HomeMy WebLinkAbout2003-P06918 - re-roof ! t
� PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po691g
Crystal Bay, Minnesota 55323 Per-mit Type: MinorAlterations
(952) 249-4600 Date Issued: ioi2i�2oo3
SITE ADDRESS: 95 Hackberry Hill
LONG LAKE,MN 55356
PID: 33-118-23-44-0013
DESCRIPTION:
Proposed Use: Residential
Permit Class: Building Census Code O/S-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: $ 111.25
Valuation: $ 4,750.00
State Surcharge Fee: $ 2.90
TOTAL FEE: $ 114.15
APPLICANT: Sela Roofing&Remodeling,Inc. QWNER: DUANE E SULANDER
4100 Excesiar Blvd. 95 HACKBERRY HILL
St. Louis Park,MN 55146 LONG LAKE,MN 55356
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.
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APPLICANT ERMITEESIG A URE ' ISSUEDBYSIGNATURE
Copies: 1-File(SiQnitures Repuired), 1-Anplicant, 1-Monthlv Reports, 1-Assessins, 1-Finance Page 1
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Total Fee: $ �-�`,'1 5 � Dace Receive • %U�-�j_ �3
Entered By: Peraut#: > '��
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CITY OF ORONO - BUILDING PERMIT APPLIC.ATION
A.11 informatiou uiust be subuiitted 'ui full before plau revie�v will be started.
(please pri�1t all irforntation)
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THE A.PPLICANT IS: (circle4one) OWNER p�Z CONTRACTOR
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JOB SITE ADDRESS: 9� �-��c}� �� Q �;.� I-�,�I ZLP: Sj 3 S �'
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NAME OF OWIVER: J;,,�,,, -t� S v �c��„ J� ,- '� PHOivE: (home)
(�vork) G !2. -��E - S�s_i
I�IAT_LL�1G��D�tESS: . CITY: 7II':
CONTRA.CTOR: " SELA i�00FING & REMODELING, INC p����; (j 1 Z ��Z 3- v
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COivTACT P�RSON: cT i (1UIS PARK,� � � ��OBILE/PAGER: G ► �_ - z ��- -���z.��
MA.II�ING ADDRESS: ID�0�05o CIfiX: ZIP:
STATE LICENSE: #
ARC�IIT'ECT/ENGL'VEERS��ROO & REMODELING. IN p�����.
11�I�,ILI�i 1G ADDRESS: ST. LOUIS PAR N 5 �'Y'� Z�:
N�1�E: � ID�t000105 ZEGISTRA.TION# �
TYPE OF ti�'ORK: Ne�v _ ition Accessory Structure
Move ReFrrodeUAlteration Land Alteration
PROPOSED tiVORK (describe iit detain: T Q�,,, �i � � r,��,,, .;:�'-�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: G�tAGE STALLS: ATT�. � DET. � - .- . ... ._
ESTI1l�IATED CO�'STRUCTION VALUATIO\ (excluding land): ��`��\ 5�
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I hereby apply for a buildin� pecmit and I acknowled�e that the information above is complete and
accurate; that the work tvill be in conformance �vith the ord'u�ances and codes of the City and with
the State Buildin� Code; that I understand this is not a permi[ and work is not to start without a
permi[; and that the work will be in accordance wich the approved plan.
A.PPLICANT'S SIGNATURE: C-, �, DATE: �`' ' � -��3
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11�'OTE! ,t'arade o Home� events require separate permit c�pproval by Police Depgrtment and
City Council 60 days prior lo the event. Non permitted events tivill not be allowed.
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Scc.13.0-t R.[GHTS OF SU$.IECTS OF D.aTA
Subd. 1. T}�e of data. The righ�s oP individual on whom t�e data is scD:� or�o be scorcd shall be as sec forch in this sccdon.
