HomeMy WebLinkAbout2004-P08226 - re-roof I
' � � PERMIT
CITY OF ORONO permit Number:
2750 Kelley Parkway- PO Box 66 Pos226
Crystal Bay, Minnesotal 55323 Permit Type: Minoraiterano�
(952) 249-4600 , Date Issued: 11/23/2004
SITE ADDRESS: '3175 7amestown Rd
I.ong Lake,MN 55356 '
PID: 28-118-23-33-0014
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DESCRIPTION:
Proposed Use: ResicUential �
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolurion#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Petmit Fee: $ 125.25 Valuation• $ 5,500.00
St�te Surcharge Fee: $ 3.25
TdTAL FEE: $ 128.¢0
APPLICANT: North OalcS Development Inc. OWNER: Micheal Awes
1033 Rid�edale Drive#282 3175 Jamestown Rd
Minnetonka,MN 55035 Long Lake MN 55356
THE UNDERSIGNED HERE�Y REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL V'VORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE F
MINNESOTA BUILDING CObE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATU ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required),1-Applicant, 1-Monthlv Renorts, 1-Assessing, 1-Finance P ge 1
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Total Fee: $ Date Received:
Entered By: Permit#•
CTTY OF ORONO -BUILDING PERMIT APPLICATION '
All i�formation must be submitted in full before plan review will be started.
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THE APPLI ANT IS: (circle one) WNE OR CONTRACTOR ',
JOB SITE ADDRESS: ���� �a""��w� � ��dhp, �^/ 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 with Police Department and City Council appr val
I 60 days prior to the event. Shuttle bus service will be reguired unless applicant demonst�ates
� su�cient on-site parking is available. Non permitted events will not be allowed.
NAME OF ONVNER: s����p��� PHONE: (home) �i Z- ( /��
(work) (o _ _��b
MAILING A�DRESS: ,31�,5.Ta..�wf.,.,� ��CITY: p,io�o ZIP;
CONTRACT�OR: /�o�l ��tkr dve✓�o r�terll� �r� PHONE: „Z- 2.� - p��
CONTACT�RSON: .�oe Far,r MOBILE/PAGER: Z.. z.3 - o
MAILING DRESS: _1303„9 �!i as�p � �Z$2CITY: /�►�g�l�„d/j� ZIP: O
STATELIC�NSE: # Z,o3��33�. EXPIRATIONDATE: 3 zo
ARCHITEC�'/ENGINEER: PHONE:
MAILING A�DRESS: CITY: ZIp; �
NAME: REGISTRATION: #
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TYPE OF WdRK: New Addition Accessory Structure
Move Home RemodeUAlteration
PROPOSED 1WORK(describe in detain:
STORIES: Z SQ.FEET OF EACH FLOOR: /,foD �9e0
NO.OF BED OOMS:�_ GARAGE STALLS: ATTACHED_,� DETACHED
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ESTIMATED'CONSTRUCTION VALUATION(excluding land): $ �D
I hereby apply fbr a building pernut and I acknowledge that the information above is complete d accur te;
that the work w�ll be in conformance with the ordinances and codes of the City and with the State Build g
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 wlith the approved plan.
APPLICANT'S SIGNATURE: ,��0 DATE: / -/ -B
31
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Sec.13.04 RIGHT$OF SUBJECTS OF DATA
Subd.L 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.Information required to be given individual.An individual asked to supply private or confidential data concerning himself sl�all be
informed oE (a)the purpose and intended use of the requested data within the collecting state ageocy,political subdivision,ot statewide sys�;(b)
whether he may refuSe or is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing 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 requiremen{shall
not apply when an individual is asked to supply investigative data,pursuant W section 13.82,subdivision 5,to a law enforcement officer. I
The com�issioner of revenue may place the notice reauired under this subdivision in the individual income tax orpronertv tax _rbfund
instructions instead qf on those forms.
Subd.3./�ccess to data by individual.Upon request to a responsible suthority,an individual shall be informed whether he is the subj t of
stored data on indivi�uals,and whether it is classified as publiq private or confidential.Upon his further tequest,an individual who is the subj�t of
stored private or public data on individuais shall be shown the data without any charge to him and,if he desires,shall be inforrrted of the conte t 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 co him f�r si�c
months thereafter unless a dispute or action pwsuant 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 autt�ority
may require the requgsting person to pay the actual costs of making,certifying,and compiling the copies.
