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Home My WebLink About2005-P08868 - re-roof PERMIT ' �?�' OF ORONO Permit Number: 2 i 0 Kelley Parkway- PO Box 66 Po8868 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 6/21/2005 SITE ADDRESS: 2695 Shadywood Rd Unit# Excelsior,MN 55331 PID: 21-117-23-24-0056 DESCRIPTION: Proposed Use: Residential Census Code O/S-General Permit Class: 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: $ 139.25 valuation: $ 7,000.00 State Surcharge Fee: $ 3.50 TOTAL FEE: $ 142.75 APPLICANT: Allstar Conshuction OWNER: Stephen&Bothaina Paulson 8401 73rd Ave N-Suite 80 2695 Shadywood Rd Minneapolis,MN 55428 Excelsior MN 55331 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. � /� �" ` .�'�� - �� APPLI SIGNATU ISSUED BY SIGNATURE � Copies: 1-File(Signatures Reguired), l-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 ,�1.. '�. .' , Total Fee: $ �� - �S Date Received: �/�"� cS� Entered By: �i Perrrait#: ` CITY OF ORONO - SL'ILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please pririt all i�ifors�lation) ------------------------------------------------------------------------------------------------------------------------ __ �-r- THE APPLICANT IS: (circle o�ie) O`VNER OR CO''�TTRACTOR „ �_------ JOB SITE ADDRESS: � �� Z�: �'�'ill this be a Pa�de of Homes, Remodelers Showcase Home or other Display Hame? ❑ Yes �NO Ifyes, a special event permit is required with Palice Departmeni and City Council apprroval 60 days prior ro the event. Slzarttle bzrs servi.ce u�ill be required unless applicant demorsstrates sz�cient on-site parking is available. Non Permitted events will not be allowed. NAMEOFOWNER: ,��---��!`� �s��i�-.� GJ� P�IONE: (honze) (work) MAILING ADDlE2ESS: ;��(5- `��v4� L�1ti��<� CITY:(;ti��\0 ZIP: CONTRA.CTOR: ��L,`� �- �� Ci� S �' PHONE:�G 5 �LT 5-� j�� CONTACT PERSON: MOBILE/PAGER: MAILIIVG ADDRESS: ; a � 77 � D�t,� /\�x CITY:��1�'�L�ZLP: � STATE LICENSE: # �� 7 EXPIRATION DATE:�/31 /� � _ ARCHITECT/ENGINEER: PHONE: MA�LING AD�I2ESS: CI'i Y: ZI�: N�?�1�: REGIS'I'RATION: # TI'PE OF WOItK: New Addition Accessory Structure Move Home Remodel/Alteration PROPOSE��'OJE2�i(describe in detar.l�: ��i:. ; ��- tir'C v�'t;� �- (-��- ��' � ��'��`_� C- S'�OF.iES: SQ.�'E.��'O��ACH��OOR: IVO. OF �ED1ROOidIS: G�i2.�GE S'T��.,I,S: A'i"TAC�I�� DE'g'AC�IEI� ESTII�IA'TEi) CONS'I'RUCTIOl�VALZIA�'ION(excluding land): $ �, �Z: G I hereby apply for a buildin�permit aad I acknowledQe that the information above is compiete and accurate; that the work�vi11 be in conformance with the ordinances and codes of the City and with the State Building Code; that I understand this is not a pzrmit and work is not to start without a pern�it; and that the work wi11 be in accordance with the approved pian. APPLIC��T'S SIGNATURE:,;' 2 �C/ DATE: � —,��%'�� ( � �1 y� � Sec,13.04 RIGHTS OP SUBJECTS OF DATA Subd. I. Type of data. The righ[s of individual on whom[he data is stored or[o be stored shall be as set fortlt in this se:tion. Subd.2. Information required to be given individual.An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and intended use of the requested data tvithin the collecting state agency,political subdivision,or statewide syscem;(b) whether he may refuse or is 1ega11y required to supply the requested data;(c)any known consequence arising fram his supplying or refusing to supply private or confidential data;and(d)the identiry of ocher persons or entities authorized by state or federal law to receive the data.This requirement shall no:apply when an individual is asked[o suoply investigative data,pursuant to section 13.32,subdivision 5,to a law enforcement officer. The commissioner of revenue mav o11ce the notice required under this subdivision in the individual income ta�or propertv tax refund instructions inscead of on those ferms. Subd.3. Access to data by individual. Upon request to a responsible aucttority,an individuzl shall be informed«�hether he is[he subject of stored data on individual5,.and whether it is classified as public,priva[e or confiden[iat. Upon his further request,an individual who is the suoject o: stored private or public data on individuals shall be shawn the data without any charge to him and,if he desires,shall bz informed of�he content and meaning of that daca. A$er an individua]has been shown the pnvate data and informed of its meaning,the data need not be disclosed[o him for siz months[hereafter unless a dispute or action pursuant to this section is pending or additional data on the individua!has been coltected or created. The responsible auchority shall provide copies of the pnvate or pubGc data upon requcst by the individual subject of the datz. The responsible authority may require the requesting person to pay che acr�al costs of making,certiiying,and compiling the copies. The responsible authority shai]comply immediately,if possible,wich any requesc made pursuant to this subdivision,or wi:hin five days o: the date of the reques[,e�cluding Sa[urdays,Sundays and legal holidays,if immediace cornpliance is not possible. If he cannot comp!y�vith the reques[ within[hat[ime,he shall so iniorm the individuat,and may have an additional five days widiin which to comply with the request,excludin�Sarardays, Sundays and legal holidays. Subd,4. Procedure when data is not accurate or comp!ete. An individual may contest the accuracy orcompte[eness ofpublic orprivate data conceming himsel£ To exercise this right,an individual shall notify in wiiting the responsible authority describing the nature of[he disagreement.The resporsible authority shall within 30 days ei[her. (a)con�ect the data found to be inaccurate or incomplete and attemp[to notify past recipients o` inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual hat he helieves the datz to be correct. Da[a in dispute shall be disclosed onfy if the individual's statement of disagreement is included with che disclosed data. The de[ermination of che responsible zuthority may be appealed pursuant to thz provisions of the administrative procedure act relating to contested cases. DATA PRIVACY'ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subj ects of data",we would like to inforn you that your request for a permit or license from the City of Orono or any oi its departments may require you to furnish certain pnvate or confidential information. You are notified that: 1. The information you furnish will be used to deter:nine your qualification for the pemiit or licea�e requested. 2. You may refuse to supply data,but refusal may require that the City deny the pe:mit or Iicense. ti. The infor.nation may be sha:ed with other local, state or federal agencies to the extent necessary to p:ocess the pernlit or license. 4. If you��equested permit or license requires Council action to approve; some infomlatior_may become public. �. You have certain:ights under M.S. 13.04(available upon request)to:evie��private data on yourself. 6. I'our full name is required to process this application or permit. �, � � �-��-� � � 'First lti[iddle Last n ��U 1 7�� 11l ✓ ��-.�/�.a� /�� Address / ��l�I � � ��,� 2�5-� �/�3�.�� C�ty State Zip Phone i understand my rights as stated above. � /�7 i�nature.� 32