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Home My WebLink About2004-P07941 - re-roof ` � �� PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P07941 Crystal Bay, Minnesota 55323 Permit Type: Mir�or atteranon� (952) 249-4600 Date Issued: 9iiai2ooa SITE ADDRESS: 1800 Lakeview Ter L.ong Lake,MN 55356 PID: 27-118-23-43-0007 DESCRIPTION: Proposed Use: Residenrial Permit Class: Building Census Code O/S-Building Pernut Type: Minor Alterarions Pernut Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: PernutFee: $ 111.25 Valuation• $ 4,405.00 State Surcharge Fee: $ 2.75 TOTAL FEE: $ 114.00 APPLICANT: Midwest Roofmg Siding OWNER' David&Christine Gorder 313 Jefferson Hwy. � 1800 Lakeview Ter Champlin,MN 55316 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN Sf RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SI'ATE OF MINNESOTA BUILDING C DE REQUIREMENTS. �--- C2�-� APPLI T P RMITEE SIGNATURE ISSUED BY SIGNATURE Covies: 1-File(SiQnitures Re4uiredl. 1-At�ulicant,1-Monthlv Ret�orts, 1-Assessins, 1-Finance Page 1 r . -- 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: ��Cj_l�p l�.2�i ��i /�j/i�- , ZIP: Will this be a Para e 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 approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: (�t L�1 I�e I -es (�l� PHONE: (ho e)/vp 3D �3 y� / (work) MAILING ADDRESS: / ��(°,w ��iYy CITY:Qr�UI�,p ZIP: CONTRACTOR: � / r� i ��- PHON� � ' � CONTACT PERSON: ,o��G.(� OBILE/PAGER: MAILING ADDRESS: "31 �,v CITY: , �c�r ZIP: �'�,�� STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeUAlteration Land Alteration PROPOSED WORK(describe in detai�: e � � Lr/ � �SG STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. 7 � 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. APPLICANT'S SIGNATURE: � DATE: l � " C� � y 1 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 s6a11 be as set for[h in this section. Subd.2: Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed otc (a}the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may Fefuse or is legally required to supply the requested data;(c)any known consequence arising trom 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 rnmmissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or urooertv 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 intormed 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 w6o is the subject of stored private or public data on individuals 3ha11 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 mont6s thereafter unless a dispute or aMion 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 to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request 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.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,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An lndividual may contest the accuracy or completeness otpublic or private data concerning himself. To exercise this right,an individual shail notify in writing the responsible authority describing the nature of t6e disagreement. The respoosible authority shall within 30 days either: (s)correct t6e data found to be inaccurate or in�mplete 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 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 furnish 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 eztent 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 permi� First Middle Last Address City State Zip Phooe I under tand m ights as stated above. S' nature