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Home My WebLink About2006-P09951 - chimney repair '" PERMIT �ITY OF ORONO Permit Number: 1750 Kelley Parkway- PO Box 66 P09951 Crystai Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 6/6/2006 SITE ADDRESS: 2640 Kelly Ave Unit# Excelsior,MN 55331 PID: 20-117-23-14-0006 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minor Alterations Permit Sub-type(s): Chimney Repair DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 63.15 valuation: $ 1,800.00 State Surcharge Fee: $ 0.90 TOTAL FEE: $ 64.05 APPLICANT: MKM Development Inc. OWNER: John&Sherry Volkmar 2615 234th. 2640 Kelly Ave St.Francis,MN 55070 Excelsior MN 55331 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 BUILDItd�',CODE REQUIREMENTS. �/ � - �' �' � � �.--—-.. .. `%'��. \� : � � G� (��. � APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 � Total Fee: $ (� �i �� 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 information) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle o�ie) OWNER OR CONTRACTOR JOB SITE ADDRESS: �c�y� I��!�� /t(;' � ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No !f yes, a specraf event permit is required with Police Deperrtnaent and City Cozmcil approval 60 c�ays prior to the event. Shuttle bus servtce�a�ill be reqa�ired unless applicant dernonstrates s:fficient on-site parking is availab(e. A�on-pern�itted eve��ts will not be allolved NAME OF OWNER: �� '►� 1�'` c' `l � �'� K �c�� PHONE: (home) � '�'�-�c:'. �. _ (work) MAILING ADDRESS: ...��i-� CITY: ZIP: CONTRACTOR: �,1�� r�: r�c E� t'��i'� ��C t PHONE: �, I�-�� -�1�L`/ CONTACTPERSON: C. >>�< �1c,� MOBILE/PAGER: �,. � }- ��3 � -�(f,��' MAILING ADDRESS: :=��.�=; ��.-3y '"C � CITY: �;�,r r��:�c �- ZIP: _;5 c 7Q STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: KEGISTRATION: # TYPE OF WORK: New Home Addition _ Accessory Structure Move Home �Remodel/Alteration'(ie: Siding, Windows ` ` ,; �� n-eY Any earth movement may require MCWD review and permits ! PROPOSED WORK(desc�•ibe in detain: �i z'c�r t�c.,�� =��:��-�t: , 'l,�. ,ti1 n�r � � K�'� � �: / '�t� CL�i G"+ ,, � .-�t� r 1�\ STORIES: ` St�.FEET OF EACH FLOOR: • NO. OF BEDROOMS: GARAG� STALLS: ATTACHED DETACHED l� ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � ,��'C% � 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 Ciry and�vith 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 wi II be in accordance with the approved plan. ' , APPLICANT'S SIGNATURE: � � � � DATE: �- �' � �' JI � Sec.13.Od RIGHTS OF SUBJECTS OF DATA Subd. I. Type of data. The rights of individual on whom the data is stored or to be stored shail be as set forth in this section. Subd.2. Infonnation required to be given individual. An individual asked to supply private or contidential dataconceming himselfshall be infonned of: (a)the purpose and intended use ofthe requested data�vithin the collecting state agency,political subdivision,or statewide system;(b) �vhether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising from his supplyin�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 shail 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 ma�lace the notice required under this subdivision in the individual income tae or Qropertv tar refund instnictions instead of on tliose forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified 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 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 sho�vn the private data and infonned of its meaning,the data need no[be disclosed to him for sir months thereatter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shal I comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannot comply with the request within thac time,he shall so inform the individual,and may have an additional tive days within which to comply�vith the request,e�cluding Saturdays, Sundays and le�al holidays. Subd.4. Procedure when data is not accurate or complefe. An individual may contest the accuracy or completeness of public or private data concerning himself. To esercise this right,an individual shall notity in writing the responsible authority describing the nature ofd�e disagreement. 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 inaccurate or incomplete data,indudine recipients named by the individual;or(b)notiiy the individual that he believes the data fo be correct. Data in disp��t?Sh3ll be disclnsPd only if the individu�l's statement nf disa�reement 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 ADVISORI' 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: l. Tl�e 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 pemiit or license. 4. If your requested permit or license requires Cowicil 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. L �:t��.,�� j�-<.`. � ��-,� e�� /1 1 c-L� �=l� First Nliddle Last -� �/ � �j � �� , Address � � � �' �'��v� C"'r � �71 i1 S' �c� 7C �-/��`Z/�� Cih� State Zip Phone I understand my rights as stated above. �_ � � L._� �...__. signac�r� Reset Form .?