HomeMy WebLinkAbout2001-P04020 - re-roof � �
PERMIT
C rTY O F O RO N O Permit Number:
2750 Kelle y Parkwa y - PO Box 66 Poao2o
Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations
(952) 249-4600 Date Issued: �i2i2ooi
SITE ADDRESS: 1940 Shadywood Rd
WAYZATA,MN 55391
P I D: 17-117-23-24-0023
DESCRIPTION: i1BC Occupancy R3
Proposed Use: Kesiaentiai .
Permit Class: Building Census Code g3�4 �'i�''� `'/\
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 125.25 Valuation: $ 5,785.00
State Surcharge Fee: $ 2.90
TOTAL FEE: $ 128.15
APPLICANT: Sela Roofing&Remodeling, Inc. OWNER: �1'F DAWSON
4100 Excesiar Blvd. 1940 SHADYWOOD RD
St. Louis Park,MN 55146 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.
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APPL ANT PERMITEE I NATURE I SLTED B SIGNATURE
Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1
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Total Fee: $ � ��' �� Date Received: Fy' _� '�-��
Entered By: �/!�'_,- Permit#: �� `�6<2-�'
CITY OF ORONO - BUII..DING PERMIT A.PPLICATION
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 O ONTRACTORj
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JOB SITE A.DDRESS: � �1"1c��( c , Z�� �� �
NAME OF OWNER: - �,+- ,-;-� PHOiVE: (home) y�� — �S��n�
(work)
1�IAILI�i 1G ADDRESS: . CITY: ZIP:
SELA ROOFINQ& REMODELING, ���
CONTRACTOR: � 4100 EXCELSIOR SLVD. PH��; �,l Z- `5� ? -��j`-��j
CO1�I'TACT PERSON: � ��pp�nS�I�IOBILE/PAGER:
NTA.IL,ING ADDRESS: CITY: ZIP:
STATE LICENSE: # �C S C� _
ARCHITECT/ENGPi IEER: PHOti'E:
1VIA,IL�'G ADDRESS: CITY: Z�:
N��: REGISTR.ATION# �
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED`VORK(describe in detain: �� (� JcS�� rl��� � l��-✓��-�--
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STORIES: SQ.FEET OF EACH FLOOR:
I�TO. OF B�DROOMS: GA_RAGE STALLS: ATT. � DET. - . � - - . -. .- ,:..
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ESTIvi IATED COti'STRUCTION VALUATIO\ (excluding land): S � �
I hereby apply for a buildin;perniit and I acknowled�e that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Buildin� 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 ccordance with the approved plan.
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APPLICANT'S SIGNATURE:,� �� i , � z DATE: � � Z- � 1
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NOTE! Parade o Homes events require separate per�iit approval by Police Department and
City Council 60 days prior to the event. Non permitted events wi11 not be allowed.
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Sec.13.0-1 RIGHTS OF SUBJECTS OF D�Ta
Subd. 1. Type of data. '!he righa of individual on whom�e dara is s�rr1 or co be scored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An indi�idual asktd w supply privare or confidendal data conce�ning himself shall
be informed of: (a)[he purpose and ineended use of the requesud dara w:�in the collecang Y[ate agency,polirical subdivision,or sratewide syscem;
(b)whuher he may refuse oY is legally rcquired co supply[he requested daa:(c)any 1�owa eoasequence arising from his supplying or refusing to suppiy
private or eonridendal data;and(d)the idendry of other peaoas or eaddes xachoriz;d by srate or federal law to receive the daca.,This requ'uemen[s6a11
not apply when an individual is asked to suppiy invesagarive data,pursu�:[co secdoa 13.82,subdivision 5,co a_law enforcement o�cer.
The commissioner of roeenue mav place the norice rewired�rd-r this subdivision in the individual income tax or proaem tax refund
instructions insccad of on chose forms.
Subd.3. Access to data by indi�idual. Upon requesc to a r.spoasible auchority,an individual shall be informed whether he is che subject
of scored data on individuals,and whether it is classified as public,privar�or confidecrial. Upon his furcher request,an individual who is the subject
of storni priva[e ot public dara on individ'uals shall be shown che dara wiu ou�any c'n>;e to him and;if he desires, shall be informed of the coacenc
and meaning of chat data. Aher an indiiidual has been shown ehe privam�aa and i�:ormed of ics meaning.[he data need not be disclosed to tiun fo�
six monchs ehereaiter unless a dispute ar acdon pursuant to chis secdon is�:nding or addiaonal daca on the individual has been collected or creaced.
'Ihe responsibte auchoriry shall provide copies of che privace or public dac�c�on requ:s:by[he individual subjecc of the data. The responsible auchoriry
may require[he requesang person to pay the actual cosu of making,cer;•ing,ar.d compiling the copies.
The responsible auchoriry shall comply immedia�aly,if possibk,wi�h any r:quest made pursuant to this subdivision,or wiehin five days of
the date of che requesc,excluding Saturdays,Sundays and tegal holidays,ii ir,.mediace eompliance is not possible. If he cannot comply with the request
wichin[hac time,he shali so inform the individual,and may have an addice;.al five days wi[hin which to comply with�he request,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data Ls not accurste or complete. An indivi�ual may contest the accuracy or completeness of pubtic or private
daca conceming himself. To exercise�his rieht,an individual shall nodfy ia wriang te respoasible authoriry describing che nacure of the disagreemeac.
The responsible aufioriry shall within 30 days either: (a)correct che dae tcund to be inaccurate or incomplete and attempc to nodfy pasc recipiencs of
inaccurate or incomplete data,including recipients named by the individLl:or(b)codfy the individual that he believes rhe data to be correcG Data
in dispuce shall be disclosed only if[he individual's statemenc of disagr:e�en�is i.c:ndad with che disclosed dara.
The decerminarion of the rasponsible authoriry may be appea:ed pursuac�to the provisions of eho adminisaarive procedure act reladng to
contested cases. . � . '
DATA PRIV�,CY AD�'ISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects oi data",we would like to inform you tha[your reouest
for a permic or license from the Ciry of Orono or any of i� depa.rmznts may require you to fumish eertain privace or
confidential information.
You are notified that:
1, The information you fumish will be used to de:ermine�-our qualification for the permit or license requested.
2. You may refuse to supply data, buc refusal nay require that the City deny the permit or license.
3, The information may be shared with ocher loc�l, state or federal a�encies to the excent necessary to process
the permit or license.
4. If your requested perm.it or license requires Council action to approve, some information may become
. . public. .
�, You have certain rights under M.S. 13.04 (a�ailable upon request) to review private iiata on yourself.
(, Your full name is required to process this aoplica�ion or permic. �
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Ciry Sta�e Zip Phone
I underst my ri s ated above.
, � � �- 2- � I
signacure
C�/� DATE TIME
CITY OF ORONO CALLED IN ,���
INSPECTION NOT SCHEOULED 0`
PERMIT N0. � COMPIETED '— '� �/�•�
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ADDRESS ' �-`" ��
OWNER CONTR. �z
TELEPHONE NO. �s�a 9�� �a� �o
� DESCRIPTION -��� �..�— G
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FR,4MING / 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARO COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES NO
� COMMENTS:
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� �ORKSATISFACTORY:PROCEED �ROJECTCOMPLETE
W CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WOFiK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR W{LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-46QQ
OwnerlContractor on sit�
Inspector. � ��_
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