HomeMy WebLinkAbout2008-00412 - roofing ' CITY OF ORONO PERMIT NO.: 2008-00412
�� 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISSUEn: 1 U24/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 123 CHEVY CHASE DR
PIN : 36-118-23-41-0017
LEGAL DESC : HILL O'WAY MANOR
: LOT 012 BLOCK 001
PERMIT TYPE : MINOR ALTERATIONS
PROPERTY TYPE : RESIDENT[A[,
CONSTRUCTION TYPE : ROOFING-ASPHALT
VALUATION : $ 20,000.00
NOTG: TEAR OFF&REROOF �� � G� ���O�
V
APPLICANT PERM[T FEE SCHEDULE 339.25
WESTURN CEDAR SUPPLY, INC. STATE SURCHARGE(VALUATION) 10.00
9700 13TH AVENUE N.
PLYMOUTH,MN 55441- TOTAL 349.25
(763)541-0304
Minnesota State License#: 20155566
OWNER
STRAUMAN, ROGER&CHRIS
123 CHEVY CHASE DR
WAYZATA, MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is no[
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspec[ions are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
� 1� /-������2y'-08' , ,
Applicant Permitee Signature � Date Issued By Si ture Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBE ABOVE.
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)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: /02 3 C�/�'v� y C�/�.5� �zir: SS.39'/
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ YeS ❑ �10 Ifyes, a special event permii is required with Police Department and City Council approval
60 days p��io�•to the event. Shuttle bus service will be required unless applicant demonstrates
sufficient on-site parking is available. Non permitted events will not be allowed.
NAME OF OWNER: �Q��/1 � S7.e.91J/►��'� �J PAONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: !�t/�' �v/'il CCD�� r r/ / /"rJ�PHONE: '6�-Sy�o,�vy
CONTACT PERSON: _�j�,�� M ILE/PAGER:
MAILING ADDRESS: 9j00 /,��� f9`£ ^/ CITY: ov�l�ZIP: ,�-yy/
STATELICENSE: #� oiSSS6G EXPIRATIO ATE:03-3/- 09
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure
Move Home Remodel/Alteration (ie: Siding, Windows)
Any earth movement may require MCWD review and permits!
PROPOSED WORK(describe in detai�: T�'4 y �i�� ,��'y�/�'
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
ESTIMATED CONSTRUCTION VALUATION(excluding land): $ o� � O '� O �—
I hereby apply for a building permit and I acknowledge that the infonnation above is complete and accurate;
that the work will be in confonnance 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: ��v�- l� �j���ATE: //2`j'�-o�
31
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Sec13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom thc data 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 orconfidential dataconceming himselfshall be
informed of. (a)the purpose and intended use of the requested data within the col lecting state agency,pol itical subdivision,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 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or oroperty tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,and whether it is dassified as public,private or confidentiaL 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 charge to him and,if he desires,shall be informed ofthe content and
meaning of that data. Afrer 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 pending or additional data on the individual has been collected or created. The
responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe data. The responsible authority
may require the requesting person to pay the actual costs 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 request,exduding Saturdays,Sundays and legal holidays,if immediate compl iance is not possible. Ifhe cannot comply with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describingthe nature ofthe disagreement. The
responsible authority shall within 30 days either (a)correct the data found to be inaccurate or incomplete and attempt to no[ify past recipients of
inaccurate or incomplete data,including recipienu named by the individ�al;or(b)notify the individual that he believes the datato be correct. Data in
dispute shall be disclosed only if the individual's statement of disagreemen[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 PRIVACY ADVISORY
In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we wouid 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:
l. 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 extent 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
City State 'Lip Phane
I understand my rights as stated above.
� � ��
ignature
Reset Form 32
,e a � r.
DATA PRIVACY ADVISORY
In accordance with M.S . 15. 165, "Rights of subj�cts 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 inform-
ation.
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 extent necessary to process
the permit or license.
4 . If your requested permit or license req�ires Council
action to approve, some information may becom� public.
5 . You have certian rights under M.S . 15 . 165 to review
private data on yourself.
6 . Your fulJ. name, and date of birth are required to process
this application or permit.
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I un erstand my rights as stated above.
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