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Home My WebLink About2002-P05683 - re-roof ` � PERMIT C ITY O F O RO N O Permit Number: 2750 Kelley Parkway- PO Box 66 P05683 Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: ioili2oo2 SITE ADDRESS: 2100 Shadywood Rd WAYZATA,IvIN 55391 PID: 17-117-23-31-0041 DESCRIPTION: UBC Occupancy R3 Proposed Use: Residential Buildin Census Code O/S-Building Pernut Class: g Permit Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 4,200.00 State Surcharge Fee: $ 2.60 TOTAL FEE: $ 113.85 APPLICANT: Maintenance Free MN,Inc. QWNER: R&P ALBERTSON 4216 83rd.Ave.N. 2100 SHADYWOOD RD Brooklyn Park,MN 55443 WAYZATA MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'WCT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �// � / �� . , _ `' � V" // � !(.'�k=�.___ APP NT PERMITEE SIGNATURE ISSUED BY SIGNATURE Conies: 1-File(SiQnitures Required). 1-Applicant 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 . _ Total Fee: $ //3� �� Date Received: i ci- / -U Z- Entered By: ��c.- Permit#: f�' �u%�.�j CITY OF ORONO - BUILDING PERMIT APPLICATIOleT All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR , JOB SITE ADDRESS: c� � " p � `IP: � �� NAME OF OWNER: ��J2,� �`��2� �J PHONE: (home) ' y7/' 7 � n1 /� (work) MAILING ADDRESS: � �— CITY: ZIP: , co�cTox: ,�l/I�%.�J t�� a /�/l�r. ��/�,PHONE: �� ) �S� -C%�� CONTACT PERSON: MOBILE/PAG R: r 3 c�,-�`f 7� MAILING ADDRESS:�dl �'3 r H'� I\�- CITI': rU ��,,z/ ZIP:��'��" STATE LICENSE: # ,�Q�� - ARCHITECT/ENGINEER: PHOl��: MAILING ADDRESS: CITY: ZIP: NAME; REGISTRATION�# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration� Land Alteration PROPOSED WORK(describe in detai�: 1�4�'�- ��f STORIES: � SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIl�iATED 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 pernut 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: �� Q �_ NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non pernzitted events will not be allowed. r' ► Sec.13.04 RIGFTTS OF S[JBJECTS OF DATA Subd. 1. Type of data. T6e righcs of individual on whom rhe data is stored or to be stored shall be as set forth in this section. Subd.2. Information reqirired to be given iadividual. An individual asked to suppiy private or confidential dard concerning himself shall be informed of: (a)the purpose and intended use of the requesced data within the collecting§tate agency,political subdivision,or statewide sysum; (b)whether he may refuse oY 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 idenury of other persons or enrides authorized by state or federel law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve dard,punuant to secdon 13.82,subdivision 5,w a law enforcement o�cer. The commissioner of re�enue mav alace the norice re4uired under this subdivision in the individual income tax or oroperty tax refund instrucdons instead of on th6se forms. Subd.3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject of swred data on individuals,and whe[her it is ciass�ed as public,private or confldendal. UQon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the dara without any charge to him and;if he desi�es,shall be informed of the content and meaning of[hat data. Afrer an individual has been shown the private dara and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to this secdon is pending or addiaonal 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 iadividual subject of the data. The responsible authoriry may require the requesang person to pay the actual costs of making,certifying,and compiling the copies. The responsible aurhority shall comply immediately, if possible,with any nquest 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 possibte. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaoual five days within which to compiy 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 compieteness of public or private data concerning himself. To exercise this right,an individual shail noafy in wricing the responsible authoriry describing�he 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 nodfy past recipienu of inaccurate or incomplete data, including recipients named by che 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 statemenc of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the adminisnative procedure act relaring to contesud cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "l�ights 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 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 shazed 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. First Middle Last Address . City State Zip Phone I underst my rights s ted above. Signacure