HomeMy WebLinkAbout2000-P02543 - re-roof . �
PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P02543
Crystal Bay, Minnesota 55323 Pe�mit Type: MinorAlterations
(612) 249-4600 Date Issued: 6i9ioo
SITE ADDRESS: 2177 Shadywood Rd
WAYZATA,MN 55391
PID: 17-117-23-43-0136
DESCRIPTION:
Proposed Use:
Buildin Census Code 434
Permit Class: g
Permit Type: Minor Alterations Permit Sub-type(s): Building Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ g3•25 Valuation• $ 2,500.00
State Surcharge Fee: $ 1.25
TOTAL FEE: $ 84.50
APPLICANT: MARK SHEPHARD OWNER: MARK A SHEPHARD
2177 SHADYWOOD RD 2177 SHADYWOOD RD
WAYZATA,MN 55391 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 BUII�DING CODE REQUIREMENTS.
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APPLICANT P ITEE I NA RE ISSLTED BY SIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
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Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BLTII1DPiG PERII�IIT 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 CONT�R.ACTOR �
JOB SITE ADDRESS: Z�77 �[����' t�."C�c�� �c� ZIP: ��'��`��
NA1tiIE OF OWNER: �`-�L C��Qc� ��C���C-f�� � PHO�tE: (home) �7 C ��`� ���
(work) �'7� � �'�`�C� �
1�IAILING ADDRESS: 'Z�77 �G--��lc���x`�i-� CITY: w��"u�=� ZIP: S�` (
CO�t'TR4CTOR• 5 G-Z�c� �5 �--���� �,; PHO�tE: � �' 2 ����C� ��
CON'TACT PERSON: C�-�-�s2� NiOBILE/PAGER: ��(�>7 •� ��5�-� �
NIAILING ADDRESS: ��5�� �5F i�,r.^-��-�(`�c.�_CITY: C`��'�=>�i� ZIP: c��� -
STATE LICENSE: # �-�� 3`3
ARCHITECTlENG1vEER: P����
I�IAILTi�TG ADDRESS: CITY: ZIP:
N��,�: REGISTRATIO�'#
TYPE OF `VORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: "�`��-�-��.a' � ���� F'�`����
t���>G-'-�L`r�. `� C..��'�'�f�C��
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIl�IA1�D CONSTRUCTION VALUATION (excluding lancn: $ �--��� ;
I hereby apply for a buildin�permit and I acknowled�e that the information above is complete and
accurate; chat the work will be in conformance with the ordinances and codes of the City and with
� the State BuildinJ Code; tha[I understand this is not a permit and work is not to start without a
pemut; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: �� ��
ry D?,TE: C� ` `� .- ���
1�'pTE! Parade Qf Homes events require separate permii approval by Poliee Department and
Ciiy Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.0�L RIGFiTS OF SL'BJECTS OF DATa
Subd. 1. Type of d3ta. The righcs oi iadividual on wham che datt is s'•ord or oo t�e sco�ed shail be as sec forth ia chis secaoa.
Subd.2. IaPormaaon reqirired to be Eivm tadividual. .1n individual uY:d to supp[y private ar coafideadal dam couceraing hi�celf shall
be iaformed of: (a)che purpose and inr:aded use of�he requesmd daa wichia che cotlecdng 3zsm ageacy,polidcal subdivision,or sratewide rystem:
�b)whe:her he may refisse or is legsIIy eequicsd m suppty ehe requesced dara:(e)aaY Imo"�n c°asequeace arisiag from his supplying or refusing to supply
privare or conr.denual dara:and(d)�he idendry of actrer peaoas or enddes auehariz�Sy scam or federai law to receive rhe dacs. This requiremenc shall
not app[y when an individual is u3:ed to supply incarigadve dara,pursuanc ro secdon 13.82,subdivision S,to a taw enfocceaeac officer.
The commissioner of re�enu riav ols' [he nodc rauired under this subdivision in the irtdividual income_ex or pcooertv mz refur.d
instrucdons inscead of on chose farms.
Subd.3. ?�ccess to data br•individuaI. lipon requeu�e a rzsponsible auchoriry,aa individual shall be informed whecher he u the subjecc
of stocod data on individuals,and whecher it is classified as public,privace or can::deadal• L,'Fon his funher�zquest,aa individual who is the subjecc
of stored privace or public daa on indir•iduals shalt be stiowa the data withouc aay ciuge m him and:if he desires,shall be iniormed of ehe concenc
ar.d meuung of dtat daca. Aher an individua!hu been shown che priva[e dae and iaiorsned oc iu meaaing,the dara need noc be disclosed oo him for
su mondu che�sahec unless a d'upute or acdon pucsuanc rn ehis secrion is pending o�addidoa�l daca on the individual has been collecred or creared.
The responsiblt au[horiry shall provide copies af�he privace or public daea upon mquesc by che iadividual subjecc of ehe dam. Tne respansible auchoriry
m�y cequire rhe«quesring person to pay the acnial cosa of mafcing,cetdfying.u:d compiling the copies.
The responsible auchoriry shall comply iav::ediately,if possible,wi�h aay;equesc s�de pursuanc to this subdivision,or wiehin five days oi
the da`of che r.ques4 excluding Saturdays,Sundays and legal holidays,if immed'uc�campli�ce is noc possible. If he caanot comply wieh the reques�
wichin thac dtne,he shail so irtform ehe individuai,and may have an addidonai five days wichia which to comply wic'�che request,exc(uding Saturdays.
Sundays and legsl holidays.
Subd.4. Proeedure w�en data is not accurate or comptete. An individual may contest the accurscy or compleceaess of public or pri�•a[e '
dara cor.cerning himself. To exerise c'�is righc,an individuai shall nodfy in wridn;�::respaesble auchoary describing che nam:e of the disagieemenc. ..
The tesponsibte aucttoriry shall wichin 30 days eir.`er. (a)corrncc che data found to te inac:c:r3G or incompte�e and aaempt to nodfy past recipienc�af
inaccurace oc incomplete dars, inciuding cecipiena named by che individual:or(6)eoufy d:e individual thac he believes[he data to be correcc. Dan
in dispuce shall be disc!osed only if the individual's stacemenc of disagreemenc is�:luded wic.�rhe d'uclosed dara.
'ilie decerminadon of ehe responsible auchoriry may be appealed pursu3.c to the provisions of the administrarive procedure act reladag to
contesc:d cases.
DATA PRIVACY AD`'ISORY
In accordaace wi[h M.S. 13.04, Subd.2, "Righa of subjeccs oi data", w•e would like co inform you that your request
for a permit or license from the Ciry of Orono or any of ics depz�men[s may require you to furnish certain private or
confidencial inforraation.
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 daca, buc refusal may require that the Ciry deny the perm.it or license.
;. The information may be shared wich ocher local, scat�or federal a�encies co the extent necessar}r to process
the permit or license.
:�. If your requested permit or licease requires Couacil action co approve, some information may become
public.
5. You have cenain riQh[s uader i�1.S. 13.04 (availabl� upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
Firsc �tiddle �t
Addr:ss •
�iry Sa` Zip Pkone
I understand my ri;hcs as staced above. .
Signantre