENGINEER: /��C`-- PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home RemodeUAlteration(ie: Siding,Windows) �--�"-' Any earth movemen may require MCWD review and permits! P POSED WORK(describe in��tai�: ) c��°--•' L��f- t'�-� �% I'G��'� �� /�� I�L .�.z l_k- "11��-*-�x.;- t:,-f?�.>.._ :� �-�'r_c.� `-��cr` r"c;t a / STORIES: SQ.FEET OF EACH P'LOOR: NO.OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ C.P� �J D - Ci� 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 a�d war1�is t to start without a permit;and that the work will be in accordance with the approved plan. ; . APPLICANT'S SIGNATURE.` � �l`-�---'"DATE: ��-� � � � � 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 for[h in this section. Subd.2.Information required to be given individual.An individual asked to supply private or confidential data concerning himself shall 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 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 may place the notice required under tivs subdivision in the individual income ta�c or property tax refund instructions instead 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 whether it is classified as public,private or confiden6al. 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 chazge 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,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 private or public data upon request by the individual subject of the data. The responsible authority 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 Sahudays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request witlun that time,he shall so inform the individual,and may have an additional five days within wluch to comply wiih the request,excluding Sahudays, 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 shall notify in writing the responsible authority describing the nature ofthe disageement.The responsible authority shall within 30 days either: (a)coaect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccutate 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 authoriry 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 subj ects 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 aze notified that: 1. The information you furnish will be used to determine your qualification for the pernut or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the pernut 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 pernut 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 rocess this application or permit. l� �'� �� ,�� , �- . F►r9t Nuaaiy� Lest �-(�-f l l-� 5'� � ��7 dress , ��;�I � c��r��.�� >-�- �n''� `��?1�� `��- ��-l/ , City � State Zip Phone I understand r' �ts as stat�ed above. � `�� '� Signature Reset Form 32