HomeMy WebLinkAbout2000-P02907 - re-roof , .j PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: Po29o�
Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations
(612) 249-4600 Date Issued: 9i6i2000
SITE ADDRESS: 1540 Long Lake Blvd
LONG LAKE, MN 55356
P I D: 26-118-23-3 3-0007
DESCRIPTION:
Proposed Use:
Census Code 434
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: Permit Fee: $ 167.25 Valuation: $ 8,943.00
State Surcharge Fee: $ 4.50
TOTAL FEE: $ 171.75
APPLICANT: GARLOCK-FRENCH ROOFING OWNER: ROBIN E CRAWFORD
2309 SNELLING AVE 1540 LONG LAKE BLVD
MINNEAPOLIS,MN 55404 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.
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APPLICANT PERMITE SIG ATURE ISSUED BY SIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
, ,, Tocal Fee: S Da�eR::.�i�'z��
. Dace.�poroved:
Er.cered Bv: P"��7'
CITY OF OROtiO - BI�ZI.DItiTG PER1tiIIT APPLICATIO�t
AI.L I�`FOR�I�TIOti l�fliST BE SLBI�ITT'TED �t�ZL BEFORE PL��REVIEtiV ti��.L
BE ST:�RTED
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THE �PPLIC:�:v'I' IS:h � (circ:e one) 0«�ER OR O�iTR�CTOR
� . ZIP: ��=5`�(_,.>
JOB SIT'E :�DDRESS: �5� c�nC�, < <<�-"- t����
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N�tiIE OF O`VNER: ;a� i PHO��E: (home)�j5�- '�' IC} -fV:� I
(w�ork)
I�L�ILL�i G�iDDRESS: ����.�;-� I;����,-� I l'��'.� �-'1 ,,;G CITY: I;���:. ZIP: �����,�d�
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CONTR�,CTOR:(; ,r oC� ��f�C.h � 0��` PHO�tE: ��a-���- "l�a°1
1�10BIL�E PHUi�1�./PAGER:
I�IAILING�DDRESS: �30 S►'� �Y�°.rwe CITY: I��li�� "n�G.�O�-�s ZIP: � S Up�-i
ST�TE LICENSE: � OUDC�I�-I a�3
ARCHITECT/E�GL�EER: PH��'�'
II�II.L�G�DDRESS: CITY: Zg'=-
`��IE: REGISTR-�TIO� �
TYPE OF titi ORb: New Addicion Accessory SQucture
Move �e:nodeL��lte:ation ✓ '` ?�!�it�ranon
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PROPOSEDtiVOR�i(describe indet.aii): ��'c'�,�' ��'< <,t rlr <�'�'z� �1^,,;��-,t�;. ��. �z�>�.
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STORIES: SQ. FEET OF EACH FLOOR:
\O. OF BEDROOI�iS: G�R�GE ST.-�i.LS: ?�TT. DET.
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ESTLI�IATEDCO�STRL%CTIO\V�I-U:�TIO�i(escludingland): S �,' `'I�� !J� -
I hereby apply for a buildin� pe:�iit and I ack�owledae that the information above is complece
and accurate; chat the work will ae in coniormance with che ordina.nces and codes of the Citti'
and �vith the Sta�e Buildina Code: c.hat I understand this is not a permit and work is not to start
withouc a permit; and that the work wiil be in accordance �vith the approved plan.
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�PPLIC��'T'S SIG��TL�RE: Da.'TE: .
�VOTE! Parade of Homes events require separate permit approval by Police Department and
Ciiy Council 60 days prior to the event. 1Von permitted events will not be allowed.
! �
Sec.l3.0�1 RiGHTS OF SUBJECTS OF DaT�►
Subd. 1. Type of data. The righct or individua!on wham�he data is scored or co be scoced shall be as sec forrh in this secdon.
Subd.:. Iafocmation req�rired to be�ven indi�idual. An individua!uked w supply privare or confidenaal dan concerning hicnself shall
be informed of: (a)ehe purpase aad intended use of rhe requested daca within ehe wUecdng§cace agency, polidcal subdivisioa,or statewide rystem;
(b)whether he may rotuse or is legally rsquired co suoply che requesud dara;(c)any Imown consequence arising from his supplying or�sfusing to supply
priva�e ar confidendal da[a:and(d)the idendry of ocher persoas or enddes authorized by snte or federal law to receive che da[a. This tequinment shall
noc apply when an individual is asked to supply invesdgadve data, pursuanc to secdon 13.82, subdivision 3, to a law enfor�ement o�cec.
'Il�e comrnissioner of reve.^,ue mav olace he nooce reauircd under this subdivision in the individaal income tax or oropem 4u retund
inscruc�ions inscesd oi on chose forms.
Subd. 3. :�ccess to data by individual. (:pon requesc to a resporuible au�horiry,an individual shall be iaformed whaher he is the subject
oi stored data on individuals,and wheeher i[is ciassuied u public, privaee or contidtnual. lipon his fur[her cequest, an individual who is rhe subjecc
oi scored priva�e or public data on individuais shall be shown che data wiehouc any charge co him and, if he desires, shall be informed of rhe contenc
and meaning of that dara. �her an individual has been shown�:e priva�e daca and informed of i�s meaning, rhe data need not be disclosed to him for
siz monchs�heceatter unless a dispuce or acdon pursuanc�o chis secdon is pending or addicioaal dara ou rhe individual has been collected or crea�ed.
The responsible au�horiry shall provide copias or che pnva�e or public da�a upon requesc by ehe individual subjecc oi�he dara. "Ihe responsible au�horiry
may require che requesting peaon to pay the actua!cosu of making,cecdfying,and compding ehe copies.
