HomeMy WebLinkAbout2008-00117 - roofing � ! �
CITY OF ORONO PERMIT NO.: 2oos-ooii�
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssvEv: 08/07/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 180 LEAF ST
PIN : 04-117-23-22-0025
LEGAL DESC : SWAN LAKE 2ND ADDN
: LOT 001 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING-ASPHALT
ACTIVITY : O/S BUILDING-i1NDEFINED
VALUATION : $ 5,854.00
NOTE:
REMOVE AND REPLACE EPDM ROOFING SYSTEM ON FLAT ROOF OF GARAGE.
APPLICANT PERMIT FEE SCHEDULE 132.75
GARLOCK-FRENCH ROOFING CORP STATE SURCHARGE(VALUAT[ON) 2.93
2301 EAST 25TH STREET TOTAL 135.68
MINNEAPOLIS,MN 5540Cr
(612)722-7129
Minnesota State License#: 0001423
OWNER
HEALEY,ROBER HOVEY&THOMAS
180 LEAF ST
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 requires separate
permi[s. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.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
requested in conformance with the State Building Code.This permit may be
revoked at any time for d e cause.
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Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Total Fee: $ �.3 5• � d Date Received: � (�
Entered By: Permit#: OU �1�0/>
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
U�lease p��int ull infornzation)
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THE APPLICANT IS: (circle one) OWNER O CONTRAC OT R�
_ __--__�_J_.___-__-
.IOB SITE ADDR�SS: ��r' `-e�.t'--� ���:� ZIP: ���� ��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS ��TO If��,es. ��.rpecial erent�ermi�i,r reyaired inilh Police Department and C"ily Cuuncil approi�nl
<0 clays prior xo the ei�en7. S'hi�tNe brrs serrrce u�il/be reguirec!un/e.ss up��/icant cleinonsii�ales
suJticient on-szle parking is cn�ciilable. �Vort-permitted ei�ents i��il!not be alloived
NAME OF OWNER: ��D/�'I q �- � Q t° PHONE: (home) ��-y lo'�I �
(worl<) /� '7���5�
MAILING ADDRESS: ��� �•{q��. � CITY: ���piJ(� ZIP: _5;z� '
CONTRACTOR: '"��yrl�G� NC ��i PHONE: ��r�-7a�-7�a9
CONTACT PERSON: �_ OBILE/PAGER:
MAILING AllDRESS:;�3 / � �S`f� �f� C[TY:�i����>/,JZIP: ��/G'�
STATE LICENSE: # /js-�� EXPIRATION DATE: .3/ �
Al2CHITECT/ENGINEER: PHONE:
MAILING AllDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accesso►y Str��cture
Move Hoir�e Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permitsi
PROPOSED WORK(describe in detai�:�f�y� /����'y�� ���p ���,/�
��/G'���c -� C �GZ �� c3-S
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STORIE : SQ.FEET OF�ACH FLOOR:
NO. OF BCDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMAT�D CONSTRUCTION VALUATION(excluding land): $ � �S�fJ(�
I hereby apply for a building permit and I acknowledge that the infoi•mation above is complete anci accurate;
that the worl<will be in conformance with the ordinances and codes of the City and with the State Building
Code;that I undecstand this is not a permit and work is not to start without a permit;and that the work wi I I be
in accordance �vith the approved plan.
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APPLICANT'S SIGNATURE: 9Qi7� DATE: �li
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Scc.13.04 RIG117�S OI�SlII3JECTS O1�D;�T:�
tiuhd- I. �I�c��e of data. Thc rights of individual on���hom the dltn is storcd or to be s[ored shall be as set Ibrth in this section.
