HomeMy WebLinkAbout2006-P10453 - re-roof PERMIT
C� _.-Y OF ORONO
:�750 Kelley Parkway- PO Box 66 Permit Number: p10453
Crystal Bay, Minnesota 55323 Permit Type:
Minor Alterations
(952) 249-4600 Date Issued:
10/13/2006
SITE ADDRESS: 649 Ferndale Rd W Unit#
Wayzata, MN 55391
PID: 02-117-23-44-0003
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: Permit Fee: $ 3��•25 Valuation: $ 24,000.00
State Surcharge Fee: $ 12.00
TOTAL FEE: $ 389.25
APPLICANT: Westurn Cedar Supply,Inc. OWNER: Peter&Ann Robson
DBA: Westurn Roofing Siding 649 Ferndale Rd W
9700 13th Avenue N. Wayzata,MN 55391
Plymouth,MN 55441
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL C[TY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
APPLICANT PERMITEE SIGNA URE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) 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 p�•i�zt all inforjnation)
------------------------------------------------------------------------------------------------------------------------
THE APPLICANT IS: (circle o��e) OWNER OR ONTRACTO
JOB SITE ADDRESS: �p �� �,��✓���{ �a l..� ZIP: SS� /l
Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home?
❑ YeS ❑ 1�0 If yes, n special event permit is reqzrired rvith Polrce Departme��t and City Coirncil approva!
60 dnys pr�ior•to the event. Shz�ttle bus se�vice lvill be r•ega�ir�ed unless applicant demonstrates
scrfficient on-site pnrkrrig is nvailable. rVon-permitted events tivill not be allo�ved.
NAME OF OWNER: /�4�,SO l`� PHONE: (home)9so�- ¢�3- 7s�/
(work)
MAILING ADDRESS: .S�I�7C CITY: O�o�O ZIP: SS 3 7 /
CONTRACTOR: c.,v PHONE: 7�3-5��-030�
CONTACT PERSON: o MOBILE/PAGER:
MAILING ADDRESS: �o G- J3.T� !�v� �✓ CITY: Nt aN j'� ZIP: Ss� �
STATE LICENSE: #j�aaisSJ EXPIRATION DATE: 03�7
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home Remodel/Alteration
PROPOSED WORK(describe i�� detni�:� �G����� G/Cf
��1ii"ORIES: 5Q.�'EE'�{'O�'�ACH�'L,OOR: � .5
NO. OF BEDROOMS: GAI�AGE STALI,S: ATTACHED DETACHED
ESTIIVIATED CONSTRIICTION VAi,�1A'�'ION(excluding land): � <:�`, �, D C; CJ
I hereby apply for a building permit and I ackno�vledge that the information above is complete and acctu•ate;
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 t11at the work�vill be
in accordance with the approved plan.
APPLICANT'S SIGNATURE: DATE: � /
�l
�
Sec.13.04 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 this section.
SuUd.2. Infonnation required to be given individuaL An individual asked to supply private or confidential dataconcerning himselfshali be
informed ofl. (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 kno�vn consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identiry 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 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav place the notice required under this subdivision in the individual income tas or property ta�refund
instructions instead of on those forms.
SuUd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be intiormed whether he is the subject oY
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 widlout 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 p�ivate data and informed of its meaning,the data need not be disclosed to him for si�
months thereafter unless a dispute or action pursuant to this section is pendine or additional data on the individual has been collected or created. The
responsible authoriN 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 shall comply immediately,if possible,with an}'request made pursuant to this subdivision,or within tive days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he ca�inotcomply with the request
within that time,he shall so inform the individual,and may have an additional tive days�vithin�vhich to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.a. Procedure when data is not accurate or complete. An individuaf may contest the accuracy or completeness of public or private data
concerning himself To e�ercise[his right,an individual shall notify in writing the responsible authority describing the natu�e ofthe disagreement. The
responsible auchoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomple[e data,including recipients named by the individual;or(b)notify the ittdividual that he believes the data to be correct. Data in
dispute shall be disclosed only if the individual's stafement of disagreement is included with the disclosed data.
The determination 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 like to inform you that your request
for a perniit or license from the City of Orono or any of its departments may re�uire you to furnish certain private or
confidential information.
You are notified that:
1. The inforn�ation you furnish will be used to detennine 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 Coiulcil action to approve, some infonnation may become
public.
5. You have certain rights under M.S. ]3.04(available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
First �1iddle LASf
����
r�����ss
Cit}� /�t�te Zio Phone
1 understand my rights as stat�ed nUove.,�
��, .�
.� �. �
ignature
�?