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Home My WebLink About2005-P08611 - re-roof � � � PERMIT CITY OF ORONO Permit ►vumber: 2750 Kelley Parkway - PO Box 66 Pos6i i Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: a�isi2oos SITE ADDRESS: 3473 Crystal Pl Wayzata,MN 55391 P I D: 17-117-23-43-0009 DESCRIPTION: Proposed Use: Residential Pernut Class: Building Census Code O/S-Building Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: ��D"lca-e d �� FEE SUMMARY: Permit Fee: $ 83.25 Valuation: $ 3,000.00 State Surcharge Fee: $ 2.00 TOTAL FEE: $ 85.25 APPLICANT: Owner/Self OWNER: Melissa Hemsworth MN 3473 Crystal Pl 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. y ��( ��J�;��_ i J�'7 ( ��n. APPLICANT PE I E S[G URE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-AssessinQ, 1-Finance Page 1 � . . 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 inforf�zation) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE anDUESS: � I�7� C y �-��tr��' 1-�l . ZIP: SS.-�`�I I Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �NO Ifyes, a special event permit is required with Police Department and City Couttcil approval 60 days prior to the event. Shzrttle bus se�-vice will be required unless applicant demonstrates sufficient on-site parking is available. Non perr��itled events will not be allowed. NAME OF OWNER: �1\� � �SS�,� � ��1 l ��,ti�r�1'l PHONE: (home)`-j��,-- ��'0 I�U I (work) MAILINGADDRESS: ��1�3 � �l�►,�"CZt (� ��I .CITY: (1t ��y1v ZIP: ^�- =�� CONTRACTOR: ;��C -\--1 � - PHONE: ��5� ��— (��-( g CONTACT PERSON: 1�1�Ic- �� j�%r��6��;:"l��-� OBIL�IPAGER: (r;�a� ��S�1_-��t�� MAILING ADDRESS:��(��-► C t�:uC� C �( . CITY: ( �-X„y��x,��1��ZIP: �1��_� STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home Remodel/Alteration X PROPOSED WORK(describe in detai�: I 1C��; ( LC%F '�Dt�l�L�, ��C'��C�� STORIES: 'i � -� SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: � GARAGE STALLS: ATTACHED DETACHED� ESTIMATED CONSTRUCTION VALUATION(excluding land): $ T(1(�U I hereby apply for a building pe�nit 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: ,?� � a �/ � ' DATE: �+ - �� - �`�� 31 . . � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of daca. The rights of individual on whom the 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 or confidential 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 private or confidential data;and(d)the identity of other persons or entities authorizcd 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 mayplace the notice required under this subdivision in the individual income tax or nronertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible audtority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as pubfic,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown[he data without any 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 informcd 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 addi[ional data on the individual has been collected or created. The responsible authority shalf 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,ceRifying,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 [he date of the request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he 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 Sacurdays, 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement.The responsible authority shall within 30 days either: (a)conect 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 correct. Data in dispu[e shall be disclosed only if the individual's statement o£disagreement is included with the disclosed data. The determination of the responsible attthority may be appealed pursuant to the provisions of the administrative procedttre act relating to contested cases. DATA PRIVACY ADVISORY 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 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 Zip Phone I understand my rights as stated above. ,; s n ��' `,�--��-yr l /�^ � — (,,> Signature 32