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Home My WebLink About2005-P08748 - re-roof PERMIT C.IT`�`,OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p08748 Crystal €3ay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 5/24/2005 SITE ADDRESS: 1340 Fox St Unit# Wayzata, MN 55391 PID: 02-117-23-31-0019 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: FEE SUMMARY: Pernut Fee: $ 125.25 valuation: $ 5,275.00 State Surcharge Fee: $ 2.65 TOTAL FEE: $ 127.90 APPLICANT: Fidelity Inc. OWNER: Allan Litwin 25467 Redwing Ave.N. 1340 Fox St Shafer,MN 55074 Wayzata MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISS[ON TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO L WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA B LDI C�,CODE REQUIREMENTS. I . 1 / �, �, '�^--. PPLI , NT PER E SIGNATURE UED BY SIGNAiURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page ] May 17 05 09: 43p F I DEL I TY I IYC �I I�I�� 651 z574223 p. 1 � � �J�' Total Fee: $ la� 1�a DateReceived• — $�� Entered By: _ Permit#: �90 CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) THE APPLICANT IS: (circle one) OWNER OR ONTRACTOR JOB SITE ADDRESS: I �� C� �i 112�� Zjp: �-j � ��11 Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes �NO If yes,a specia!event permit is required with Police Departmen�and City Counci!approval 60 days prior to the event. Shutt/e bus service wil!be requrred unless applicant demonslrates su�cient on-sile parking is avar/able. Non permitted events wi/!not be al/owed. NAME OF OWNER: A�\a�, '��-t-� �.,r� PHONE: (home)�h z `{13 ��1 (work) MAILING ADDRESS: 1'�`t0 Fo-� ST rzzt CI'TY:f�f��>u ZIP: �5 3�1 t CONTRACTOR: F�o��y �v�� PHONE:�rr 51 2►=,"I yZ.1 Z CONTACT PERSON: D a��a� �1�2 z�� MOBILE/PAGER: ��„ ,��.� ��S c,3 MAILING ADDRESS: ��yt�'i ZE��..��n�� 1 CITY: S��r ZIP:� �i�o'1�- STATE LICENSE: # Z u 3 i la3�1 � EXPIRATION DATE: � I�-�� E. , ARCHITECT/ENGINEER: ,�o ��.C.. PHONE: MAILING ADDRESS: CITY: ZTP: NAME= REGI5TRATION: # TYPE OF WORK: New Addition Accessory Structure Move Home Remodel/Alteration '�C__ PROPOSED WORK(describein detain: �k .n�o.►E �T� � N�L�S �• ZEOI�c� c,v;t�l i,5,rc.u,! 3b v z.�a. s;�,�;��S �Pe.r t c � - STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETAC�TED ESTIMATED CONSTRUCTION VALUATION(excluding land): S �Z,-1 '7 �u I hereby apply for a building permit and I acknowledge that the information above is cornplete and accurate; that the work will be in conformance with the ordinances and codes ofthe City and with the State Building Code;that I understand this is not a permit and ork's not to start without a permit;and that the work will be in accordance with the approved pla APPLICANT'S SIGNATURE: DATE: - � ' C�� 31 May 17 05 09: 43p FIDELITY INC 6512574223 p. 2 Sec.13.04 RIGH7'S�F SUBJECfS OF DATA 5ubd.1. Typc of data. The rights of individua!on whom the data is stored or to be stored shall be as set forih in this section. Subd.2, lnformationraquiredtobegivenindividual.Anindividualaskedtosupplyprivateorconfidentialdataconceminghimselfshallbe infortned of: (a)the purpose and intended use of the requested data wilhin the col lecting sfate agency,political sobdivision,or s�ntewide systam;(b) whether he may refuse or is legally required to supply the requested data;(c)any known wnsequence azising from his supplying or refusing to supply private or confidential data;and(d)the identity of othet persons or entities authorized by state orfede�al lawto receive thedata,This requirement shall not apply when an individuel is asked to supply investigative data,pursuent to section 13.82,subdivision 5,to a law enforcement officer. Thc commissioner of revenue mav�lace the notice rcguired under this��i�+vicinn in th��.+��..��„�I income tax or oro r+.��ax refi�� instructions instead of o�those fortns. 5ubd.3. Access to data by individual.Upon request to a rcsponsible authority,en individual shall be infortned whethen c�is the subjectof stored data on individuals,and whether it is ciassi fied ns publ ic,private or confidential. Upon 6is fuRher request,an individual who is the subject of swred private or public data on individuals shall be shown the data without any chatge to him and,ifhe desires,shall be infortned of the content and meaning of that data. Af1er an individual has been shown the private dala and informed of its meaning,the data need not be disclosed to him forsix months chereaftcr unless a dispute or action pursuant to this section is pending or additional data on the individual hes bcen collected orcrealed. The responsible aulhority shall provide copies af the priva[e or publ ic dala upon request by[he 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 authoriry shall comply immediately,iFpossible,with any requcst made pursuant to this subdivision,or within five days of thedateoftherequest,excludingSaturdays,Sundaysandlegalholidays,ifimmediatecomplianceisnotpossible. Jfhecannotcomplywilhtherequest within that time,he shall so inForm the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, 5undays and legal holidays. Subd.4. Procedurewhendataisnotaccurateorcomplete.Anindividualmaycontesttheaccurdcyorcompletenessa('publicorprivatedate conceming himself.To exercise this right,an individual shall notify in writing the responsibleauthority describing the nature of thedisagreement 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 inaccurateor incomplete dat�including recipients named by the individual;or(b)notify the individual that he bel ieves the datam be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detertnination of the rasponsible authority may be appealed pursuant to the provisions ofihe administrative procedure act relating to wntested Cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.o4,Subd.2,"Rights of subj ects 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 depar[ments may require you to furnish certain private or confidential information. You are notified that: l. The information you fumish 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 Ciiy 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 appli on or permi[. � �. ��►�.�..�2..+� First Middle Lact � �'?�t�¢� �t�' `�`' �� Address l��• v '1 -G�Z ��l l Z�'1 � �-1 tl�- City ,� State Zip Phone 1 un a my ' ht s stated above. J IV Sien 32