HomeMy WebLinkAbout2003-P06800 - re-roof i� PERMIT
CITY C)� ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P06800
Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations
(952) 249-4600 Date Issued: 9�22�2003
SITE ADDRESS: 2118 Shadywood Rd
WAYZATA,MN 55391
PID: 17-117-23-42-0016
DESCRIPTION:
Proposed Use: Residential
Buildin Census Code O/S-Building
Pernut Class: g
Pernut Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 139.25 Valuation: $ 6,300.00
State Surcharge Fee: $ 3.65
TOTAL FEE: $ 142.90
APPLICANT: Huepenbecker Construction OWNER: KEVIN S MADEJA
1008 Barberry Cir 2118 SHADYWOOD RD
Waconia,MN 55387 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.
�
.
� �1 y�1��� /c�
A C T P I E SI ATU SSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Avplicant, 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII.,DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR TRACTOR
JOB srrE ann�ss: ���8' �Q�l���o� �.P� z�:
NAME OF OWNER: �Y6� �c��%� PHONE: (home) �5� �7/-�a�
(work) (oZ --�g��
NIAILING ADDRESS: a � � i� • CITY: O!�'A�1 D
CONTRACTOR: " l.l� t' c° 9 /'- PHONE: �- ��a—��!
CO�I'I'ACT PERSON: o MOBILE/PAG'�R: �a - 5�
MAII.ING ADDRESS: �9 �' P ', CITY: �%Q�oy`A ���.,�Z
STATE LICENSE: # Z,7�'0
ARCHITECT/ENGINEER: . -PHONE: .
MAILING AD Z�'
NaME: REGISTRATION# •
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: %P`�' � Q� �( �°1'l00� _
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: � GARAGE STALIS: ATT�. � DET. � - -_ . . - . �
ESTIlVIATED CONSTRUCTION VALUATION (excluding land): �a (D��� �
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 accor nce 'th e approved plan. ,
APPLICANT'S SIGNA . DATE: ��l a3
NOTE! Parade o�Homes events require sep ate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
�
Sec.13.04 RIGHTS OF S[JBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom[he dara is sw:�or[o be stored shall be as set forth in this secaoa
Subd.2. Information reqirired to be given individual. An individual askcd w supply private or confidenaal dara concecning himself shall
be informed of: (a)che purpose and inrended use of the cequesud dara wi�in the collecang�rate agency,polidcal subdivision,or statewid�rystem;
(b)whe�her he may refuse oY is legally requind to supply che tequested daa:(c)any lmown consequence arising from his supplying or refusing to supply
privace or confidendal data;and(d)the idendry.of o[her persoas or endaes auehorized by state or federal taw to eticeive the data..'Ihis requiremenc shall
noc appiy whan an individual is asked to supply invesdgadve daea,pursuaac to secdoa 13.82,subdivision S, co a law enforcemenc officer.
The commissioner of re�enue mav piace the nodce reauired erder this subdivision in che individual income_tax or proaertv tax cefund
instruccions inscead of on chose forms.
Subd.3. Access to data by indi�idual. Upon requesc to a resroasibie anthoriry,an individual shall be informed whe[her he u the subject
of scored data on individuals,and whe[her it is classified as public,privat�or confidecrial. Upon his further reques�aa individual who is the subject
of scored private or public data on individuals shall be shown the data wi�out any c'narge to him and;if he desires,shall be informed of the contenc
and meaning of[hac data. After an individual has been shown the privau�an and in:ormed of ics meaaing,che daca need not be d'uclosed to him for
six mon[lu chereafcer unless a dispute or acaon pursuanc to this secdon is p:nding or addidonal data on the individual has been collected or created.
'It►e responsible auehoriry shall provide copies of the private or public data cron reques:by the individual subject of[he dara. The responsible authoriry
may rcquire[he requesting person to pay the actua!coscs of making,cerjring,and compiling the copies.
'Ihe responsible auchoriry shall comply immediatety,if possible,wieh aay r_quest made punuant to this subdivision,or wichin five days of
the date of the requesc,ezcluding Saturdays,Sundays and legal holidays,if uamediat-compliance is not possible. If he cannot comply with the requesc
within chat time,he shall so inform ehe individual,and may have an addicoaal five days wiehin which to comply wich the request,ezeiuding 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 pri�•ate
da[a concerning tiunself. To exercise[his right,an individual shall nodfy ia wriang�:e responsible suthoriry dascribiug che namre of the disagreement.
The responsible au�horiry shall wichin 30 days either: (a)correct the dan fcund to be inaccurate or incomplete and aaempt to nodfy past recipienct of
inaccurate or incomplete dara,inctuding recipients named by[he individLl;or(b)�odfy the individual thac he believes rhe dara to be carrect. Dara
in dispuce shail be disclosed only if che individual's sta[emenc of disagree�ent is i^.c:�ded with the disclosed data.
The de�erminarion of the rosponsible au[horiry may be appea::d punuac�to the provisions of che adminis�adve procedure act relating co
contested cases. .
DATA PRIV�CY AD�'ISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects ot data", we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of iu deparments may require you to fumish certain priva[e or
confidencial information.
You are notified that:
1, The information you furnish will be used to de:emune�•our qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license.
3, The information may be shared with other loc�1, sta[e or federal agencies to the excent 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 cer[ain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6, Your full name is required to process this xoplicacion or perm.it.
First Middle Last
Address •
C�ry Sm� Zip Phone
I underst my rights as s ted above.
mre