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Home My WebLink About2005-P08880 - re-roof PERMIT CITY O� ORONO Permit Number: 2750 KellEy Parkway - PO Box 66 Po888o Crystal E3ay, Minnesota 55323 Permit Type: (952) 249-4600 Minor Alterations Date Issued: 6/24/2005 SITE ADDRESS: 965 Forest Arms Ln Unit# Mound,MN 55364 PID: 07-117-23-12-0020 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 9�•25 va�uation: $ 3,500.00 State Surcharge Fee: $ 1.75 TOTAL FEE: $ 99.00 APPLICANT: Owner/Self OWNER: HERBERT G OLSON ETAL MN 965 FOREST ARMS LA MOUND MN 55364 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 REQUIREMENTS. 1 � ��---� � ��W� �� APPLICANT PERM E SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-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 pri�it all infor•t��ation) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle o�ze) O�V1VE R CO'_'�TTR.A.CTOR JOB SITE ADDI2ESS: �/� � Ok'�5 ��/2l�lS �/!� ZIP: ✓ J�^3� `� `ti'ill this be a Parade of Homes, RemodQlers Showcase Home or other Display Home? ❑ Yes � NO If yes, a special event perrnit is required with Police Departmer�t and Cr.ty Council approval 60 days prror to the event. Sl�zrttfe btrs ser-vice will be reqtrired a�nless applicant demor�strates sz�cient a�-site parl�ir7g is available. Nor�Pernzitted ever�ts will not be alloti4�ed. NAME OF OWNER: ��,�/3�2T ��-5 E'1(/ PHONE: (honze) .��-y ,,2 0��,�� (work) S'�l�9`� MAILINGADDRESSC��sT ��it( CITY: Ov�� ZIP: �3� � CONTR.ACTOR: ��L,� PHONE: CONTACT PERSON: MOBYLE�PAG�R: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: NiA�LING ADDI2ESS: CI'i Y: ZIP: Nt�.'�iE: REGISTRATION: # TYPE OF WO�tK: New Addition Accessory Structure Move Home Rzmodel/Alteration PROPOSED��i'O�(describe in detaz�: ,�,� �4Df= ,�3 ,�pvA�2� S S'T'ORTES: �_ S�.�'E��'O�EACI-��OR: /��f� �i0. OF �EDI2OOidI�: _� ��E S'TALL,S: ATT'A��-I�� 2 DETACI�EI�_ ESTII�IA'TED CO?vS�'RUC'TIOI�sVALIJA�'I�N(excluding lancl): $ 3,�'O O I hereby apply for a building permit and I acknowled�e that the information above is complete and accurate; that the work wi11 be in conformance with t:�e ordinances and codes of the City and with the State BuildinQ Code;that I understand this is not a permit and work is not to start without a pe:mit;and that the work wi11 be in accordance with the approved p1an. A_PPLICA,�T'S SIGNATURE: DATE: � o? O `—' �1 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 s[ored shall be as set forth in this section. 5ubd.2. Information required to be given individual.An individual asked ro supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the reques[ed data within the cellectin;state a;ency,political subdivision,or statewide system;(b) �vhether he may refuse or is le�aity 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 identiry of other p^rsons or entities authorized by state or federal law to receive the data. This requiremeni shali no:apply when an individual is asked to supply investigative da[a,pursuant to section 13.32,subdivision 5,to a law enforcement officer, The commissionec of revenue mav n11ce the notice required under this subdivision in the individual income ta�or pronertv tax refund instn!ctions ins[ead of on those ferms. Subd.3. Access to data by individuxl. Upon request to a responsible authority,an individttal shafl be informed whether he is the subject of stored data on individuals,.and whe�her it is classified as public,private o,-confidential. Upon his fui-[her request,an individual who is the subject o: stored private or public data on individuals shall be sho�vn the data�vithout any charge ro him and,if he desires,shall be informed of che contenc and meaning of[hat data. After an individua]has been shown the pnvate data and informed of its meaning,the data nezd not be disclosed to him for six months thereafrer unless a dispute or action pursuant to[his sec[ion is pending or additional data on the individual has been collected or created. The responsible au.hority shall providz copies of the pnvate or pu6(ic data upon request by the individua!subjec[of[he daca. The responsible auchority may require the requesting