HomeMy WebLinkAbout2006-P10541 - re-roof � ''�
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p1o541
Crystai Bay, Minnesota 55323 Permit Type:
Minor Alterations
(952) 249-4600 Date Issued: 11/8/2006
SITE ADQRESS: 4745 Creekwood Tr Unit#
Maple Plain,MN 55359
PID: 30-118-23-33-0008
DESCRIPTION:
Proposed Use: Residential
Census Code O/S -Building
Permit Class: Building
Permit Type:
Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 125.25 valuation: $ 5,810.00
State Surcharge Fee: $ 2.95
TOTAL FEE: $ 128.20
APPLICANT: Midwest Roofing OWNER: Steven&Clolleen Yockey
313 Jefferson Hwy 4745 Creekwood Tr
Champlin,MN 55316 Maple Plain,MN 55359
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.
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T ERM[T IGNATURE ISSUED BY SIGiC�ATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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Total Fee: /�6 ' �v Date Receive : ��' g'��
Entered By: Permit#: ����
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please pri�it��Il i�ifor•mation)
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THE APPLICANT IS: (circle o�ze) OWNER OR CONTRACTOR
JOB SITC ADDRESS: �-��j('����j�;�}��( _ ZIP:
Will this be a Parade of Homes, Remodelers Sho�vcase Home or other Display Home?
❑ I�es ❑ NO lf yes, a specral eve��t pernii!rs reqtrired tinitlz Police Depar�tnre��t and Ci1y Coirncil npproral
60 da��s prior Co the evef7t. Shzrtde bzis serl�ice will be reguired unless applicantdemonstrutes
su�cie»t on-site parlcing is availab(e. r��`on-pern�itted evetats i�vrll noi be alloti�ved.
NAME OI'OWN�R: �f�{,� �(�(��(���/ PHONE: (home) ��}7;3Z73�7
(work)
MAILING ADDI2ESS: ��� CITY: CI�C�IUC� ZIP:
CONTRACTOR: �(�l� 151 )��l'Jt-(fi�E� PHONE: `7(�`�{-27�(�1F
CONTACT PERSON: '�J���p� MOBILE/PAGER: `�
MAILINGADDRESS: �(�3; r�r��`�S �l/ CITY: C�(���1/I(�`�tU ZIP: ���/�
STATE I,ICENSE: # �(�,�';{���?�7�7 EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAM�: REGISTRATION: #
TYPE OF WORK: New Home Addition Accessory Structure ___
Move Home RemodeUAltecation (ie: Siding, Windows) �_
Any earth movement may require MCWD review and permits !
���p�SF��I��.K�flescr�l��s�a�letrri�: �-����(_�. _ kC �'C��t- l�f�!( -
STOI2IES: SQ.FEET OF EACH FLOOR:
NO. OF BEDI200MS: GARAGE STALLS: ATTACHEll llETACH�D
ESTIMATEI)CONSTRUCTION VALUATION(excluding land): $ �f�. J�
I hereby apply for a buildinQ permit and I acknowledge that the information above is complete and accurate;
that the�vork will be in conformance with the ordinances and codes of the City and with the State Building
Code;tl�at I understand this is not a permit and work is� ot to tart without a pennit;and that the work wi Il be
in accordance with the approved pl�n. '
APPLICANT'S SIGNATU �� DATE: (�
� ��...
31
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Sec.13.04 RIGF[TS OF SUBJF.CTS OF DATA
Subd. I. Type of data. The rights of individual on�vhom the data is stored or to be stored shall be as set forth in this section.
SuUd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himselfshall be
informed oE (a)the purpose and intended use of the requested data�vithin the collecting state agency,political subdivision,or statewide system;(b)
�vhed�er he may refuse or is legally required to supply d1e requested data;(c)any known consequence arising from his supplying or refusing to supply
priva[e or confidential data;and(d)the identity ofother 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 13.8?,subdivision 5,to a law enforcement officer.
The commissioner of revenue ma�lace the notice reguired under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those fonns.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,ln individual shall be intormed whether he is the subject of
stored data on individuals,and whether it is classitied 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�vithout any charge to him and,if he desires,shall be informed of the content and
meaning of Ihat data. Atter an individull has been shown the private data and infonned of its mcaning,the data need not be disclosed to him for sis
months thereaf[er unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or creared. The
responsible audiority shall provide copies of the private or public data upon request by the individual sul�ject of the data. The responsiblc auchority
may require the requesting person to pay the actual costs of makine,certifying,and compiling the copies.
The responsible authority shail comply immediately,if possible,with any rcquest made pursuant to this subdivision,o�within tive days o(�
the date ofthe request,escluding Saturdays,Sundays and legal holidays,if iinmediate compliance is not possible. Ifhe cannot comply with the request
within that time,he shall so infonn the individual,and may have an additional tn�e days within��hich to comply with the request,e�dudine 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 esercise[his ri�ht,an individual shall notify in wTi[in�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 notify 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 correc[. Data in
dispute shall be disclosed only if the individuul's statemen[of dislgreement is induded with the disclosed data.
The detennination 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 would lihe 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 infonnation.
You are notified that:
1. The information you furnish will be used to determine your qua(ificati�n for the permit nr license
requested.
_. i'OU 1113Y I'c'.iiiSZ iu Sii��iiy�atd,but refusal Cldy CCCUiie tilai iiiC Ciij'Cieny the pern�it O�licerse.
3. The information may be shared with other local, state or federal agencies to the extent necessary to
process the pef-mit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. I'ou 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 pennit.
First lliddlc Last
lddress
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Cih � Statc Zip Phone
I underst�nd mv ights as s te a e. 1
P
aturc
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