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Home My WebLink About2005-P09435 - re-roof � _ • ' PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P09435 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 11/21/2005 SITE ADDRESS: 1490 Long Lake Blvd Unit# Long Lake,MN 55356 P�� 26-118-23-33-0002 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: FEE SUMMARY: PermitFee: $ 125.25 valuation: $ 6,000.00 State Surcharge Fee: $ 3.00 TOTAL FEE: $ 128.25 APPLICANT: Jerid Adickes Construction OWNER: Trygve&Brooke Bjorgen P.O.Box 92 1490 Long Lake Blvd Montrose,MN 55363 Long Lake,MN 55356 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. � ,�- �_ ' ��z-� .� ,�-� AP LIC P ITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, I-Septic) Page 1 ! � ' Total Fee: $ � �n �� Date Received: � -,.�-�-(�S Entered By: Permit#: '<��'y��S� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all i�zfor»��ation) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle o�ze) OWNER OR C�RACTOR C r 7 �: , JOBSITEADDRESS: f�� ,�t- �,1�'G� 'Jr�r,;, ZIP: � �' �� Will this be a Parade of Homes, Remodelers Sho�vcase Home or other Display Home? ❑ Yes � �O If yes, n spec•ia(even!permit is r•egzrirec!tivith Polrce Deparhrrent and City Coamcrl npproval 60 days pr�ror to the event. Sht�ttle bus service will be reqt�ired a�nless applicnnt demonstrntes sufficient a�-site parkrng i�available. Non�er-milted evenls will not be crllowed. / NAME OF OWNEIZ: ( �u G, �;�, G�� r�� . r � r'�Ln PHONE: (home) (work) MAILING ADDRESS: ��l�U L��; /�,G.� ��j�C� CITY: '�f�'`�U ZIp; ��r., �c� -7 CONTRACTOR: v t'.r r C� �C�,-c�C; C�•�S�'- PHONE: �L�-��'"�d7� CONTACT PERSON: J �� MOBILE/PAGER: " '' MAILINGADDRESS: F� 6',��,� �� CITY: /��r,-d,.�sc ZIP< �� ;E��z � S'I'AT�LICENSE: # /�,��f � �'`7iz/ EXPIRr�TION DATE: (��, ARC�IITECT/ENGINEER: PHONE: MA1LiNG ADDRESS: CI�'Y: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Sidin�, Windows) � PI20POSED VVORK(describe in�letain: f��,r <�� c� sti.,-�lts ��„� r(��ticc, w �r 7; �-,�:y;1,�,-,�. sa S'TOIZIES: SQ.FEET OF EAC�I FLOOI�: NO. OF BEI)ROOMS: GAItAGE ST'AI.I.S: AT'I'AC�IEI) I)E�['ACI-�ED ES'I'I1i�IAT'E� C0�1STI�i1CT�0Ii�VALIJAT'ION(excluding iand): � H �� , I hereby apply for a builciing pennit and I ackno�vledge that the infonnation 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�vithout a pennit;and that the work will be in accordance with the approved plan. a��Ic��r�Ps s��.��u�: l � ��: � �-, �� 31 . , � 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. Information 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 of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising from his supplying or refusing ro supply private or confidentia(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 mayplace the notice required under this subdivision in the individual income tax or orooertv 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 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 therexfter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authoriry shall pcovide 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 tnade pursuant to this subdivision,or within five days of the date of the reques[,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 individual may wntest the accuracy or completeness of public or private data conceming himself.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The responsible auNiority shall within 30 days either. (a)coaec[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 co�rect.Data in disQute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detennination of the responsible suthority 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: l. 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 pern�it 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 application or permit. � �J�f �� cJti�,L< G�.�� First Middle Last �° g�k Cl-�- (��,��,rdS�G M�l ��v 3�.3 Address '�6� -.� �P-��7� City State Zip Phone I understand my rights as stated above. . Signature 32