HomeMy WebLinkAbout2001-P04367 - re-roof CITY •- F R NO PERMIT
� � � Permit Number:
2750 Kelley Parkway - PO Box 66 P04367
Crystal Bay, Minnesota 55323 Pe�mit Type: Minor Alterations
(952) 249-4600 Date Issued: 9it9i2ooi
SITE ADDRESS: 3585 Crystal Pl
Wayzata,MN 55391
PID: 17-117-23-43-0145
DESCRIPTION: UBC Occupancy R3
Proposed Use: Residential
Buildin Census Code O/S-Building
Permit Class: g
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 167.25 Valuation: $ 8,548.00
State Surcharge Fee: $ 4.30
TOTAL FEE: $ 171.55
APPLICANT; Western Cedar Supply OWNER: Don Bergstedt
9700 13th Ave 3585 Crystal Pl
Plymouth, MN 55441 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-�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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APPLICANT PERMITEE SIGNATURE [SSU BYSIGNATURE
Copies: 1-File(Sienitures Repuired). 1-Anplicant, 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
Total Fee: $ Date Received:
,Enter'ed By: Permit#:
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all inforrrcation)
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THE APPLICANT IS: (circle one) OWNER OR RACTOR>
JOB SITE ADDRESS: �� ` S ��'C,,�,S�r�. � ��� C� �. ZIP: �J S 3 c/
�.
NAME OF OWNER• ��cr� �j' es� S�'�� PHONE• (home) �/�/--- q r��
� (work)
MAILING ADDRESS: �--rv��? CITY: i,::,�x Z� f�, ZIP: S5 3�/
CONTRACTOR: �"1z /t �c���' � � PHONE: ��.3 �'S����'�J C �
CONTACT PERSON: �`���- M BILE/PAGER:
MAILING ADDRESS: ' CITY: f ZIP:SS
STATE LICENSE: # `, C�/ E,
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New� Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: %�"�z''�����/�t'>�-��
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIl�iATED CONSTRUCTION VALUATION (excluding land): $ �,r 5 ��z`� ��
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.
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APPLICANT'S SIGNATURE: �''I�� DATE: `�' �� �/
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF DAT�1 •
Subd. i. Type of data. The rights of individual on whom[he data is stored or co be scored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himSeif shall
be informed of: (a) the purpose and intended use of the requested data within the collecang'state agency, poliacal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required ro supply the requested data;(c)any Imown consequence arising fmm his supplying or refusing to supply
priva[e or confidential data;and(d)the idenriry of other persons or entiaes authorized by s[ate or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investieaave data, pursuant to section 13.82, subdivision 5, to a law enforcement officer.
The commissioner of re�•enue mav plac� che nodce reauired under this subdivision in the individual income tax or propertv tax refund
instructions ins[ead of on those forms.
Subd. 3. Access to data by indi�•idual. Upon request to a responsibte authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject
of srored private or pubtic data on individuals shall be shown the data wi[hout any charge ro 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 informed of ics meaning, che data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secdon is oending or additional data on[he individual has been collected or creaced.
The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the acrual costs of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to[his subdivision, or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request
within that time,he shall so inforrtt the individual,and may have an addiaonal five days within which to comply wi[h the request,exciuding 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 concerning himself. To exercise chis rieht,an individual shali nodfy in wridng the responsible authority describing[he na[ure of the disagreement.
The responsible authoriry shall within 30 days either: (a}correct the data found ro be inaccura[e or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he befieves the data to be correct. Data
in dispute shall be disclosed only if the individuat's statement of disagreement is included with the disclosed data.
Tlie de[ermination of the rosponsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relaang to
contested cases.
DAT�. PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your reauest
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 pemut or license requested.
2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license.
3. The information may be shared with other local, state or federal ajencies to the extent necessary to process
the pemut or license.
4. If your requested pernut or license requires Council action to approve, some information may become
public.
j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
I undecstand my rights as stated above.
Signature