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Home My WebLink About2003-P07019 - re-roof CITY OF ORONO PERMIT 2750 Kelley Parkway - PO Box 66 Permit Number: Po�oi9 Crys+�l Bay, Minnesota 55323 Permit Type: Minor Alterations (952)�49-4600 Date Issued: 11i19i2oo3 SITE ADDRESS: 1980 Spates A�e Wayzata,MN 55391 PID: 10-117-23-42-0021 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Pernut Class: Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 139.25 Valuation: $ 6,500.00 State Surcharge Fee: $ 3.75 TOTAL FEE: $ 143.00 APPLICANT: �'ear Round Roofing Inc. OWNER: Mr. &Mrs. Crear 1507 Pulaski Rd 1980 Spates Ave Buffalo,MN 55313 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. .-, ',:f', �� / �9 , /��'/ �cL �f ��_ ��',eti C-�� A PLICANT PERMITEE IGNAT G I SUED Y SI ATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 Total Fee: $ Date Received: Entered By: Permit#: � 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 JOB SITE ADDRESS: 1�SO s�q�CS �v� - ZIP: Will this be a P ra e 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 approva160 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: PHONE: (home) (work) MAILING ADDRESS: /9�'� �p�r�".� C�v�, CITY: �v�wa ZIP: CONTRACTOR: �� ,�oli�a� ��e✓s PHONE: ��3-�Z7-Q��Z CONTACT PERSON: � MOBILE/PAGER: �i z -2 zi - 96 08 MAILING ADDRESS: /Sa � v�c�,�� ,� CITY: �✓��r/s ZIP: SS'.3/3 STATE LICENSE: # �0 3 SZ�SS ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration Land Alteration PROPOSED WORK(describe in detai�: q��/ —�� 9L d� �6 P� STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $_ �.SO�� `� 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 will be in accordance with the approved plan. APPLICANT'S SIGNATURE: iG��v� . i�/K � DATE: �� l� �..� Sec.13.04 RIGHTS OF SUBJECTS OF DATA � Subd.1. Type of data. T6e rights of Individual on whom the data is stored or to be stored shall be as set torth in this seMion. _ � Subd.2. Information requtred to be given individual. An lodividual asked to supply prlvste or conRdential data concerning himsel[s6a11 be informed of: (a)t6e purpose and intended use ot the requested data within the collecting state agency,politicsl subdivislon,or statewide system;(b) whether he may retuse or is legally required to supply t6e requested data;(c)any known rnnsequence arising from 6is supplying or refusing to supply prlvate or confidential data;and(d)the identity of other persons or endties authorized by state or tederal law to receive the data.T6is requirement shall not apply when sn indlvidual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. T_he rnmmissioner ot revenue mav olace the notice reauired under this subdivision in the individual income tax or orooertv taa refund instructions lnstead of on those forms. Subd.3. Access to data by indlvidual. Upon request to a responsible authority,an indlvidual shall be informed whether he is the subject of stored data on individusls,and whether it is classltied as public,private or contldentiai. Upon 6(s further request,an Individusl who is the subJect of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of t6e trontent and meaning o[that data. After an Individual has been shown the private data and informed of its meaning,the dats need not be disclosed to 6im for six months t6ereafter unless a dispute or action pursuant to thls 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 of t6e data.The responsible sut6orlty may requlre t6e requesting person to pay the actual costs of making,certifytng,and rnmpiling the copies. T6e responsible suthority shall comply immediately,ii possible,with any request made pursuant to this subdivision,or withln tive days of the date of the request,excluding Saturdays,Sundays and legal holidays,if Immediate compliance is not possible.It he cannot comply with the request within that time,he shall so inform the Individual,and may have an additional tive days within w6ich to comply wlth the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure w6en data is not accurate or complete. An individual may contest t6e accuracy or completeness of public or private data cronceraing himself. To exerclse this rlght,an indlvidual shall ootlfy in writing the respoosible aut6ority describing the nature of the dlsagreement The responsibie authority shall within 30 days either: (a)correct the data tound to be inaccurate or incomplete and attempt to notify past recipients ot inaccurate or Inrnmplete data,including recipients named by t6e indlvidual;or(b)notify the individual that he believes the data to be correct. Data in dlspute shall be disclosed only if the individual's statement of dlsagreement is included wit6 the dlsclosed data. T6e determination of the responsible authority may be appealed pursuant to the provisions ot the administrative procedure act relating to rnntested csses. 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. First Middle Last Address C�tY State Zip Phone I understand ts as stated above. � � Signatu % �