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Home My WebLink About2007-P11726 - re-roof PERMIT CITY OF ORONO 2750 Kelley Par'kway- PO Box 66 Permit Number: P11726 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249=4800 Date Issued: 11/30/2007 SITE ADDRESS: 3865 Shoreline Dr Unit# Wayzata,MN 55391 PID: 20-117-23-22-0007 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 83.25 valuation: $ 3,000.00 State Surcharge Fee: $ 1.50 TOTAL FEE: $ $4.75 APPLICANT: Owner/Self OWNER: Paul Larson MN 3877 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. / � � P CAN E TEE SIGNATURE ISSUED B SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 � � : Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO-BUII.DING PERNIIT APPLICATION All information must be submitted in full before ptan review will be started. (please print all information) _ THE APPLICANT IS: (circle one) OWNER R CONTRACTOR JOB SITE ADDRESS: ��'��.5 C�/l,/,� ��,�'z�: �5.�9'/ Will this 6e a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑YCs ❑NO If yes,a specia!event permit is required with Police Depcmment a»d City Courtcel approvat 60 days prior to the evem. Shuttle bus service wi11 be required unless applicant deraorrstrates su�ciem on-site parki�is available. Non-permiued everits will not be alloweci NAME 4F OWNER: ��l/� L/`7�//��0,/I� PHONE: (home) 9.5�-y7l q/�Z (work) 9SZ-Gl7/-ZZ/c� MAILING ADDRESS:3�6-s S'.f�.��/� /1ie CITY: �?��ZIP: Ss"3�'/ CONTRACTOR: � /� PHONE• CONTACT PERSON: — MOBILE/PAGER: •^- MAILING ADDRESS. �- CITY. ZIp. STATE LICENSE: # --- EXPIRATION DATE: -- ARCHITECT/ENGINEER: `— PHONE: '� MAILING ADDRESS• — CiTY• ZIP: — NAME• --- REGISTRATION: # -- �� o� TYPE OF WORK: New Home �� dition Accessory Struc#ure Move Home RemodeVAlteration(ie:Siding,Windows) Any earth movement may require MCWD review and permits! PROPOSED WOItK(describe in detai�. �L/�G4G� �'A�F STORIES: ` �� SQ.FEET OF EACH FLOOR: � 6 � NO.OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED � ESTIMATED CONSTRUCTION VALUATION(ezclnding land); $ �� Q�0�- 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: DATE: �/-30"�� 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The righu of individual on whom the data is stored or to be stored shalt be as set forth in ffiis section. Subd.2. Infom�ation required to be given individual.An individual asked to su�ty private or confidential data conceming himself shall be infomied of: (a)the purpose and intended use of the requested data within the collecting state agency,potitical subdivision,or statewicie system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or wnfidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall not apply when an individual is asked to supply investigative data,pwsuant to section 13.82,subdivision 5,to a law enforcement offtcer. The commissioner of revenue mav olace the notice required under this subdivision in the individual income taac or pronerN tar refiu�d instructions instead of on those fortns. Subd.3. Aa;ess to data by individual.Upon request to a responsible aut}writy,an individual shall be infortned whether he is the subject of stored data on i�dividuals,and whether it is classified as public,private or contidential. 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 chazge to him and,if he desires,shall be informed of the content and meaning of t6at data. After an individual 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 dispuce or action purs�mnt to this 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 iadividual subject of the data. The responsible authority may require the requesting person to pay the actual wsts of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the requesy excluding Saturdays,Stu�days and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within that time,he shall so inform the individual,and may have an additiona(five days within which to compty with the requesf,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or eomplete.M individual may contest the accurnc,y or wmpleteness of public or private data conceming himself.To exercise this right,an individual shall�wtify in writing the responsible authority describing the nature ofthe disagreetnet�t.The responsible aathority shall within 30 days either: (a)corcect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomple[e data,including recipients named by the individual;or(b)notify the individual that he believes the 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 determination of the responsible authority may be appea(ed pu�uant to the provisions of the administrative 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 I ike to inform you that your request for a permit or license from the City of Orono or any of its depardnents may require you to furnish certain private or confidential information. You aze notified that: 1. The information you fumish will be used to determine your qualification for the permit or ticense 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 e�ctent necessary to process the permit or license. 4. If your requested permit ar 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 ful!name is required to process this application or permit. �� ;�� F��t nuaa�e �st 3�'G-S 5��'.��1��,� �/�' Address ��.��/� ./�/'� -�.5.3�� z r�'7�- ZZ�j. v City State Zip Phone 1 nnderstand my rights as sta above. �/' Signatnrc `� �� Reset Porcn : . , 32