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Home My WebLink About2009-00806 - windows __ ., � CITY OF ORONO PERMIT NO.: 2 l09-00806 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUEn: U13/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 3155 JAMESTOWN RD PIN : 28-118-23-33-0012 LEGAL DESC : CAMELOT : LOT 001 BLOCK 001 PERMIT TYPE : MINOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYP� : WINDOWS ACTIVITY : O/S BUILDING-LJNDEFINED VALiJATION : $ 14,097.00 NOTE: 5-WINDOWS ANI�4-SASH REPLACEMENTS IN EXISTING OPENINGS. li I I , �i APPLICANT PERMIT FEE SCHEDULE , 265.50 PELLA WINDOWS DOORS STATE SURCHARGE(VALUATION) II 7.05 15300 25TH AVE N.+SUITE# 100 PLYMOUTH,MN SSj447 MAIL-IN FEE 2.00 i (952)345-6047 TOTAL I 274.55 Minnesota State Lice�se#:20165884 I OWNER DECUBELLIS,KE ETH&JENNIFER 3155 JAMESTOWN RD LONG LAKE,MN 35356- AGREEME T AND SWORN STATEMENT The work for which thi permit is issued shall be performed according to the approved plans and pecifications,applicable City approvals,and the State Building Code. is permit is for only the work described and does not grant permission fo additional or related work which requires separate � permi[s. All provision of laws and ordinances goveming this type of work � shall be compied with�vhether or not specified herein.This permit will expire and become nul and void if construction authorized is not i commenced within 18 days of the date of issuance,or if construction is suspended for a perio of 180 days at any time after work has commenced. The applicant is respo sible for assuring all required inspections are requested in conformaa�r►ce with the State Building Code.This permit may be revoked at any time fdr due cause. �� cCe�' ii � �� a �� aq Appiicant Permite Signature Date Iss y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED OVE. � � � , . . � RECEIVEC� Total Fee: $O`Z7 , 0 V 1 3 2009 Date Received• �� /O o � —�. Entered By: � f`�T� ^F ORONO Permit#: • o70G 9�D�1b ' CI�'Y'OF ORONO -BUILDING PERMIT APPLICATION All infdrmation must be submitted in full before plan review will be started. i (please print all information) --------------------------------------------------------------------------------------------------------------�- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR i JOB SITE AD�RESS: � l 5 �' �o �e �-�0(,.s !1 Rd Z�: s�' 3�� Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? � ❑Yes � NO If yes,a special event permit is required with Police Department and City Council appro l al 60 days prior to the event. Shuttle bus service will be required unless applicant demonstra�ies suff cient on-site parking is available. Non permitted events will not be allowed. i NAME OF O�'NER: K t /1 �@ C� h e ll� S PHONE: (home) 8 0 7 • S�,ti i / work) MAILING AI�DRESS: 3 � S S J� fr?C S�OW� CITY: L.o� Ca� ZIP: 5� 3 S� �– Pella Windows and Doors i CONTRACTOR: 15300-25th Ave.North, Ste. #100 'HONE: �(S� ��5 •G o47 CONTACT P'ERSON: _ plymouth, MN 55447 GER c�b d� D E,T P� ,�'>>� MAILING ADDRESS: _ License# 20165884 Z�' —� STATE LIC�NSE: # �63-745-1400 �`��' i ARCHITECT/ENGINEER: PHONE: MAILING DRESS: CITY: ZIP: AU � NAME; REGISTRATION: # TYPE OF V�ORK: New Home Addition Accessory Structure � Move Home Remodel/Alteration(ie: Siding,Windows) � Any earth movement may require MCWD review and permits�— PROPOS WORK(describe in detain: � W/ �1l�o W S ~ � S �S fl r! �l lQ�(�C - /'�t � S v L �!' STORIES: � SQ.FEET OF EACH FLOOR: NO.OF BE ROOMS: GARAGE STALLS: ATTACHED DETACHED� ESTIMATE;D CONSTRUCTION VALUATION(excluding land): $ ��. � � 7 � I hereby apply for a building permit and I acknowledge that the information above is complete and acculrate; that the work will be in conformance with the ordinances and codes of the City and with the State Bui�ding Code;that I u�derstand this is not a permit and work is not to start without a permit;and that the work w 11 be in accordance with the approved plan. APPLIC�IT'S SIGNATCTRE: � DATE: �� ( � a � I 31 I , • .. 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 forth in this section. Subd.2. InformaUon required to be given individual.An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and intended use ofthe 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 this subdivision in the individual income tax or pro�ertv 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 individuais shall be shown 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 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 af 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 authorily shall comply inunediately,ifpossible,�aith z.ny requesY made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.Ifhe 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,excluding 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 conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe 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 shalf be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the 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 fumish certain private or confidential 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 plication or permit. �� /Yl Sc hi n I�. First Middle Last l� a o � g� �� S-�i`�.-� S�� r� Address B�oo f�/f�ly�o� � � n � �'�l � � City State Zip Phone I understand my rights as stated above. � S' ure �� e $ ,,, .,, �,, 32 ' — � aP�N � E TIME CITY OF ORONO CALLED IN � QCl I INSPECTION �r SCHEDULED iPERMIT NO.� �v� MPLETED i ADDRESS � J� I OWNER CONTR. i TELEPHONE NO. �` �v/^ �7 �i DESCRIPTION � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMINCa ❑ MECHANICAL FINAL ❑ LAKESHORENVEfLANDS y I ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z� ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q I ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPIAINT J ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP =i ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL JI ❑ PIUMBING FINAL ❑ FOUNDATION/REMOVAL 2I OWNERICONTRACTO O MEET YOU:_YES_NO � COMMENTS:�/��!�f� , � /.��/'L W � ❑WORK SATISFACTORY:PROCEED �ROJECT COMPLETE ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY BEFORE C�/ERING PERMANENT O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WFLL RETURN i ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED I 0 INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. iCaD for the next inspection 2a hours in advance. (952) 249-4600 I OwnerlContractor on site: Inspector. ( White Copyll�spector's File Canary Copy/Site Notice I