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Home My WebLink About2005-P09512 - re-roof PERMIT CITY OF ORONO ' Permit Number: . 2750 Kelley Parkway- PO Box 66 P09512 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 12/30/2005 SITE ADDRESS: 3505 Crystal Pl Unit# Wayzata, MN 55391 P�� 17-117-23-43-0140 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: After The Fact FEE SUMMARY: Permit Fee: $ 125.25 valuation: $ 6,000.00 State Surcharge Fee: $ 3.00 TOTAL FEE: $ 128.25 APPLICANT: Owner/Self OWNER: Miles Lord MN 3505 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. � � ' !/ '� �/' Cc_,_- (-t��-' �. T�� APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, l-Septic) Page 1 Total Fee: $ � �"�' `�� Date Received: ��/3o�U�� Entered By: _ Permit#: ��-�/ �-- CITY OF OR�NO - BUILDING PERMIT APPLICATI0�1 All information must be submitted in full before plan review will be started. (please�ri�zt all infor�nation) ----------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (cii•cle o�ze) OWNER OR CONTRAC . , � � ,�!�� JOB SITE ADDRESS: �-- �� I�!" ' .� �� _ f � l � s � � �Vill this be �a-P�/�rade of Homes, Remodelers Showcase Home or other Display Home? ❑ I'eS I �(I iv0 If>>es, a special ei�er�t pernzit is�•eqz�ired tivith Police Depnf•trr�ei�t arrd City Cocuvcil npproval T 60 days prror to the event. Shutt(e birs service x�ill be��egi�ired urzless applica��t c�emorasd�ntes sufficient on-site prn�king is available. No�-perrnitted events rvill not be nllowecl. . -,. f ,�Q NAME Ok'OWNER: �� PHONE: (home) ( �v �'�� -' (work) , ' L - _ ��.�� -��-.� � �� . - MAILING ADDItESS:,.� • - CONTRACTOR �� PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP; STAT�LICENSE: # EX�IRAT'IO1V DATE: ARC�-II'I'ECT/ENGINEEIZ: PHONE: MAILTNr ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORI{: Ne�v Hom-c Addition Accessory Structure Move Home Remodel/Alteration (ie: Sidin�, Windows) P12 PQ,SEI)� RK(describe i�i detai : � �- + � �� ` � � - � � � S'I'ORYES: �_ �Q.�'�ET O�Ef1�I�FL,001�: � ��`3 1�10. OF BEDIZ001i�IS:� GAI�AGE S7'ALLS: A'I"'TACI-�EI) I)E'g"�C'�IEI➢_ �ST'I?!'IA'TEfi�C'0�1ST'1�i1C'T'I0�1�'��1�'Y'IOI�i(exc�uclir►g land): � �.!�[= UU, c� I hereby apply for a btiilding permit and I acknowledge that the infoi7nation above is complete and accurate; that the work will be in conformance with the ordinances aud codes of the City and with the State Buildin� Code;that I understand tl�is is not apennit and��orlc is not to start w� hout a pennit;and that the work will be in accordance with the approved plan. APPLIC��'�''S SIGIVA'I�iJRE: _ , �� ,�DA'�'E: � �� 31 � �l 1 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Infoi7nation required to be given individuaL An individual asked to supply pnvate or confidential data conceming himself shall be informed of: (a)the pu�pose 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 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 13.32,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income ta�c or prooertv tax refund insuvctions instead of on those fomis. Subd.3. Access to data by individuaL lipon request to a responsible authority,an individual shall be infomied whetherhe is the subject of stored data on individuals,and�t�hether it is classified as public,ptiva[e 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 ch�rge to him and,if he desires,shall be infomied of the content and meaning of that data. After an individual has been shown the priva[e data and informed of its meaning,the data need not be disclosed to him for six mondts thereafter unless a dispute or action pursuant to this section is pending or additional da[a on the individual has been collected or created. The responsible authority sh111 provide copies of die private or public data upon request by the individual subjec[of the data. The responsible authoiity may require the requesting person to pay the actual costs of making,cer[ifying,and compiling the copies. The responsible aud�oriry shall coiiiply immediately,ifpossible,with any request made pursuant[o this subdivision,orwithin five days of the date of the request,excluding Sahirdays,Sundays and legal holid�ys,if immediate compliance is not possible. If he cannot comply with die request within that time,he shall so infoi�n the individual,and may have an additional five days within which co comply with the request,excluding Sahtrdays, Sundays and tegal holidays. Subd.4. Procedure when datl is not accurate or complzte, 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 authoiiry describing the nature of the disagrzement.The responsible authority sh.ill within 30 days either: (a)con'ect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes the data to be coirect. Data in disoute shall be disclosed only if die individual's st�tement of disagreement is included with the disclosed data. The determination of the responsible auchority may be appealed pursuant to[he provisions of the administrative procedure act reluting to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to infomz you that your request for a pern�it 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 inforniation you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to suppiy data,but refusal may require that the City deny the pennit or license. 3. The inforniation may be shared with other local, state or federa] agencies to the extent necessary to process the pennit or license. 4. If your requested pennit or license requires Couucil action to approve, some infonnation may become public. 5. You have certain rights under M.S. 13.04(available upon request)to revie�v private data on yourself. 6. Your full name is required to process this application or pernlit. First �liddlc Last Address Cit� State 7ip Phone � und�rstand n�y ri� t�as stated ahovc, _ , � � �r i � � � � � Si��nature i?