HomeMy WebLinkAbout2004-P07662 - addn/remodel/repair f
PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P07662
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 6/30/2004
SITE ADDRESS: 1100 Old Crystal Bay Rd S
Wayzata,MN 55391
PID: 09-117-23-14-0001
DESCRIPTION:
Proposed Use: Residential f0,3(f 0) P2
Permit Class: Building Census Code
Permit Type: Minor Alterations Permit Sub-type(s): Addn/Remodel/Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 111.25
Valuation: $ 4,200.00
State Surcharge Fee: $ 2.60
TOTAL FEE: $ 113.85
APPLICANT: Garlock-French Roofing Corporation OWNER: Robert Gumnit and Frances Graham
2301 East 25th Street 1100 Old Crystal Bay Rd S
Minneapolis,MN 55406 Wayzata MN 55391
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.
g1/4••Q Ca&LA-ivil
APPLICANT PERMITEE SIGNA ISSUED BY SIGNATLI�RE�
Copies: 1-File(Siinitures Required). 1-Applicant,1-Monthly Reports. 1-Assessin¢. 1-Finance Page 1
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.
1 P*2-• (please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR D
JOB SITE ADDRESS: IU)b b\tt Cofaxl \uy RU(h(X .‘)1A-4-1/\ ZIP: GC-79
Will this be a Parade of Homes,Remodellers Showcase Home or other Display Home?
® Yes al 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: R b\2& ryl n i PHONE: (home)°1 )-Li1(-1-11001
(work) 1)15?-F,2G,-LAG)1
MAILING ADDRESS: \\bD Old Otijp/A BGt Rd►,S CITY: 0 nNt d ZIP: c,C,361i
CONTRACTOR: GAY WOK- F1/e nc.L'1 12.0 0 f1 i;161 CAA'?• PHONE: -1ad--1 )
CONTACT PERSON: KAY\ CintLy 1 P&V Jl MOBILE/PAGER:
MAILING ADDRESS: E(A ' ' 1 St. CITY: Mvb• ZIP: CZ.,40(0
STATE LICENSE: # 000\y a , EXPIRATION DATE: 3 131 10 S
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure _ _
Addition _ Move Home _
Remodel/Alteration
PROPOSED WORK(describe in detail): R.e.Qla1,2 YRp&&1Ys 'I-)
eVDM vboE• PerEetrr0 m& nitinoaiLe, io 1 Alo..Y t'kakt, \roof sve.m an hume
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ 141 DD. 0 0
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: C-25- o y
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 concerning 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 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 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 may place the notice required under this subdivision in the individual income tax or property 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 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 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 individual may contest the accuracy or completeness of public or private data
concerning himself.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
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 maybe 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
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.
PONAI i 8 C (4 A,re'pour
First Middle Last f
3oy3 4S-t- ,4Sn _
Address
('1�� S . 0iii 5—SYo6 6 12 - 276.19!0
City State Zip Phone
I understand my rights as stated above.
ald2 • a-ek-i— es-).
Signature /
, .
4-0.0.- z,. State of Minnesota Department of Commerce Licensing Division
- ' Department of Commerce Telephone: (651)296-6319
.4'''., „71 '-` p 85-7th Place East,Suite 600 E-mail address: licensing.commercesastate.mn.us
A ' St.Paul,MN 55101-3165 Website address: commerce.state.mn.us
Residential Building Contractor License
Legal Name: GARLOCK FRENCH ROOFING CORP Business Structure:
DBA: CORPORATION
Address: 2301 E 25TH ST
MPLS, MN 55406
License Identification Number: BC- 1423 Qualifying Person: DAVID J KAREL
License Expiration Date: 3/31/2005 Continuing Education: 7 Hrs CE due by 3/31/2005
JUN.2.5:200 12:12 6127229754 004Nfi4/GP.RLOOK FRENCH ROOFING #5245 P.004/006
diN
Total Fee: $ //3.6 Dote Received: 6- D
Entered By: ' = Permit#: P 670b
CiTY OF ORONO - BUILDING PERMIT APPLICATION
Ml information must be submitted in full before plan review will be starl:ed.,
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR ONTRA.CTOIt
JOB SITE ADDRESS: IUD : . . ' . n -+It't ZIP: Gc.739
Will.this lie a. Parade of Homes,Remodelers Showcase Hom.e 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: RD\2•er ` m fl1 PHONE: (home)°Y'a --lciDJ
(work) c' 5 -h
MAILING ADDRESS: qp O\ . LM .\ 16/41 Rrh•S CITY: Ours ZiP: S 5'7,91
CONTRACTOR: Gar1D( - Yves( , "01)fi$;1 ( Op • PHONE: Ula-1aa--I Iel
CONTACT PERSON: por1 CAIN(iFay MOBILE/PAGER:
MAILING ADDRESS: a3 1;11 eplYr a id-• CITY: �. ZIP: �a -3�•0(p
STATE LICENSE: # ()DO 1 1y p,-2, EXPIRATION DATE: 3 tailp 5
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION #
TYPE OF WORK: New Accessory Structure
Addition Move Home
Remodel/Alteration 7t
PROPOSED WORK (describe in detail): RepGtL . • ' T&& r
QDM 'CODE v I f C.Ai . w eYl horse
ow.uywkoyt
STORIES: SQ. FEET OF EACH FLOOR:
NO. Oi+BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 9, DD. DO
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 I3i.ii.l.ding Code; that I.
