HomeMy WebLinkAbout2007-P10829 - re-roof * � PERMIT
CITY �F ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P10829
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued:
3/16/2007
SITE ADDRESS: 1040 Loma Linda Ave Unit#
Mound,MN 55364
PID: 08-117-23-23-0028
DESCRIPTION:
Proposed Use: Residential
Census Code O/S -Building
Permit Class: Building
Permit Type:
Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
This pernut replaces Permit#P09841,New Contractor,New Wark Being Done
FEE SUMMARY: PermitFee: $ 181.25 valuation: � $ 10,000.00
State Surcharge Fee: $ 5.00
TOTAL FEE: $ 186.25
APPLICANT: United Framers Builders&Remodelers OWNER: Cindy Shapiro
6240 White Drive 5704 Deville Dr
Prior Lake,MN 55372 Edina,MN 55436
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 PERMITEE SIGNATURE ISSUED BY S]GNATURE
Copies: 1-File(Signatures Reguired), ]-Applicant, l-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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l�'�� Total Fee: $ �Q�L(� U���Received: 3 ��� �d 7 (�
Entered By: Permit#: �j
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 O CONTRACTOR
JOB SITE ADDRESS: JO (�(5 �,aJ-yI� �;"� �•�p ZIP: SS�Cp�,/�
Will this be a Parade of Homes,Remodeters 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. Shuttle bus service wi!!be required unless applicant demorrstrates
. sufficient on-site parking is available. �Von-permitted events widl r►ot be allowed.
NAME OF OWNER: � ; ��, �,n J�,,y PHONE: (home)Q�a--�/'3�- Q��9
(work)
MAILING ADDRESS: S�� ,� ,,;1� �- CITY: � :Y ZIP: S S�3
CONTRACTOR: �n:���an�.,. ' < �nr�� PHONE: ��`.22 G- �09 gb
CONTACT PERSON: - p� .,,_. MOBILE/PAGER:r�53 � S 7- ��s/>
MAILING ADDRESS: �e/U r. CITY:�r•'o- ZIP•���.Z
STATE LICENSE: #/�C o?vs g�/ 3� EXPIRATION DATE: o g�
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detain: `�,���.n� �o� �o��
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ /�1 �oQ'. �
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 pennit and work is not to start without a permit;and that the work will be
in accordance with the approved plan.
APPLICANT'S SIGNATURE:i����— 6��� DATE: f v
31
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Scc.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. Information required to be given individual.An individual asked to supply private orconfidential data concerning himselfshall be
informed of: (a)the purpose and intended use of the 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 shal I
not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
Tha�^�^m�a<�oner of revenue m�v olace the notice rgguired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
' Subd.3. Access to data by individual. Upon requestto a responsible authority,an individual shall be infortned 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 individuals 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 ofthe private or public data upon request by the individual subject ofthe data. The responsible authoriry
may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible suthority shal I 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,ifimmediate compliance is not possible. lfhe 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 of public or private data
conceming himself. To e�:ercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement.7'he
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 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 extent necessary to
process the permit or license.
4. If your requested permit or license requires Council action to approve,some information may become
publia
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 permit.
First Middle Last
Address
C�� Statc Zip Phone
1 understand my rights as stated above.
A 6�� 3�/�� �
Signeturc
Reset Form 32
e� =TFj TIME V
CITY OF ORONO CALLED IN ���
INSPECTION N ICE SCHEDULED �
PERMIT N0. ���' COMPLETED
ADDRESS lC�`t�J L.��1?'1Lt L(t12�Q /gTJ`�
OWN ER CONTR..���l��/��/N�
TELEPHONE NO. �nS� ��7 �,�0 7 7
� DESCRIPTION `—
l� 01 FOOTING 11 MECHANI AL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
� 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑CORRECT WORK&PROCEED C, ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. �� pH0T0 TAKEN
INSPECTOF WlLL RETURN � CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Cail forthe next inspection 24 hours in advance. �952� Z49-4600
OwnerlContract o 'te:
Inspector. `
White Copyllnspector's ile Canary CopylSite Notice
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�)Q G} S DAT ` TIME `�
�CITY OF OR�CYU� J CALLED IN /���
INSPECTION NOTICE SCHEDULED �� .�
PERMIT NO. .4Cp_ a.bznJ�C- COMPLETED
ADDRESS �d�D �H'N-ta � �� �
OWNER CONTR. L��� c.a
TELEPHONEN0. ��7� ��� .3�7 7 �Q�-
� DESCRIPTION / G�-� G`'���5 �
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/ LING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUM8ING ❑ FOUNDATION/REMOVAL
� OWN /CONTRACTOR TO MEET YOU: YES NO
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� COMMENTS:
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W� WORKSATISFACTORY:PROCEED PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
O INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (952� 249-4600
Owner/Contrac or s te:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
.
