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Home My WebLink About2003-P06931 - re-roof � PERMIT ��T � OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P06931 Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: 10/24/2003 SITE ADDRESS: 3443 Livingston Ave WAYZATA,MN 55391 P I D: 17-117-23-43-0064 DESCRIPTION: Proposed Use: Residential Pernut Class: Building Census Code O/S-Building Pernut Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof DETAILS: Approved per resolurion#: Separate pemuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 54.00 Valuation• $ 1,500.00 State Surcharge Fee: $ 1.25 TOTAL FEE: $ 55.25 APPLICANT: DEI�INIS L HEGER OWNER: DEM�TIS L HEGER 3443 LIVINGSTON AVE 3443 LIVINGSTON AVE WAYZATA MN 55391 WAYZATA MN 55391 THE UNDERSIGNED HEREBY REQUESf S 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. 1 �N� � � C�� APPLICANT PERMITEE SIGNA ISSUED BY SIGNATURE Conies: 1-File(SiQnitures Re4uired), 1-Auplicant, 1-Monthlv Renorts, 1-As�essinQ, 1-Finance Page 1 � T'u`tal Fee: $ Date Received: '� � ��'� Entered By: �`��L� Permit#: � � �/ CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please pri�:t all information) -------------------------------------------------------- --------------------------- ------------------- THE APPLICANT IS: (circle on O��iVE OR CONTRACTOR � .� ��Z,�. � JOB SITE ADDRESS: �'j `(`�3 � ��c v��i �t--�l,� (�r-c ZIP• �S3c( � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a special eti�ent permit is required with Police Department and City Council approva160 days prior to the event. Non perniitted events will not ,_. be allowed. NAME OF OWNER: ��1� w .,— . �� PHONE: (home) `� � �`�7j � °9�# L � (work) MAILING ADDRESS: �j t� y � �--� v � �nq�r� ��ITY: � 2-1a c�-ZIP: 5 3 G ) CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration L� Land Alteration � ;� PROPOSED WORK(describe in detai�: �Z(t��r— � F �'— — 1"�-C- Q��: 1— STORIES: SQ. FEET OF EACH FLOOR: _ � S � X `�j � � NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � �� D �� I hereby apply for a building permit and I aclrnowledge 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«zthout a permit; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: � v�v�,� L DATE: L c� Sec.13.04 RIGHTS OF SUBJECTS OF DATA y • Subd.l. Type of data. T6e rights of indlvidnal on whom the data is stored or w be stored shall be as set fort6 in this section. Subd.2. Information required to be given individual. An indivldual asked to sapply private or rnnfidential data concerning 6imseltshall be informed ot: (s)t6e purpose and intended use of the requested data within the collecting state agency,political subdivislon,or statewide system;(b) whet6er he may refuse or is legally required to supply t�e requested data;(c)any known consequence arising from hIs supplying or re[using to supply private or confidential data;and(d)the identity ot other persons or entities authorized by state or federal law to receive the data. This requlrement shall not apply when an individual is asked to supply investigative data,pursuant to sectton 13.82,subdivision 5,to a law enforcement ofticer. The commissioner of revenue mav olace t6�ootice reauired under this subdi��sion in the individual income tax or orooertv tax refund instructions tostead of on those forms. Subd.3. Access to data by individual. Upon request to s responsible authority,an indlvidual shall be in[ormed whether 6e is the subject of stored data on individuals,and whether it ls classified u public,private or rnnfidential. L:pon hls further request,an individual who is the subject ot stored private or publlc data on individuals s6a11 be shown the data without any charge to him and,if 6e desires,shall be informed of the content and meaning of that data. After an individual 6as been s6own the private data and informed of iu meaning,t6e data need not be disclosed to 6im for six months thereafter unless a dlspute or action pursuant w this seMion is pending or additiooal data on t6e individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by t6e individual subject ot the data. T6e responsible authorlty may require the requesting person to pay the actual rnsts o[making,certitying,and compiling the copies. The responsible suthority shail comply immediately,it possible,with any request made pursuant to this subdlvision,or within five days of the date o[the request,excluding Saturdays,Sundays and legai holidays,if immediate compliance is not possi6le.If he cannot comply with the request within that time,he shall so inform the indivldual,and may haie an additional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure w6en data is not accuratr or complete. An individual may contest the ac¢urgcy or rnmpleteness otpublic or private data concerniag himself. To exercise this right,an Individual s6a11 notify in writing the responsible authorlty describing the nature of the disagreement.The responsible aut6ority shall within 30 days eit6er: (a)eorrect the data found to be inaccurate or incomplete and attempt to noti[y past reciplents of inaccurate or Incomplete data,including recipients named by the indivldual;or(b)ootify the individual t6at he be8eves the data to be correcw Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible suthority may be appealed pursuant to the provislons of the administrative procedure aM relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rghts 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 confdential information. You are notified that: 1. The information you furnish�ill 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 egtent 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 1i.S.13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. Flrst Middle Last Address City State Zlp Phone rstand my rights as stated ab ve. � � L e