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Home My WebLink About2004-P07152 - re-roof f � . CITY OF ORONO PERMIT 2750 Kelley Parkway- PO Box 66 Permit Number: Po�is2 Crystal Bay, Minnesota 55323 Permit Type: Minor A�terarions (952) 249-4600 Date Issued: ii6i2ooa SITE ADDRESS: 3880 Shoreline Dr Wayzata,MI�155391 PID: 17-117-23-33-0151 DESCRIPTION: Proposed Use: Commercial-Business Pernut Class: Building Census Code O/S-Building Pernvt Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 853.75 Valuation• $ 80,000.00 State Surcharge Fee: $ 40.50 TOTAL FEE: $ 894.25 APPLICANT: McPhillips Bros.Roofing Co. OWNER: Hennepin County 2590 Centennial Dr. Attn:Marcia Wilda M/C 608 St.Paul,MN 3880 Shoreline Dr 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 BUILDING CODE REQUIREMENTS. : :' / G�/v -- �i, - APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Covies: 1-File(SiQnitures Reauired), 1-AUulicant, 1-Monthlv Renorts, 1-Assessin¢, 1-Finance Page 1 %! � � �/ Total Fee: $ Date Received: � Entered By: Permit#: r'-�%�?/ S-�--- CITY OF ORONO - BUILDING PERMIT 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 CONTRACTOR -� nr� r� Q �^� � ? � './� . i / L _.�i i�.��If C ��'� . JOB SITE ADDRESS: �� 0 � �� L i�t� ! � ZIP: �� 7 �� Will this be a, Pa o�HHomes, 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. Non pe�mitted events will not be allowed. � � � 1 i� � NAME OF OWNER � PHONE: (home) (work) �•/� -.3�/�'-�3/,� MAILING ADDRESS: �� ,�r� ��5 ',��. "��- CITY: �"Z '�v. ZIP: � CONTRACTOR: '�, �1 � �° ^ r/`iGZ� PHONE: �5 �- l7` -� " �� 2- CONTACT PERSON: .' �...¢ MOBILE/PAGER: - MAILING ADDRESS: ��"<�� C�,�-�.-�--tD 1��'-� CITY: _,.'� :�� ZIP: � ,�/�� STATE LICENSE: # __-----�-- ---- ' �ARCHITECT/ENGINEE . v��-`�-�� PHONE: `�� -'��3� MAILTN�-A�D SS: i� G � � f��'� �r.� CITY: /,-� y�/�� - ZIP: �a�i NAME: ��1� _ ,� ��2 REGISTRATION # � TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration Land Alteration PROPOSED WORK(de,�ribe in detai�: �'` ,� � (�� J � ��_ �t�-�� //j�- � � � ��—�' / , �� - % ; STORIES: SQ. FEET OF EACH FLOOR: /U�� --��,�� NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ,, j S�� f J � ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �� CJu � 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 permit; and that the work w711 be in accordance with the approved plan. '1 ' / j APPLICANT'S SIGNATURE: � �.L-t��--' DATE: / �' 0 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. T6e rights of individusl on w6om t6e data ls stored or to be stored shall be as set forth in this section. Subd.2. Information requlred to be giveo individual. An individual asked to supply prlvate or contidential data concerning hlmself shall be informed ot: (a)the purpose and Intended use of t6e requested data within the rnllecting state agency,political subdivision,or statewide system;(b) whether he may refuse or Is IegaOy required to supply t6e requested data;(c)any known consequence arising trom his supplytng or refusing to supply private or confidentisl data;snd(d)the Identity of other persons or entities authorized by state or federal law to receive the data. This requlrement shall not apply when an individual is asked to supply InvestigaUve data,pursuant to section 13.82,subdivision 5,to a law enforcement of£cer. The rnmmissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or urooertv tsx refund instructions instesd of on those forms. Subd.3. Access to data by individual. Upon request to a responslble suthority,an individual shall be informed whether he is the subjeM of stored data on individuals,and w6et6er it Is classitied as public,private or confidential. Upoo his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without sny c6arge to hIm aad,it 6e desires,shall be intormed of t6e content and meaning ot t6at data. After sn individual has been shown the private data snd Informed of its meaning,t6e data need not be disclosed to 6im for six months thereafter unless a dispute or action pursuaot to this sectlon is pending or additlonal data on t6e individual has been collected or created. The responsible authorlty shall provide copies of t6e private or public data upon request by the individual sub ject of t6e data. T6e responsible aut6ority may require the requesting person to pay the actual costs of maldng,certifying,and rnmpiling the copies. The responsible suthority shall comply immedlately,it posslble,with any request made pursuant to this subdivision,or within five dsys of the date of the request,ezcluding Saturdays,Sundays snd legal holidays,if immediate compliance is eot possible.It he cannot comply with the request within that time,he shall so inform t6e lodividual,and may 6ave an additional tive days wlthln whic6 to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure w6en data is not accurate or complete. An indlvidual may contest the accuracy or completeness of public or prlvate data rnncerning himseif. To exerclse this right,an indlvidual shall nodiy in writing the responsible authority describing the nature of the dlsagreemen� The responsible authority shall within 30 days either: (a)correct the data found W be inaccurate or incomplete snd attempt to notify past recipients o[ lnaccurate or iernmplete data,including reclpients oamed by the lndividual;or(b)ootify the individual t6at he believes the data to be correct. Data in dispute shall be disclosed only It the individual's statement of disagreement is included wit6 the disclosed data. The determination of the responsible suthorlty may be appealed pursuant to the provisions ot the administrative procedure sM 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 egtent 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. First Middle Last Address CotY State ZIp Phone I understa m rights a tat above. � �� z� ��- Signature