HomeMy WebLinkAbout2005-P09298 - building - re-roof PERMIT
CITY OF ORONO
2750 Kelley Paskway- PO Box 66 Permit Number: P09298
Crystal E3ay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued:
10/14/2005
SITE ADDRESS: 2660 Pheasant Rd Unit#
Excelsior,MN 55331
P��� 21-117-23-23-0022
DESCRIPTION:
Proposed Use: Residential Census Code O/S-Building
Permit Class: Building
Permit Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 209.25 Valuation: $ 11,600.00
State Surcharge Fee: $ 5.80
TOTAL FEE: $ 215.05
APPLICANT: Sela Roofing&Remodeling,Inc. OWNER: Gregory&Gayle Hayhurst
4100 Excesior Blvd. ' 2660 Phesant Rd
St.Louis Park,MN 55146 Excelsior,MN 55331
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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AP ANT PE TEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total?+E�: $ � Aate Received:______��'r���
�ate�red 8y: 1 7 i� �`:� ��'�t� Permat#: ; ,l,Q� � �l e��
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CITY OF ORUNO - BUILD�IG PE�IT APPLICATZON
Al��n�ormation mt�st be submitted in full before p�an xeview will be started.
(please prir�l all�nformativn)
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THE APPLICANT I5: (circle one) OWNER OR TRACTO�t
JOB SITE ADDItESS: ��L�!�J �!� ��_�i__�� � ZIP:
Will this be a Parade of Homes,l,tem�ode�ers 5bowcase Home or other Disp�ay kiome?
❑ Yes � No If yes, a specaal event permit is re,�uired with Podice Department and City
� Council approva160 days prior to the event, Non permit�ed�vents will nbt
be allowed.
NAM� OF OWNER � PHONE: (laome)���- 1� f O
(work)
MA�ILING A,DDRE55: �Ge-/� CITY: ZIP:
�LA ROOFINCa 8►REMODELING, INC
4�00 EXCELSIOR BLVD. , /
CONTRAC"TOR: 3T.L PHONE: �1, '
CONTACT PERSON: �U�oo0�05o MOBILE/PAGER:
�L�NG A�DD�tESS: C�`�'Y: ZIP:
STATE LICENS�: #
ARCfIITEC'I'/ENGINEE�t: PHONE:
MAILING ADD�LES5: CZTX: ZIP:
NAME: �GISTRATION#�
TYPE OF WORIi: New Aacessory Structt�re
Addition N�ove
Re�odeUAlterarion Land Altex�tion__.
PROPOS�+D WO�(deseribe in de�ai�: ��Ql li�����6�'%�� �T l �%J��
S'TORIE5: �Q.FE�T OF E.ACH FLOOkt:
NO. OF BEDROOMS: GARA,GE 5T.�L�,S: ATT. DET'.
ESTIMATED CONSTRUCTION V.A�U,A,x'�ON(e�c�udiz�g�aud): $ � O, �
I hereby apply for a building permit and Z aclmowledge that the a�nfonnation abovc is complete and accurate;that the
work w�ll be in c�nformance with thc vrdinaaces and codcs of the City and �ith t�e 5tate �uilding Code; that I
understand this is not a permit and work is not to start without a pernzit;and that thc work will be in accotdance with
the appxoved plan,
APPLICA,�IT''5 SIGN,A,'�'�URE• DATE: ��7 '
Titi'd L9z'ON S3�dS �NI�00�1 d�3S Wdb Z:Z S00Z'�Z'1�0
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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.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ZIP:
Will this be a Parade of Homes,Remodelers Showcase Home or other Dispiay Iiome?
❑ Yes ❑ NO If yes,a special event permit is reguired with Police Department and City Councid approval
60 days prior to the event. Shz�ttle bus service will be reguired a�nless applicant demonstrates
su�cient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(describe in detai�:
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF SEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $
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:
,1
- . ' .
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Sec.13.04 RIGHTS 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 az set forth in this section.
. __ _ . ___ ---._Subd-2.—Infaanation�equirtd�to_begiueniadividual_An.indixiduaLasked-to-suPP�KPci�ate_or.confideatial�ata.conceminghimselfstiallbe�__._ �.
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 legaily 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 identiry 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 m��lace the notice reyuired under this subdivision in the individual income tax or prooerty 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 infonned of the content and
meaning ofthat 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 col lected 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 authoriry
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 ofthe 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 tive days within which to comply with the request,ercluding 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 authoriry 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. Dats 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
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.
c/����
First Middle Last
Address
City State Zip Phone
I understand m ri hts as stated, ove.
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Signature
32
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L)� DATE TIME
ITY OF ORONO CAL�ED IN
INSPECTION NO C SCHEDULED �s��a
PERMIT NO. o�a� COMPLETED
ADDRESS � !"���-Q�� l��
OWNER CONTR.
TELEPHONE N0. ��a� ,�7/ � ��(p O
� DESCRIPTION �.Ckh. �
� 01 FOOTING 11 MECHANICAL RI EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNERICONTRACTOR TO MEET YOU�YES_NO
� COMMENTS:
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� � CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next ins ection 24 hours in advance. (J52� 249-46��
Owner/Contracto
Inspector.
White Copyllnspector's File Canary Copy/Site Notice
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DATE TIM
CITY OF ORONO CALLED w Cv}.�-C�o
INSPECTION NO IC�F SCHEDULED 7�S��i� (U% �' .,Tt�
PERMIT NO. � � COMPLETED
ADDRESS �(n lo��� �iL� � i c�-:� /�A
OWNER CONTR. ��C���c-._._
TELEPHONE NO._ ��S� ��S ���-(p
� DESCRIPTION ��_l��/�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 0 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 -SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING Rl 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINA� 36 FOUNDATION/REMOVAL
Z OWNE ONTRACT TO MEET YOU: YES_NO
� COMMENTS:
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W� ❑ RK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ORRECT WORK 8 PROCEED � ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN ❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ne t inspection 24 hours in advance. (J52� 249-4600
OwnerlCo c site:
Inspector.
White Copyllnspect r's File Canary CopylSite Notice