The respa�nsible authority shall comply immediately,ifpossible,with any request made pursuant to this subdivision,or within five ys of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the uest
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Sa ys,
Sundays and legal halidays.
Subd.4.Procedure when data is not accurate or complete.An individual may contest ihe accuracy or compleceness of public or priva�data
concerning himself.'�o exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disageementJ The
responsible suthority shall wit6in 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipie ts of
inaccurate or incomplete data,including recipieats named by the individuai;ot(b)nodfy the individual that he believes the data to be co►rect.D,ta in
dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. I
The deternvnation of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordan�e with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your req�est
for a permit or li�ense from the City of Orono or any of its departments may require you to furnish certain privat�or
confidential info�nation.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or lice�se
rec�uested.
2. Ydu may refuse to supply data,but refusal may require that the City deny the permit or license.
3. Th� information may be shared with other local, state or federal agencies to the extent necessar}�to
pr cess the permit or license.
4. If}�our requested permit or license requires Council action to approve,some information may becolme
pul�lic.
5. Yoµhave certain rights under M.S. 13.04(available upon request)to review private data on yourse f.
6. Your full name is required to process this application or permit.
�o �
First tddle Lsst
N �
Address
� �t.•t/ �o Z- _�
City State Zip P6one
I understand my'',rights as stated above.
Sig ature
i 32
' " '•"���'_- State of Minnesota Departrnent af Commerce Licensing Division
• � Departrnent of Comrr�oe Telephone: (651j 296-6319 -
` 85-7th Plaoe East.Su�e 600 E-ma�addsess: �9•commer�sta .mn.us
,�, � ;3 St Paul,MN 55101-3165 Website addre.ss: comrt�eroe.state.mn.us
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F���t��t�����ildin Cor�ra���r ��en��
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��atr►amei N4FtTH Q� [�'�.{�MENT INC , ; $+ssme��tuc�
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aadress: 19��FC�D RD _. `�f ::_. ��
MINNETONKA, MN 55305
License Identification Number: BC- 203TT332 QualiFying Person: DOYLE L RANDALL
�icense E�iration Date: 3/31/2005 Continuing Education: 7 Hrs CE due by 3/3 /2005 _
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<� ATE TIME "
CITY OF ORONO CALLED IN �� ��
INSPECTION NO & SCHEDULED — _�:��—+lTc-�I
PERMIT NOf' v Z� COMPIETED
ADDRESS �T�! �1 S '� GZ-/"Y`��S 'fD'u�Yl
OWNER ' CONTR. �Y� �YS
TELEPHO � . � � — `
� DESCRIP�ION
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� 01 FOOTING; 11 MECHANICAL RI 18 EXCAV/GRADING/FILUNG
Q 02 FRAMIN� 13 MECHANICAI FINAL 19 LAKESHORE/WETLANDS
y 03 INSULA ON 24/25 WOOD BURNER/FIREPIACE 34 TREE REMOVAL
Z 04 WALL B�. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 OEMO�SITE 27 SEPTIC MAINL 21 COMPLAINT
`� 07 DEMO�-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUM�ING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUh�IBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERfCONTRACTORTOMEETYOU: 1I�N0
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W WORK SATISFACTORY:PROCEED ❑PHOJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPOFlARY
� BEFORECOVERING PERMANENT
�CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. �
Call for the next spection 24 hours in advance. (g52) 249-4600 �
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Owner/Contract�� '
Inspector.
White Copyllnspecto�a Rle Canary Copy/Site Notfce I
DATE TIME ✓
CITY OF ORONO ALLED IN �a'
INSPECTION N t C� SCHEDULED o?- D '3 O
PERMIT NO. G COMPLETED � K
ADDRESS 3'�7J� GZm�d
OWNER CONTR.
TELEPHONE NO �'S2 2 3�I i�g,3
� t - ���
� DESCRIPTION \7�
� 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
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL j 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 WARD COVER REMOVAL
J 10 PLUMBING FINAL ' 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOW TO MEET YOU:_YES_NO
� COMMENTS: j
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W ❑WORKSATISFAC ORY:PROCEED ❑ PROJECTCOMPLETE
W �ORRECT WORK I&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTIOtJ TEMPORARY
� BEFORECOVERIMG PERMANENT
❑CORRECTUNSAF�ECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR IJVILL RETURN
❑STOP ORDER PO�TED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call fon the next inspection 24 hours in advance. (g52) 249-4600
Owner►Contra r it
Inspecto
White Copyllnspector's File Canary CopylSite Notice
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