HomeMy WebLinkAbout2001-P04202 - re-roof � '` PERMIT
�ITY OF ORONO Permit Number:
2750 KelleyParkway- PO Box 66 Poa2o2
Crystat Bay, Minnesota 55323 Permit Type: MinorAlterations
(952) 249-4600 Date Issued: ai2oi2ooi
SITE ADDRESS: 1950 Shoreline Dr
WAYZATA,MN 55391
P I D: 10-117-23-42-0012
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Build'mg-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 4,300.00
State Surcharge Fee: $ 2.15
TOTAL FEE: $ 113.40
APPLICANT: Western Cedar Supply OWNER: Maria Cornejo
9700 13th Ave 1950 Shoreline Dr
Plymouth,MN 55441 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEIvIENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUEDBY SIGNATURE
Conies: 1-File(SiQnitures Reauired). 1-Apulicant 1-Monthlv Renorts, 1-Assessin¢, 1-Finance Page 1
,• , ,•
Total Fee: $ Date Received:
Entered By: Permit#:
` CITY OF ORONO - BUII�DING PERMIT 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 OR�ONTRACTOR
JOB SITE ADDRESS: . � 9 So S/'1��/ i/?e �/'� ZIP: ,S,s 3ct L
NAME OF OWNER: j'�p/'r�/�- �Or/)e�J 6 PHONE: (home) �/����Oa��
(work)
MAILING ADDRESS: ��r�� CITY: �chd ZIP: �
CONTRACTOR: (.t1C�c, n Ccool.� f PHONE: �� 3 �"'s�l/'�3a�
CONTACT PERSON: �r�-E– (r- MO II.E/PAGER:
MAII.ING ADDRESS: °l7 oc) ��fi`r9�r iv . CITY:� ZIP: j S< <
STATE LICENSE: # .S . ,6
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
N,�1ViE; REGISTRATION#
TYPE OF WORK• ew Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: %«�'����v�o�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �t ��'�
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 pernut and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICA��1T'S SIGNATURE: >`��� DATE: g`������
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[IB,TECTS OF DaTA —
Subd. 1. Type of data. The righrs of individual on whom[he data is stored or to be scored shall be as set focth ia this secdon.
Subd.2. Information req�red to be given individual. An individual asked to supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and inrended use of the requested data wirhin the collecting Ytate agency,polidcal subdivision,or sratewide rysum:
(b)whether he may refuse oY is legally required to mppiy the requested data;(c)any lmown coauquence arising from his supplying or retusing to supply
privace or confidendal data;and(d)the idenary of orher persons or enuaes auchorized by state or fedecat law to receive the data. This requirement shall
not apply when an individual is asked to supply invesugadve dara,punuant to secdon 13.82, subdivision 5, to a law enforcemenc o�cer.
The commissioner of re��enue mav place the nodce rewired under this subdivision in the individual income tax or proDertv tax refund
instrucaons inscead of on those focros.
Subd.3. Access to data by individual. Upon requesc to a responsible authority,an iadividual shall be informed whether he is the subject
of stored dara on individuals,and whe[her it is classified as public,private or confidenaal. Upon his further request,an individuai wha is the subject
of stored private or public data on individuals shall be shown rhe data wichout any charge to him and,if he desires,shall be informed of the content
and meaning of rhat data. After an individuai has been shown the private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to[his secdon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible authority
may require the roquesring person to pay the actual coscs of making,cerdfying,and compiling the copies.
The responsibte authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,exctuding Satutdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shali so inform the individual,and may have an additional five days within wtuch to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data u not accurate or complete. An individual may conust the accuracy or completeness of public or private
data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct rhe data found to be inaccurate or incomplece and attempt w nodfy past recipienrs of
inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the individual that he believes the dara to be correct. Data
in dispuce shall be disclosed only if the individual's stacement of disagreement is included with the disclosed dara.
The de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the adatinistretive 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 determine your qualification for the per�ut or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut 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.
Fint 1�tiddle Last
Address .
City State Zip Phone
I understand my rights as stated above.
Signacure •