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Home My WebLink About2004-P07246 - reroof ITY F RONO PERMIT C O O 2750 K�I�y=.:.'�rkway - PO Box 66 Permit Number: Po�246 Crystal Bay, Minnesota 55323 Pe►'mit Type: Minor Alterations (952) 249-4600 Date Issued: 2i2oi2oo4 SITE ADDRESS: 2293 Shadywood Rd WAYZATA,NIN 55391 PID: 17-117-23-43-0004 DESCRIPTION: Proposed Use: Residential Permit Class: Building Census Code O/S -Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 9�.25 Valuation: $ 3,150.00 State Surcharge Fee: $ 2.10 TOTAL FEE: $ 99.35 APPLICANT: John Haley#1 Roofer OWNER: x w&s a uoDEwaI,D 6305 Cambridge St.#201 2293 SHADYWOOD RD St.Louis Park,MN 55426 WAYZATA MN 55391 Tf�UNDERSIGNID IIIItF..BY REQUESI'S 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 REQUIRF.MFNTS. 7 i� '-�,� l � 2� � _ , _-��i�-�--�. ;�' /�7�,�� C � �'� G2�� APPLICANTPERMITEESIGNATURE [ UEDBYSIGNATURE Conies: 1-File(SiQnitures Reauiredl, 1-Aovlicant, 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1 Total Fee: $ Date Received: ��J �7`� ��' Enfere��3y: Permit#: ;?;��;L� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan revie�� v�ill be started. (please print all infornsation) THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: ��a�3 ��Eo�yWo�s� �`C� � ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. 11'on permitted events will not be allowed. NAME OF OWNER: K�.��. �l�-��c� PHOI�"E: (home) `�5� - �71- 7(�-fa (7 (work) MAILING ADDRESS: aaR� �`�-�� CITY: � ZIP: SS3`�l CONTRACTOR: �S�-�n� �t�� t (ro��-� � PHO\�: �5 a � `��.�- �l��-� CONTACT PERSON: Cc;w,., (,��S.o �e� 1�IOBILE/PAGER: �I o�-��(�- 3l t 5 MAILING ADDRESS: ��a( �a��.;,, �t, CITY: St .(.��-> � Qr-l1� ZIP: 55�'+(� STATE LICENSE: # �� - ARCHITECT/ENGINEER: PH01`'E: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATIO�i # TYPE OF WORK: New Accessory Structure Addition 1�Iove RemodeVAlteration Land Alteration PROPOSED WORK(describe in detai�: t�a�- a�-� `ti ��-�{ �� c��-c{ STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GAR.AGE STALLS: ATT. DET. �� . ESTIMATED CONSTRUCTION VALUATION (excluding land): $_ .j � � 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 pernut; and that the«-ork will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: �-a�� '-�� Sec.13.04 RIGHTS OF SUBJECTS OF DATA , , �� Subd.1. Type of data. The rights ot individual on whom the data ls stored or to be stored shall be as set forth In this sect(on. Subd 2. Information required to 6e given individusl. An individual asked to supply private or conedential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he ma}refuse or is legally required to supply the requested data;(c)any known consequence arlsing from his supplying or refusing to supply private or conf dential data;and(d)the identlty of other persons or entities authorized 6y state or federal law to receive the data.This requirement shall not apply when an individual is asked to supply Investigative data,pursuant to section 13.82,subdivision 5,to a Isw enforcement otticer. The commissioner of revenue mav ulace the notice reauired under this subdlvision in the individual income tax or oronertv tax refund instructions instead of on those forms. Sub�3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classifled as public,private or confidential. Upon 6is further request,ao lndividual who ls the subject of stored private or public data on individuals shall be shown the data without any charge to hlm and,if he desires,shall be informed of the content and meaning of t6at data. After an individual has been shown the private data and lnformed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject otthe data.The responsible authority may require the reqaesting person to pay the actusl costs of making,certifying,and compiling the copies. T6e responsible authority shall comply Immediately,if posslble,with any request made pursuant to this subdivision,orwithin five days ofthe date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compllance is not possible.If he cannot comply with the request within t6at time,he shall so inform t6e lndividual,and may have an addltional five days wlthin which to comply 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 completeness of public or private data concerning himself. To exercise thls right,an individual shall aodty io writing the responsible suthority describing the nature of the disagreement The responsible aut6ority shall wit6ln 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurste or incomplete data,including recipients named by the individual;or(b)noti[y the individual that he belleves the data to be correct. Data in dlspute shall be disclosed only if the individual's ststement of dlsagreement Is included wlth the disclosed data. T6e determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure aM 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 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 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 eztent 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. �scc�.� �. W�o�D�� First Middle Last �3 a� �'se.�..,�ov-ao�-� 5� � Address 5�-.�-,�� Y�k. �s�-« 6 ca�aa��3cc5 City State Zip Phone I understand my rights as stated above. � � Signatur _