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Home My WebLink About2003-P06478 - re-roof i . ITY F PERMIT C O O RO�� Permit Number: 2750 Kelley Parkway- P� Box 66 Po6a�a Crystal Ba;,,Minnesota 55323 Permit Type: MinorAiterano� (952) �49-4600 Date Issu�d: 6/30/2003 ; SITE ADDRES`S: 21�50 Shevlin Dr Wayzata,��Mi 55391 PID: 03-117-23-34-0020 � DESCRIPTION: Proposed Use: Residenrial Permit Class: Building Census Code O/S-Building Pernut Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: i _ NOTICES/REMARKS: _ , FEE SUMMARY: Permit�ee: $ 195.25 Valuation• $ 10,995.00 State Surcharge Fee: $ 6.00 TOTAL FEE: $ 201.25 APPLICANT: Westurn Roofmg OWNER: J&U I POTTINGA 9700 13th Ave 2150 SHEVLIN DR Plymouth,MN 55441 WAYZATA MN 55391 THE UNDERSIGNED HEREBY REQUESTS PIItMISSION 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 RBQUIRFMENTS. � � c�� APPL ANT PERMITEE SIGNA RE IS D BY SIGNATURE Couies: 1-File(SiQnitures Required),1-Aunlicant 1-Monthlv Renorts, 1-AssessinQ, 1-Finance Page 1 Total Fee: $ Date Received: Entered By: Permit#: , CITY'OF ORONO - BiTII�DING PERNIIT APPLICATIOleT f� All inforn�ation must be submitted in full before plan review will be started. i (please print all information) ------------------- - THE APPLICANT IS: (circle one) OWNER CONTRACTOR JOB S ITE ADDRESS: o�J�� 11�'1 �i"i'�/� ZIP: �� l NAME OF OWNER:... ��.'�s e- �c�'f`+'1!'�'�_ PHONE: (home) �a �o�l�- l��T (work) 9 � �1-�`!� MAILING ADDRFSS: �}w1�- CITY: G✓�. zti. ZIP:S��/ CONTRACTOR. ��n PHONE: 7��^ Sy/^�30� CONTACT PE1t30N: Cl/�c MOBILE/PAGER: (�v l2�a`�'ya-SS M A I L IN G A D D R E S S: �4 ! �`� C�: ` ! ZIP: ,SSS/� STATE LICENSE: # � ARCHITECT/ENfGINEER: PAO�� MAILING ADDI�.ESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WOR�: New Addition Accessory Structure Mo�ve � Remodel/Alteratian Land Alteration PROPOSED WOKtK(describe in detai�: `�� /`�'�'��r STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. Q� ESTIMATED C4NSTRUCTION VALUATION (excluding land): $ �Ot ��s 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 pernut; and that the work will be in accordance with the approved plan. APPLICANT'S $IGNATURE: DATE: ,� d NOTE! Parad mf Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non pernutted events will not be allowed. Sec.13.04 RIGFI'TS OF S[JBJECTS OF DATA � � Subd. 1. Type of data. 'Ihe rights of individual on whom the data is stored or to be stoced shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the reqaesmd data within the collecting 3tau agency,polirical subdivision,or statewide system; (b)whecher he may refuse ot is legally required to supply the mquesud data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idenaty of o[her persons or enfldes authorized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara,pursvant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the noace rewired under this subdivision in the individual income taz or proaertv taz refund instructions instead of on those forrt►s. Subd.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 class�ed as public,private or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge w him and;if he desires,shall be informed of the content and meaning of[hat data. After an individual has been shown[he private data and informed of its meaning,che data need not be disclosed to him for six months thereafur unless a dispuu or acdon pursuanc w this secaon is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon nquest 6y the individual subject of the data. The responsible authority may requiro the requesang person to pay the actual cosu of making,cectifying,and eompiling the copies. The responsible authoriry 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 possibte. If he cannot comply with the request within that tune,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individuat may conust the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in wricing the responsible authoriry describing rhe naturo of the disagmement The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccunte or incomplete data, including recipients named by the individual;or(b)noafy the individual t6at he believes rhe data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detezminadon of the responsible authority may be appealed pursuant to the provisions of the administraave 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 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 detemune 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 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. Fi�� Middle Last Address Ciry State Zip Phone I understand my rights as stated above. Signacure