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Home My WebLink About2008-00273 - roofing CITY OF ORONO PERMIT 1Y0.: 2008-00273 ' 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 10/06/2008 952 249-4600 FAX: 952 249-4616 ADDRESS : 85 GOLDEN VIEW DR PIN : 33-118-23-43-0012 LEGAL DESC : PETERMAN 2ND ADDN : LOT 003 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 13,219.00 APPLICANT PERMIT FEE SCHEDULE 250.75 ROOF COMPANY NA INC. STATE SURCHARGE(VALUATION) 6.61 745 TOWER DR. TOTAL 257.36 MEDINA, MN 55340 (763)550-0444 Minnesota State License#: 20172153 OWNER HILBELINK, M&A 85 GOLDEN VIEW DR LONG LAKE, MN 55356 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 requices separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified hcrein.This permit will expire and become null and void if construction authorized is not 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 responsible for assuring all required inspections are reques[ed in conforma with the State Building Code.This permit may be revoked at any,tim u . / . -�,�f� � �o � � , ��' �Q �a� � � � �, ApQ 'tcant Permitee Signature Date Issued By Si ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRI ABOVE. 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 print all information) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: �S� C��Po��/i�'�t1'" �/�. ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �NO If yes, a special event permit is required tivith Police Deparinzent and City Council approval 60 days prioi�to the event. Shuttle bus service will be requi��ed unless applicant demonstrates sufficient on-site parking is available. Non-permitfed events will not be allowed NAME OF O WNER: �t K e �� ,��j�� PHONE: (home)%S'Z"97�v"�g� � (work) MAILING ADDRESS: $�� o��f�=,,�— �,�_ CITY: L�'d'��/�� ZIP: CONTRACTOR: /��C?� C�. N� Z Gt C= PHONE: 7(�� S'��J -�Q44 CONTACT PERSON: ��G�h MOBILE/PAGER: MAILING ADDRESS: �9� �Fj l,t1P•' ��. CITY: �%PC1ii2�t ZIP: S�.S'�3 �' STATE LICENSE: # 2 c /7 Z j 5 3 EXPIRATION DATE: CI Y ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure ---� Move Home Remodel/Alteration (ie: Siding, Windows) � Any earth movement may require MCWD review and permits ! PROPOSE�WORK(describe in detai�: lPk:��_c�� l.�7��C�� /L�PGV �OO STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $��: D C� 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 ordinanees 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: ��"�"� � , �' (�� 3] Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. L Type of data. The riehu of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himselfshall 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 refusin�to s�pply 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 shal) 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 mav place the notice reauired under this subdivision in the individual income tax or Rroperty tax refund instructions 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 subject of stored data on individuals,and whether it is classified as public,private or confidential. 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 charge[o him and,if he desires,shall be informed ofthe content and meaning of that data. Afrer 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[o pay the actual costs of making,certifying 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 ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compl iance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excludine Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the 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 recipients of inaccurate 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 induded�vith the disclosed data. The determination of lhe responsible authority 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 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 confidentia) information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit 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. 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 Cit�� State Zip Phone 1 understand my ri s a ted ab . ., � 3 i Si nat e �� Reset Porm 32 �'G��" ' ,r,DAT TIME ✓ CITY OF ORONO CALLED IN /v � � INSPECTION NOTICE SCHEDULED 1D" _ PERMIT NO.��►�rS' -C��3 COMPLETED ADDRESS �.� �'O10��%��cl aQ/2� OWNER CONTR.�� Z �/�� TELEPHONENO. !"�o� - 55b — 0��- � DESCRIPTION �� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT J ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ NARD COVER REMOVAL v ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � J O � � O � W � Q � Z W � W � j d W� WORKSATISFACTORY:PROCEED �� PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED S: ISSUE CERTIFICATE OF OCCUPANCY O ❑ C�RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContractor on site: Inspector. White Copyllnspector's File Canary Copy/Site Notice DATE TIME / CITY OF ORONO CALLED IN INSPECTION N ICE SCHEDULED PERMIT NO. � �]�oMPLETED ADDRESS �rTG� ('�C� l)f'�r..c� OWNER CONTR. 6� F C�O�V'� �'y� TELEPHONE N0. � DESCRIPTION � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD.. ❑ W�4TER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAI ❑ SEPTIC�INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL v ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a J / �� O �` �. � O � W � Q � 2 W � W � � ^ � d , y W� ❑WORKSATISFACTORY:PROCEED �PROJECTCOMPLETE W ❑CORRECT WORK 8�PROCEED � ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. rj pH0T0 TAKEN INSPECTOR WILL RETttRN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� 249-46�� OwnerlContractor on site: Inspector. l / � ,� White Copy/lnspector's File Canary CopylSite Notice