The responsible auehoriry shall comply immediately, if possible,wi�h any request made punuanc co this subdivision,or within five days of
�he date of the requesc,axcluding Saturdays.Sundays and legal holidays,if immediace comptiance is no�possible. If he cannoc comply with che requesc
wi[hin rhac rime,he shall so iniorm ehe individual,and may have an addidonal five days wirhin which to comply wirh the requesc,ezcluding Sacurdays,
Sundays and legal holidays.
Subd.4. Procedure w6en data is not accunte or eomplete. An individual may con�est the accuracy or compleceness of public or private
data conceming himself. To exercise ehis right,an individual shall notify in wricing che responsible auchoricy describing rhe naeure of che disagreemenc.
The responsible auchoriry shatl within 30 days eicher: (a)correcc che data found�o be inaccucare or incomplete and aaempt to nocif}�past recipiena of
inaccurace or incomplece data. includin¢ recipiencs named by che individual:or(b)nod"ry rhe individual �ha�he believes the dara to be correcc. Data
in dispute shall be disclosed only if rhe individual's sca�emenc of disaereement is included wirh rhe disetosed data.
The decertnination of the responsibte auchoriry may be appealzd pursuant to che provisions oi the adminisaadve procedure acc relacing �o
contesced cases.
DAT?► 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 permic or license from che Cicy oi Orono or any of ics depanmencs may require you to furnish certain private or
confidential informacion.
You are :,o�ified that:
1. Ihe informacion you furnish will be used to decermine your qualification for che permit or license requested.
2. You may refuse to supply daca, buc refusal may require that the City deny the permit or license.
3. The information may be shared wich ocher local, scace or federal agencies to che 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.
�. You have certain rights under �I.S. 13.04 (available upon request) to review private daca on yourself.
6. Your full name is required co process this application or permit.
First 1�tiddle Lbsc
Address
Ciry State Zip Phone
I undencand my rights as staced above. -
Signamrc
i
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�� ` � STATE OF MINNESOTA
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.�'''��o H'•.. DEPARTMENT OF COMMERCE , �
� 133 Eaet 3eventh St. "
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St F�uf,MN SS 1 OI -
., . --,: (651)296-Q19
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` `�85$' BI3II.�ING GQNTRAGTOR
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BUII..BIIZ
' CORPORATION -
, C}ARLOCK FRENCFi ROUFINC�CORP _ ;.
;; Eapue� 3f31fZ001 ?Hrs�:E due tay 3131,t200Y,�
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' C}ARLt7CK FREN�'H I��OFI2+i4 COkF :
' 2309 3N�.LING AVE
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MP'i.S MN 55404-0000
' QP:DAVID.�KAREL ::
cM-oosa' ;�
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� 3 �� Date Received: � -5 -��
Total Fee: $ � �
Entered By: �� Permit#: A� Z 9�C�
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
- - --------------------- ---------------------------
c� --------------------------------------------------------- -
� THE APPLICANT IS: (circle one)�OWNER OR CONTRACTOR
JOB SITE ADDRESS: j ��o L dnl �- 1��.� � �✓p, ZIP: 5 53 g(a
�
� �5�-_
NAME OF OWNER: r�-�DYYI�-��T�'L.�z�l o t�/S PHONE: (home) `��'�'3`�'1 '�
�' (work) �15a-�I--13 -�' 1'"J 3
MAILING ADDRESS: S�S�o M I nl N�'T6�.5,�j�Dd? CITY: l���- I��t ZIP: �S 3 3 ,
CONTRACTOR: �►�� PHONE:
� CONTACT PERSON: ��32��} �LS����IVIOBILE/PAGER: lo i�--�S�`�- jo g '7
�� MAILING ADDRESS: CITY: ZIP:
3 STATE LICENSE: # �j 13 3
�
� ARCHITECT/ENGINEER: �n� 'C PHONE:
O
bp MAILING ADDRESS: CITY: ZIP:
� NAIVIE: REGISTRATION#
O
�
�' TYPE OF WORK: New Addition < Accessory Structure
�
Move Remodel/Alteration Land Alteration
� PROPOSED WORK(describe in detai�: /.�pp �-"=�Sr�y orJ -�l� � ( s�
,�
� sr��' �o t-n��J o��� i � 1 °� �3 �r-�� ���� )
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STORIES: � SQ. FEET OF EACH FLOOR: 2 �� � AflD� CZc�a S�
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. T�T��-�
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � �(;1���"1 �c�
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: �I � �
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
5
� ,
Sec.13.04 RIGHTS OF S[JBJECTS 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 to supply the requested data;(c)any lrnown consequence arising from his supplying or
refusing to supply private or confidential data;a�(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 individua! is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revern►e mav olace the notice reauired under this subdivision in the individual income tax or orocem taz refund
insrr»�tio instead of on those forms.
Subd. 3. Access to data by individual. Upon request to 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
discloseci to him for six months thereafter unless a dispute or action pursuant to this secaon is pe�ing or additional data on the individual has been
collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require ihe requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry 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 individual may contest the accuracy or completeness of public or
private data conceming lvmself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the tiature of the
disagreement. The responsib(e authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy
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 conect. 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 auihoriry may be appealed pursuant to the provisions of the administradve 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�ity of Orono or any of its departments may require you to fumish certain
private or confidential information.
You are notified that:
1. The information you fumish 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
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.
�r��- �a y� Eu�u�� n
First Middle Last
S�c7 M J /J i��`TDI��1�' �
Address M �
s� 5�33� g 5a- u� 3--5��3
City State Zip Phone
I understand my rights as stated above.
l Uvt"Y�`� / ��
Signature
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