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Home My WebLink About2005-P08732 - re-roof PERMIT CITY OF ORONO 2'5C Kelley Parkway- PO Box 66 Permit Number: p08732 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 5/17/2005 SITE ADDRESS: 139 Chevy Chase Drive Wayzata,MN 55391 PID: 36-118-23-41-0025 DESCRIPTION: Proposed Use: Residential Permit Class: Building Census Code O/S-Building Permit Sub-type(s): Building-Re-Roof Permit Type: Minor Alterations DETAILS: Approved perresolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 153.25 Valuation: $ 7,500.00 State Surcharge Fee: $ 3.75 TOTAL FEE: $ 157.00 APPLICANT: W• F. Smith Construction OWNER: Mr. &Mrs.Beltrand 5975 Lynwood Blvd 139 Chevy Chase Dr Mound,MN 55364 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. 1 _.__� �;�// l ��/ -� J APP CANT PF,R EE SIGNATURE ISSUED E3Y SIGNATURE Copies: i-File(SiQnituresRequired), 1-Applicant, 1-MonthlvReports, 1-AssessinQ, 1-Finance Page 1 Total Fee: $ /S� �' �� Date Received: °,3=/Ga -C.�� Entered By: �/U- Permit#: '�"� CITY OF ORONO - BUILDING PERMIT APPLICATION i ti�� A l l in formation must be su bmitte d in fu l l be fore p lan review wi ll be starte d. (please print all i�ifornzation) THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: I �I � ��y ��f�s� �12. ZIP: S S-� S� � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes,a special event permit is required with Police Deparnnent and Ciry Council approval 60 days prior to the event. Shzrttle bus service will be required unless applicant demonstrates su�cient on-site parking is available. Non pennitted events will not be allowed. NAME OF OWNER: � � i f� � p�� l� T�rA � PHONE: (home) (work) MAILINGADDRESS:S 4}u`-� CITY: ZIP: CONTRACTOR: U� • C' S�"� ��'I�� Co 1�S�i PHONE: �1�� n� �S-�� CONTACT PERSON: �i, �� MOBILE/PAGER: (�I a- ' �� - 31 ( � — MAILING ADDRESS: (nS�S So S�L,..,u�� L k` �r CITY:/�;n.,��'�''�S�� ZIP: SS�G L� STATE LICENSE: # S3� 7 EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home Remodel/Alteration� ��-� � �S ` �, PROPOSED WORK(describe in detai�: E/'s�- � � STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(excluding land): $ '�� I 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: �– �� " �� S� 31 Sec.13A4 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in[his section. Subd.2. Information required to be given individual.An individual asked to supply private or confidentia]data concerning himselfshall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political 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 priva[e or confidential data;and(d)the identity of other persons or entities authori2ed by state or federal law to receive the data.This requirement shafi not apply when an individual is asked to suppty investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or�roperty tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individua]shall be informed whether he is the subject of stored data on individuals,.and whether it is classified as public,private or confidential. Upon his further reques[,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge ro him and,if he desires,shall be informed of the content and mea�ing of that data. After an individua]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 au[hority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shail comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.Ifhe cannot comply with[he 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[he accuracy or completeness ofpublic or private data conceming himself.To exercise this right,an individual shall notify in writing the responsible authority descnbing the nature of the disagreement.The responsible authority shall within 30 days either. (a)con�ect the data found to be inaccura[e or incomplete and attempt to notify past recipients ef 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 inctuded with the disdosed data. The determination of the responsible authority may be appealed pursuant to the provisions of[he administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subj ects 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 deparhnents may require you to fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the pemzit 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. �.1, �' S-n-. t d--l� First Middle Last � S � � S� � . ��.�� i�< � ;�' Address j'v� � n��-� �-, s � }�1 r' S s�� / �r s�,�/�a ��s� City State Zip Phone � I un erstand y ri s as s ted above. �� ^� Signature 32