Suhd-2. Infonnt�tion reyuired to b�given individual.An individual asked to supply private or confidentitd data conceming himsclfshall bc
in�brmed of. (a)the purposc and intended use of Uie requestcd data�vithin the collecting stnte agency,political subdivision.or state�vide system:(h)
�chether he may rel use or is Iegully required to suppl��the requested data;(c)�ny known consequence arisine(�om his supplyine or refLsing to suppl��
nri��ate or cont identi,il dcita;and(d)the identity ofother persons or cntities authoriud by state or fcderal Inw to receive the data. 'fhis reyuiremcntshall
not apply�vhen an indi��idu��l is askcd to supply investigative data.pursuant to section 13.82,suhdivisiun�,to n I�iw enforcement oll�iccr.
fhc commissioner of rcvenue ma�°qlace the notice reyuired under this subdivision in the individu�l income t�»or oro»ertv ri�rcfund
instructions instead of on those forms.
Subd.�. Access to data by individual. Upon requestto a responsible authority,nn individual shal I be intbnned whether he is dic subject ol
stored data on individuals,and whether it is clttssit icd us public_privute orconfidential. Upon his furUier request,an individunl�vho is the subject ol
stored private or public data on indi��iduals shall be slwwn the datti without cinv charee to him and.if he desires_shnll be intbrmed of the content and
mcanini of that data. niter,in individual h.�s bcen sho�an the privatc data and inlormed ol'its menning_the data need not be disdosed to him�or six
nwnths there.dter unless a dispute or action pursuant to this section is peiiding or��d�itional data on tlic individual hns been collected or cre�ted. l�he
responsible�wthorit}�sh�l I pruvide copies ol thc private or public data upon reyuest by ihe individual subject of the dlta_ 'I'he responsible,wthorih�
may require the requesting person to pay the�clual costs of makine_certif}�ing_,md compiling the copies.
l'hc responsible authoriry shall camply immcdiately,ifpossible,with an}�request m�de pursuant to this subdivisiun,or within five d����s ol
the dute ofthe reyuest.c�cludine Saturdn��s,tiundays and Icg�l holid�ys.if immediate compliance is not possible. If he cannot comply with the requcst
witl�in th�t[ime,he shnll so infomi the individual,and may have an additional Ilve d�ys within which to comply n�ith the request,e�cluding St�turdays,
Sundays and legul holiduys.
Subd-�. Procedurewhendataisnot.iccurateorcompletcAnindividualmaycontesttheaccuracyorcompictenessofpublicorpriv�tedat.�
concernine himsdC To esercitiethis right,�n individual shall notif���in�vritine the responsible�wthoriq�describingthe natureol�thedisaercement �I�he
responsible nudiorih�shall���ithin 30 da��s either (u)currect the��ita found tu be inaccurate or incomplete and�utempt to notilj�past recipicnts u(
inaccurnte or incomplete d,ua,includin�recipien[s named by the mdividtt�l:or(b)notify the individull that'he believes the data to be correct. lluta in
dispute shall be disclosed onlv iftl�e individuaPs statement of disaereement is included with the disclosed datn.
fhc dcrermination ofthc responsihle�wthorirv mn��he.ippe;iled punuant to the provisions ol the�dministrtitivc procedurc act r��l.itin��to
contested cais�s.
DATA PRIVACti' ADVISORY
In<<ccurdance���ith M.S. I�.O1.Subd.2."Rights ofsubjects ot�data".���e���ould liketu inform��ou that vour request
I��r a��ermit c>r license (i-om the Cily��f Oruno or any��f its de�artmei�ts may reyuire you to fw�nish cerC�tin private or
confidential inlbrm�ition.
You arc notificd that:
I. fhc inibrm�ition you furnish �vill be uscd to determine your qualilicution �or the permit or license
requested.
2. You may� rel�usc tu sup�ly datn. but refusal ma�� rcquirc that U�e City deny the permit or license.
3. �I'hc inlormation may be sharcd �vith uther IocaL slute or lcderal agencies to the cztent necessar�° �o
�rocess the permit or license.
4. I I����iur rcqucsted ��ermit or license reyuires Council action to a��pruve. some intbrm��tion ma�� hecome
��ublic.
�. You have certain righls�mder M.S. 13.04(av�ilable upun request)to review private data em yow�scli�.
6. Your l�ull namc is rcyuircd to process this application or permit.
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1 understand �ny rights as stated above.
Signahu•e /
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