HomeMy WebLinkAbout2001-P04366 - re-roof PERMIT
C�T ." �C�F ORONO PermitNumber:
2750 kelley Parkway - PO Box 66 P04366
Crystal Bay, rilinnesota 55323 Pe►'mit Type: Minor Alterations
(952) 249-4600 Date Issued: 9�i9�2ooi
SITE ADDRESS: 2171 Shadywood Rd
Wayzata,MN 55391
PID: 17-117-23-42-0022
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Atterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 153.25 Valuation: $ 7,761.00
State Surcharge Fee: $ 3.90
TOTAL FEE: $ 15�.15
APPLICANT: Western Cedar Supply OWNER: Jacquelyn Robertson
9700 13th Ave 2171 Shadywood Rd
Plymouth, MN 55441 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-�REAL IMPROVENIENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STWCT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERM[TEE SIGNATURE ISSU EY S[GNATURE
Copies: 1-File(SiQnitures Required). 1-Aonlicant, 1-Monthlv Renorts. 1-Assessine. 1-Finance Page I
Tota� Fee: $ Date Received:
• Entered By: Permit#:
CITY OF ORONO - BUILDING PERNIIT 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 O CON ACTOR�
JOB SITE ADDRESS: ' � �` t Q ZIP: G �
,
NAME OF OWNER: ,_�,�-�(��(' ��`-x`� PHONE: (home) f�7� ��
(work)
MAILING ADDRESS: ��m�'- CITY: � � � � ZIP:
CONTRACTOR: � � , f f PHONE: ���- 5 y"l'�<�S CT��
CONTACT PERSON: ���.�,L� M(Y /PAGER:
MAILING ADDRESS: �f"7�'� !� �}c.�' �,1 . CITY: ZIP: 5S Y�
STATE LICENSE: # or�45�6
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New l� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: /�'`� �E`����-��o�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIlVIAT'ED CONSTRUCTION VALUATION (excluding land): $ '�], ���/ '�
I hereby apply for a building permit and I aclrnowledge 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: l -��' �/
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF S[lB.TECTS OF DAT.�
Subd. I. Type of data. The righ[s of individual on whom the data is stored or co be scoced shall be as set forth in this secdon.
Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidendal data conceming himself shall
be informed of: (a)rhe purpose and intended use of the requesud data within the collecting State agency,political subdivision,or statewide sysum;
(b)whether he may refuse oY is legaily required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply
privace or confidendal data;and(d)the idenriry of ocher persons or endaes au[horized by stace or fedecal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the nodce re4uired under this subdivision in the individuai income tax or oropertv rax refund
instructions inscead of on those forms.
Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be uifocmed whether he is the subjecc
of s[ored data on individuals,and whe�her it is classified as public, private or confidenaal. Upon his further request,an individual who is rhe subjecc
of stored private or public data on individuals shall be shown the data wirhout any charge to him and, if he desires,shall be informed of the concent
and meaning of chat data. After 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 pursuant to this secdon is pending or additional data on the individual has been collected or created.
The responsible authoriry shalt provide copies of the privace or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the actual cosu 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 reques[
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
5undays 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
data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing rhe 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 rhe individual;or(b)notify the individual that he believes the data to be correct. Data
in dispute shall be disclosed only if the individuai's statement of disagreement is included with the disclosed data.
The decerminarion 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 Ciry of Orono or any of its departments may require you to fumish 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 pemut 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 Stace Zip Phone
I understand my rights as stated above.
Signamre ,