person to pay[he actual costs ofmaking,certifying,and compiling the copies. The responsible autt;ority shail comply immediately,ifpossible,wi.h any request made pursuant to this subdivision,or within five days oF the dace of the request,e�cluding Sa[urdays,5undays and legal holidays,if irctmediate compliance is not possible. If he cannot comply with che request within that time,he sha11 so inform�he individual,and may have an additional five days�vid�in which to co;nply with che request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple[eness ofpublic or private data conceming himself. To exercise this right,an individual shatl no:ify in wiiting the responsibiz authority descnbino the na[ure of the disagreement.The responsible authority shall within 30 days either: (a)con ect the data found to be inaccura[e o;incomplete and attempt to notify pasc recipients o:` inaccurate or incomplete data,including recipients named by[he individual;or(b)notify the individual that he believes the data to be correct. Dat2 m dispute shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed data. The determinauon of the responsible zuthority may be appealed pursuanc to the provisions of the administra!ive procedure zct rela!ing to contested cases. DATA PRIVACY ADVISORY In accordance�vith M.S. 13.04,Subd.2;"Rights of subjects oi data",we would like to infor,n you that your request for a permit or license from the City of Orono or any of its departrrients may require you to furnish certain private or confidential information, You are notified that: 1. The information you furnish will be used to deter.nine your qualifcation for the pemzit or licease requested. 2. You may refuse to supply data,but refusaL may require that the City den_y the pe:mit or iicense. ti. The infor.mation may be sha;ed with other local, state or federal agencies to the extent necessary to process the pernlit or Iicense. 4. If vour;equested permit o:license requires Council actior. to a�preve, some infornzation may become public. �. You have certain rights under M.S. 13.04(zvailaole upon request) to:eview private data on yoursei`. 6. Your full name is required to process this applicatien or permit. � ,�-/L'� `��/�j1!/� � G�SD/Y —� First 1l�Ii dle Last -�'fG� ��sr �,�"�%s �N Address �'�r�t/h/d �/� ��`� �Soz �IJ,z�Za�'s-� C�ry State Zip Phone d understand my rights as stated above. � �, Signature 32 ZJ�� A TIME ✓ CITY OF ORONO CALLED IN '�� INSPECTION N ICE SCHEDULED ' PERMIT NO. d COMPLETED ADDRESS ��05 J7��7'� �/'Y�'tS �'�.� OWNER R��PLl�D��47t� CONTR. TELEPHONE NO.—___ g�Z' "�7Z -��S 7 � DESCRIPTION ��^ �� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 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 � COMMENTS: � w � � � O � � O � W � Q � Z W � W � � d � WORKSATISFACTORY:PROCEED PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED - ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDlTION WITHIN HOURS. C PHOTO TAKEN INSPECTOR WILL RETURN ,�CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next" spection 24 hours in advance. �952� 249-46QQ OwnerlContra �t : Inspector. ��, White Copyllnspector's File Canary CopylSite Notice l/ DATE , TIME C TY OF ORONO CALLED IN � '��J� INSPECTION NOTICE SCHEDULED 7��! �.�-� PERMIT NO.�0 �'�d'�� COMPLETED ADDRESS �I� 5� �U'Z�� G�L�i�m!� �c�� OWNER �F�-�- �/�IZ.�.r`n- CONTR. — TELEPHONENO. � 7� — �� DESCRIPTION P�2 —�'i�^-t� � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q 05 FIN ' 14 SEWER HOOK-UP 06 PROGRESS � EMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 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 � OWNERICONTRACTOR TO MEET "« NO � COMMENTS: �r�� w�� !h�'�cl'� � �zL j O �� O `` 5`�l.S� o��-�f� W � Q � Z W � W � � d W� WORK SATISFACTORY:PROCEED PROJECT COMPLETE W ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. �; PHOTOTAKEN INSPECTOR WILL RETURN !] CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR O INSPECTION REOUIRED.CAL�TO ARRANGE ACCESS. Call for the ne t inspection 24 hours in advance. (952� 249-46�� OwnerlContr ite: Inspector. � White Copyllnspector's File Canary CopylSite Notice