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Home My WebLink About2001-P04225 - re-roof PERMIT CITY OF ORONO Permit ►vumber: 2750 Kelley �arkway - PO Box 66 No422s Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: g�23i2oot SITE ADDRESS: 105 Chevy Chase Dr Wayzata,MI�I 55391 P I D: 3 6-118-2 3-41-000 8 DESCRIPTION: UBC Occupancy R3 Proposed Use: Residential Buildin Census Code O/S-Building Permit Class: g Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 5,000.00 State Surcharge Fee: $ 2.50 TOTAL FEE: $ 113.75 APPLICANT: Grussin Roofing, Inc. OWNER: Mr. &Mrs. Lathrop 4305 Shady Oak Rd 105 Chevy Chase Dr Hopkins, MN 55343 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-� ( t �`7'�'��'-o'' . �� APPLICANT PERMITEE SIG ATURE ISSUEDBY SIGNATURE Cooies: 1-File(SiQnitures Required). 1-Anr�licant, 1-Monthlv Reports,1-Assessine. 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) -------------------------------------------------------------------------------��----�_�------------------------- THE APPLICANT IS: (circle one) OWNER O �CONTRACT JOB SITE ADDRESS: %� 5 (j,l� �L1�a �'��1 L't sE� L`��-- ZIP: NAME OF OWNER: (�- � c� �--U�6)i��'; C� PHONE: (home) W 13 --`��9,6 (work) MAII.INGADDRESS: ��'�, 5��' ��v�� r,��=��.�ITY: ��'��.:�� ,� ZIP: :5�=�� `�� , _ - � CONTRACTOR: C•r �'CG S S� '/U G'�� . �� PHONE: �l��t � �>�� 'f''� -`' CONTACTPERSON: ,�C>t' MOBILE/PAGER: MAILING ADDRESS: �� r� S� `��x.��L�r)� /�-`rl CI'TY: /�-��i ZIP: -5��"� ��`l� STATE LICENSE: # C�•�, � -�. �- ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detain: � � � — (�% � ' - I L- c:- �.L:c -f'� �" _ � . STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION(excluding land): $ •'?� �:'rl f C��,f` I hereby apply for a building permit and I acl�owledge 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 pernut; and that the work will be in accordance with the approved plan. , '� APPLICANT'S SIGNATURE: � ' L�(,.�' �.��y DATE: �� G �' � ;I 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. � � Sea13.04 RIGHTS OF SLIB.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 forth in this secrion. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial dara concerning himself shall be informed of: (a)the purpose and inteaded use of the cequesud dara within the collecting"state agency,poliucal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply�he requested data;(c)any�own coasequence arising from his supplying or refusing to supply private or confidentiai data;and(d)the idenriry of other persoas or enrides authorized by state or federal law to receive�e data. Tfvs requiremeat s6all not apply when an individual is asked to supply invesdgadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income rax or propem rax refund insttucdons inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is class�ed as public,private or confidendal. Upon his further request,an individual who is the subjecc of stored private or public dara on individuals shall be shown the dara without any charge to him and,�if he desires,shall be informed of the content and meaning of that data. Afrer an individual has been shown the private data and informed of iu meaning,the dara need not be disclosed to him for six monrhs thereafter unless a dispute or acaon pursuant to this secrion is pending or addidonal dan 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 data. The responsible authoriry may require the requesang person to pay the acmal cosu of making, certifying,and compiling the copies. The responsib(e authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the da[e of the request,excluding Saturdays,Sundays 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 addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise this right,an individual shall nodfy in wriang the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the individual thac 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 authoriry may be appealed pursuant to the provisions of the administradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Righu 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 detemune your qualification for the permit 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 eztent necessary to process the permit or license. 4. If your requested perm.it 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 . Ciry Srate Zip Phone I understand my rights as stated above. �� "// /'��-�� ` �L�-2 C�1`.', LJ Signaturo