understand this is not a permit and work is not to start without a permit;a.n.d that the work will be in accordance with.
the approved plan.. r
APPLICANT'S SIGNATURE: .4. o�Z •
�y 141 DATE: C y
JUN.25'2004 12:12 6127229754 GARLOCK FRENCH ROOFING #5245 P.005/006
Sec.13.84 RIGHTS OIFSUaJRC7'S OF DATA
Sated.I. 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-
:ON.2. Information required to he given individual.An individual naked to supply private orconfidential date concerning himself droll be
Informed of: (a)the perpnee and intended uta of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may reface or is/legally required to supply the requested data:(c)any known ceesoquonce arising from Pile enppiying or ralh,Ing to supply
private or conlldantlal data;and(Odle Identity of other persons or entitles authorized by/tate or rderal law to receive the data.This requirement/hall
not apply when an Individual Is naked to supply Investlgntive data,pursuant to section 13.82.rwbdtvlelon 5,to a law enforcement officer.
The cammlsalaner.afreyenna may nine lbanallrr clanked under this auhdlvlalon In the Indlddaal Income tea or ar,onerty lax retinal
Jantruednna instead of on those forme.
Sehd.3. Access to data by Individual. Upon requital ton responsible authority,an individual shall be informed whether be Is the subject of
stored data on lndividuala,and whether It le classified as public,privateer conlldentd. Upon hie bather request,an Individual who IF the subject or
stored private or public data on Individuals shall he shown the data without any charge to him nail,Whe desires,shell be informed of the content and
meaning of that data. After an Individual hie been shown the private data and informed of ire meaning,the data need not be disclosed to him for ale
months thereafter sinless a dispute or action pursuant to this saction is pending or nddttlonal data on the individual has been collected or created.The
responsible authority shall provide copies of the private or pnblie flats noon request by the individual object of pito date.The responsible enthotity may
require the requesting porton to pay the actual costs of molting,certifying, and compiling the copied.
The responelble authority shall comply immediately,if poselbk.with any request made pursuant to dice auhdivhdon,or within five day/of the
date of the request,excluding Saturdays,Senday/end lagnl holidays,if immediate compliance Is not powlhia if he cnnuor comply with the request within
that time,he shall en inform the individual,and Puny have an nddittonni live days within which to comply with the roost,excluding Saturday..Sundays
end legal holidays.
Sated.4.Procedure when data Ie not accurate or complete.An individual may contest the accuracy or completeness/of public or private date
eoocerisinghimself To exercise this right,no individual eball notify In writing tbe reeponeible authority describing Hie online of the disagreement.The
responsible authority shall within 38 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify pact recipients of
Inaccurate or incomplete data,Including recipients named by die individual;or(b)notify the indiidual that be believes lite date to be correct.Data In
dispute shall be disclosed only If the Individual's statement of disagreement in included wok the dirrioFed data.
The determination of the responsible authority nosy be appealed pennant to the provisions of the administrative procedure act relating to
contested costes.
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 ore 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 thin the City deny the permit or license.
3. The information may he 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 tnformtatlon may become
public.
S. 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
j1
r Vet v r• d C�,�,�y��,��r
First Middle Lest
3 01 y 6-6 11 14,Kn <
Address
M pp Moi ,
15 . _ 5-5"-Lie G I a - 2 76.-99a.
eddy Slam Zip Phone
I understand my rights as stated above.
signature
+ :