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Home My WebLink About2003-P06953 - re-roof PERMIT CIT'� �F ORONO Permit Number: 275G�Keifey Parkway- PO Box 66 P06953 Crystal Bay, Minnesota 55323 Permit Type: Minoraiceracions (952) 249-4600 Date Issued: ioi29i2oo3 SITE ADDRESS: 744 Brown Rd N L.ong Lake,MN 55356 PID: 34-118-23-12-0005 DESCRIPTION: Proposed Use: Residential Buildin Census Code O/S-Building Pernut Class: g Permit Sub-type(s): Building-Re-Roof Permit Type: Minor Alterations DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 153.25 Valuation: $ 7,455.00 State Surcharge Fee: $ 4.25 TOTAL FEE: $ 157.50 APPLICANT: Westurn Roofing OWNER: T Schultze&M Steil 9700 13th Ave 744 Brown Rd N Plymouth,MN 55441 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. , ,,/. ,%"� -� . �. .: . ` ") �j!'� '�\v,�h_.i� L % ; i : ' f� � �<-t—/ � � / APPLICANT PERMITEE SIGNATURE IS UED BY SIGNATURE Cooies: 1-File(SiQnitures Required), 1-Anolicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 '�"otal Fee: $ Date Received: "Entered By: Permit#: CITY OF ORONO - BUILDL�TG PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) THE APPLICANT IS: (circle one) O�VNER O NTRACTOR JOB SITE ADDRESS: ��y /�ja✓/� �p� tio�� ZIP: S S.�-� Will this be a Parade of Homes, Remodelers Sho�s-case 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 permitted events will not be allowed. NAME OF OWNER: � ScLw/'�'Z� PHONE• (home) ��-�/`7'�--03.� (work) MAILING ADDRESS: `jr�/►�� CITY: ZIP: CONTRACTOR: C-��/'� ��1'X)' PHONE: �3 S�l^�-�Y CONTACT PERSON: ivJ}gy� MOBILE/PAGER: �'�aB�--y�,SS MAILING ADDRESS: -�/ �� l��`��v�CITY: �f�� ZIP: � STATE LICENSE: #_ `�'�� ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition Move RemodeUAlteration Land Alteration PROPOSED WORK(describe in detai�� • ��Cb � STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE ST_-�LLS: ATT. DET. ESTIMATED CONSTRUCTIOI�' VALUATION (excluding land): $ �� ls� I hereby apply far a building pernut and I aclrnowledge thar the information above is complete and accurate;that the work will be in conformance with the ordinances and codes of the City and wzth 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. APPLICANT'S SIGNATURE: DATE: �� a 6� 1 Sec.13.04 RICHTS OF SUBJECTS OF DATA � � Subd.1. Type of data. The rights of individual on whom the datn is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the colleMing state agency,political subdi�ision,or statewide 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 confidential 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,pursuant to section 13.H2,subdivision 5,to a law enforcement ofticer. The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tac or oropertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. lipon request to a responsible authority,an individual shail be informed whether he is the subject of stored data on individuals,and whether it is classifed as public,private or rnnlidentiaL L`pon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without iny charge to him and,if he desires,shall be informed of the content and meaning of that 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 dispute or action pursuant to this section is pendin;or additional data on the iudividual has been rntlected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject o[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�+ithin five days of the date o[the request,exduding Saturdays,Sundays and legal holida}�s,i[immediate compliance is not possible.If he cannot comph with the request within that time,he shall so inform the individual,and may have an additional five da�s within which to comply with the request,excludins Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An indi�idual may contest the accurary or compieteness of public or private data concerning himself. To exercise this right,an individual shall notify in writin;the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to noUfy past recipients of inaccurate or incomplete 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 appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACl":�DVISORY 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 deternune}�our qualification for the permit or license requested. 2. You may refuse to supply data,but refusal ma�-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 appro��e, some informarion may become public. 5. You have certain rights under NI.S. 13.04(available upon request)to re��ew private data on yourself. 6. Your full name is required to process this application or permit. ,:_ , 'Y P /y I,C�' First �l Middle Last Address C�tY State Zip Phone I understand my rights as stated above. � � Signature � '