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Home My WebLink About2006-P09654 - re-roof PERMIT CITY Q�F ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P09654 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 3/24/2006 SITE ADDRESS: 1895 Fox Ridge Rd Unit# Long Lake,MN 55356 PID: 03-117-23-13-0007 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: $ 2�9.25 valuation: $ 17,000.00 State Surcharge Fee: $ 8.50 TOTAL FEE: $ 287,�g APPLICANT: Sela Roofing&Remodeling,Inc. OWNER: Andy Anderson 4100 Excesior Blvd. 1438 85th Street St. Louis Park,MN 55146 Buffalo,MN 55313 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. � ! � i �_�__,�-�.�� 'YlC e vl /� APPLICANT PEKMI"I'EE SIGNATURE ISSUED QY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Rcports, 1-Assessing,(If Septic, 1-Septic) Page 1 a , Total Fee: $ DateReceived: 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 CONTRACTO !7 � � / JOB SITE ADDRESS: ?S � C� il�� 0�` ZIP: SS�SIv Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ YCS ❑ 1�0 /f.i'es, a s/�ecial even!permi!is reqzri�•ed irilh Police Deparunen�and C'ity('oi�ncil app�•oval «)days prior lo the erent. Shultle bus sen�ice i+�i/l be required am/ess app/icant demonstra�es si�Jfrcie�it on-site pni•king is ai�arlable. .'�'on-pernritted even�s x�ill no1 be alloired. NAME OF OWNER: �t/�/ /q �-� ,}�/L� PHONE: (home)�/,� -3n�-#7�� ,� work) MAILING ADDRESS: �/�/,�� ',st� S� CITY: � �-��i ZIP: SS;'�/ � , CONTRACTOR: PHONE: �150'� —`�/.S-��' CONTACT PERSON: ,� l MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # C -'�nSD EXPIRATION DATE: � LING.INC, 4100 EXCELSIOR BLVD. ARCHITECT/ENGINEF�.: PHONE: MAILING ADDRESS: ��#�.�� CITY: ZIP: 1vAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding, Windows) 1/ PROPOSED WORK(describe in detai�: �(� ✓C�'l�/' STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED / � ��r>C/ �`�/ ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � � 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. -. �, -- ' ��y��fr/��"�_��TE: � 4G APPLICANT S SIGNATURE: � 31 Sec.13Ad RIGH"I�S OF SCB.IECTS OF DATA Subd I. 'I ype of data. 'The rights of individual on whom the data is stored or to be stored shall be as sel forth in this section. Subd.2. Information required to be eiven indi�idual. An individual asked to supply private orcontidential data concemin2 himseH�shall be infonned of: (a)the purpose and intended use of the requested data within the collecting state agency.political subdivision,or statewide system:(b) �chether 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 dala. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a law enforcement officer. The commissioner of revznue mav qlace the notice reauired under this subdivision in the individual income ta�or propertv ta�refund instruc[ions 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 suhject of stored data on individuals,and whether it is classified as puhlic,private or confidential. Upon his further requ�st,an individual who is the subject of stored private or publ ic data on individuals shall be show�n the data without 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.the data need not be disclosed to him ibr six months thereatter unless a dispute or action pursuant to this sectiai is pending or additional data on the individual has been col lected or created 'Che responsible authority shall provide copies ol the private or public data upon reyuest by the individual subject ofthe data. T'he responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. I'he responsible authority shall comply�immediatelv,ifpossible,with any request made pursuant to this subdivision.or within five da��s of the date ofthe reyuest,excluding Saturdays.Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannot comply�vith the request within that time,he shall so inform the individual,and may have an additional tive davs within�ifiich to comply with the request,e�cluding Saturdays, Sundays and legal holida}s. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of publ ic or private data concerning himself. To esercise this right,an individual shall notif�in writing the responsible authority describing the nature ofthe disagreement The responsible authority shall within 30 day�s 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)notifj'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 lhe 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 fi�om the City of Orono or any of its departmenLs may require you to furnish certain private or confidcntial information. You are notitied that: L The information you furnish will be used to determine your qualitication for the permit or license requested. 2. You may refuse to supply data,but refusal may rcquire that the City deny�the permit or license. - 3. �I�he information may be shared �vith other local. state or federal agencies to the ertcnt 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 dala on yourself. 6. Your full name is required to process this application or permit. First Middle Last /� G.l��-� �.✓�✓ ��.f.'C./�� ,Add ress ��t.�� Fic�U�ltvV & REMnn€61N6;-1P�^ 4�100 EXCELSIOR BLVD. c�ty "�T- I._i�UIS PARK, MN ��4�� sta�e z�� Nno�e I understand my rights as stated��Q105(� ��-- %li�-- ��___ _ Signature v Reset Form 32