� PERMIT
CITY OF ORONO permit ►vumber:
2750 Kelley Parkway- PO Box 66 P09841
Crystal Bay, Minnesota 55323 Permit Type: -k
Minor Alterations `
(952) 249-4600 Date Issued: �
5/9/2006 �)��(� ��
SITE ADDRESS: 1040 Loma Linda Ave Unit# �
v$
Mound,MN 55364 ��
PID: ��
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=T� TIME V
CITY OF ORONO CALLED IN �'�
DES( INSPECTION N ICE SCHEDULED �
PERMIT NO. a��' COMPLETED /
Propos v
ADDRESS �� �(��Q .�glJ'e, iing
Permit —
OWNER CONTR.��/'� /N/Gt�I — Re-Roof
Permit p� _
TELEPHONE NO. �S� ��7 ��O 7 7
DETA � DESCRIPTION � �
01 FOOTING 11 MECHANI AL RI 18 EXCAV/GRADING/FILLING
Appro � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Separz �
04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
NOTI W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINA� 36 FOUNDATION/REMOVAL
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jt, � OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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O O ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
V 0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY (
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
� ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ?CIFIED
❑ INSPECTION REQUiRED.CALLTO ARRANGE ACCESS. �ES AND STATE OF
Call for the next inspection 24 hours in advance. �95Z� Z49-46��
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OwnerlContract o ite:
In; '
Inspector. �
White Copyllnspector's ile Canary CopylSite Notice TURE
� - --rr���ie Notice
Copies: 1-File(Signatures Required), 1-Appuca�,,, . _ �t��) Page 1
f Total Fee: $ /�(o _ �=' Date Received: !J U y�%/
�� � �'�>
Entered By: �Q,�1 � Permit#• �/ �, �rF,
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforniation)
------------------------------------------------------------------------------------------------------------------------
�
THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR��
JOB SITE ADDRESS: /U`1G Lu��ti ���4 .��-� ZIP: �S 3��
Will this b a rade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes NO !f yes, a special ecent permit is reqziired with Police Department and City Coarncil approl�a!
60 days prior to the event. Shuttle ba�s service will be required unless applicant demonstrates
scfficient on-site parking is availabfe. Non-permitted events wrll not be allowecf
NAME OF OWNER: C.7�� ��z�oe.-�, PHONE: (home) �J�Z-`I�G. - %/y
^ (wock)
MAILING ADDRESS: �'�C;�� I��t��C? �l'�� CITY: �c����2 c� ZIP: �-5_y�
CONTRACTOR: I���h�.�c ,..,µ-�;,,.,� I-,�-, /�%�� ���r �F PHONE: �lSZ� z�3 -c:��c�y
CONTACT PERSON: i;�, ���t c� MOBILE/PAGER: u�Z-`sl�i� z�d�'
MAILING ADDRESS:�7 3C�� (.'Ee�.- �-e S CITY: C-����i.�i l� ZIP: , L ��
STATE LICENSE: # ��' - Z��y4-C,K� ?s! EXPIRATION DATE: 3 3i- c� 7
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Altecation (ie: Siding, Windows) `�� C
Any earth movement may require MCWD review and permits !
PROPOSED WORK(describe in detai�: ���(�;« ;�'j�� �i�-c�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTII�IATED CONSTRUCTION VALUATION(excluding land): $ /G'�c'Ut�
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 Buifding
Code;that I understand this is not a permit and work is n o s rt ithout a permit;and that the work will be
in accordance with the approved plan.
,l
APPLICANT'S SIGNATURE: DATE: ��� ��' �
..
31
Sec.13A4 RIGF[TS 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. Infonnation required to be given individual. An individual asked to supply private or confidential data conceming himselfshall be
infonned of: (a)the purpose and intended use ofthe requested data�vithin the collecting state agency,poli[ical subdivision,or statewide systein;(b)
whether he may rePuse or is legally required to supply d1e requested data;(c)any known consequence arising from his supplying or refusin�to supply
private or conYidential data;and(d)the identicy of other persons or entities authorized Uy 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 la�v enforcement officer.
The commissioner of revenue mav olace the notice required under this subdivision in the individual income tar or oropertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is classitied as public,private or contidential. Upon his fuRher request,an individual who is die subject of
stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shal(be informed of the content and
meaning of that data. After an individual has been shown the private data and infonned of its meanin�,the data need not be disclosed to him for sia
months thereafter unless a dispute or action pursuanf 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 die individual subject of the data. The responsible authority
may require the requesting person to pay the actual costs of making,certit'ying,and compiling the copies.
The responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of
the date ofthe request,e�cluding Sawrdays,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 no[accurate or complete. An individual may contest the accuracy or completeness of publ ic or private data
conceming himseff. 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)correc[the data found to be inaccurate or incomplete and attempt to notiCy past recipients of
inaccurate or incomplete data,including recipients named by[he individual;or(b)notity 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 audioriry 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 sliared 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 application or permit.
First Nliddle Last
Address
Cit�� Statc Zip Phone
I understan y rights ted o e.
Sign� ur
Reset Form �?
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