Subd.3. Information reqirired to be given indiridual. Art iLdi�idual asi�to suppfy priva[e or confideodal dat�concocning himseLf shall
be informed of: (a) the purpose and in�ended use of the rcques�cd dara ui�iu the collecang Yta[e agency, polidcal subdivisioo,or scatewide sys�.m;
(b)whc�her he may refuse oY is legally requircd to supply the tequested dan;(c)any ico•xn coasequence arising from his supplying or refusing to supply
priva�e or conndendal da�a;and(d)�he idendry of o�h�r persoas or eadries ze�horized by s�ace oc f�deral law co rceive the data..This requircrnent shall
not apply whtn an inditi idual is asked to supply invesdgaave dact, pursL�:��o seccoa 13.8?, subdivision 5, to a law cnforcemeat officer.
The commissioncr of r�•enuz m�v place che no�cc r-auircd �r�-r this sutdivision in the individual ircome tax o� oropem taz rcfund
instructians inscead of on chose foRns.
Subd. 3. Access to dat�b}-tndiridual. Upon request to a r-s�oasible au�.oriry,an individual shall be informed whether he is[he subject
of scored data on individuzls, and whe�her it is classiFied as public, pri�ac�or confideerial. Upon his furtber requesc, an iodividual who is the s�bject
o!scored private or public dare on individuals shall be shown the dam uiu ouc any cnarge to him and;if he desires, shall be informed of[he conten[
ar.d meaning of that da�a. After an individual has been shown the privaa Cati and ic:ormcd of ia meaning, the dara need not be disclosed to him for
si.r mon�hs �hereatter uriless a dispute or acdon purzuant to chis secdon is Fending or addidooal data on the individual 6as been collec�ed or crea�ed.
The responsible au[horiry shall provide copics of the privace or public dau�,on req�es:by�ho individual subjcct of�he data, 'Ihe responsible authoriry
r3y require �he requesting person to pay the accual costs of rtukin¢, ce=:Jing, and compiling the copies.
The responsible au�horiry shatl comply immedia�ely, if possible, wi�h any r_quest made pursuant to this subdivisio�, or wi�hin five days of
the dae�of�he reques�,e.�cluding Sanirdays,Sundays and legai holidays,ii ir..media�_compiiance is not possible. If he cannot comply wi�h the requesc
wi�hin�hac ame,he shall so inform che individual,and may have an addice;31 Five davs wichin which to comply wi�h the request,excluding Saturdays,
Sundays and legal holidays.
Subd. 4. Procedure when d�ta Ls not accurnte o�comp(ete. :�n indivizuzl may contest tha accuracy or completeness oFpublic orpri�•a�:
dac�conceming himself. To exercise this ri¢ht,an individual shall notiFj u wridng co responsible authoriry d_scribing ehe nature of the disagre:meo�.
The responsible auchoriry shall within 30 days either: (a)comct the da�tcund to be irv�ccuate or incomple�e and attempt to nodfy past recipiencs of
inaccurate or incomplece dac3, inciuding recipients named by the individ�J;or(b) corify the individual that he believes th�da[a to be correc� Dats
in dispuce shill be disciosed only if the individual's statement of disagr::�en[is �.cl�ded with the disclosed daca.
1lu decerminarion of the responsible au�horiry may be appea:ed pursuac�to the provisions of the adminis[rarive procedure act rdadng to
contes;ed easas.
DATA PRIV:�CY AD�ZSORY
In accordance with N1.S. 13.04, Subd. 2, "Rights of subjects ot da[a", we woutd like to inform you that your reauest
for a permit or license from the City of Orono or any of i� depar.,.eacs may require you to furnish certain privace or
confidential information.
You are notified char.
1. The informacion you furnish wilt be used to de:zmune vour qualification for the permit or license requested.
2. You may refuse to supply data, bu� refusal eiay require that the City deny the permit or licease.
3. The informatioa may be shared wich o[her loczl, state or federal a;encies to the exteat necessary to process
the permit or license.
d. IF your requested permit or license requires Council accion to approve, some informacion mav become
public. . "
�. You have cer[ain riQhts under h1.S. 13.04 (a•:ailable upon request) to review private data on yourself.
6. Your full name is required �o process this aoplica�io❑ or permi�.
Firs� �(iddie Last
Address
Ciry State Zip� Phone
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I unde�stand my ri;hts �a,stared above.
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