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Home My WebLink About2004-P08058 - re-roof ' "� PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: PososB Crystal Bay, Minnesota 55323 Permit Type: M�nor aicerac�ons (952) 249-4600 Date Issued: �0��2004 SITE ADDRESS: 3452 Livingston Ave Wayzata,MN 55391 P I D: 17-117-23-43-0018 DESCRIPTION: Proposed Use: Residential Permit Class: Building Census Code O/S-Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: �.- ---- � �--- � --�- ...�:,..,. ....�.,. � �..,. FEE SUMMARY: Pernut Fee: $ 26.55 Valuation: $ 600.00 State Surcharge Fee: $ 1.00 TOTAL FEE: $ 27.55 APPLICANT: Owner/Self OWNER: Corbin Martin M� 3452 Livingston Ave Wayzata,MN 55391 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 BUILDING CODE REQUIREMENTS. � � _ �� _. r� � C l `J�� ;` �:� ./1�/: 1 J APPLICANT PERMITEE SIGNATURE I SUED BY SIGNATURE Conies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Revorts, 1-Assessine, 1-Finance Page 1 I , _ . 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 print all informatio�z) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: 3 '� s�` �t� i '��h ��-e-. ZIP: S�q i Will this be a Parade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes, a special event permit is required with Police Department and City Council approval60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: �mr�%� �• ✓�a�f' `� PHONE: (home�qsa� y��"O 78 S � (work) MAILING ADDRESS: �ysa L;� ;n 5s�n �e• CITY: �Fr VJ�rv�t�- ZIP: S$34 � CONTRACTOR: �1``°w�-e- ��n e'� PHONE• 5am¢ a s a bo�e, CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: �-Iovn� p�r�Q,� pHONE: suv�,.e- �s a�°u� MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move Remodel/Alteration � Land Alteration PROPOSED WORK(describe in detai�: �o� n e..�a c�-e-cl o�r� � rc�o�- �e, roo-'F: n o v e� .ex; �� o-� h� o-� STORIES: I SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.�,C ESTIMATED CONSTRUCTION VALUATION (excluding land): $ 3 7� ' �� ma'�"cr�'a�s I hereby apply for a building pernut and I aclmowledge 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 start without a permit;and that the work will be in accordance with the approved plan. � APPLICANT'S SIGNATURE: DATE: ID— � 1 ��`-{ . , 1 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. 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. Subd.2. Intormatlon required to be given individual. An tndividuai asked to supply private or confldential data concerning himself shall be informed of: (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 known consequence arising trom his supplying or refusing to supply private or co�fidential data;and(d)the identity of other persons or entities authorized by state or federsl law to receive the data. This requirement shall not apply when an tndivldual!s asked to supply invest[gative data,pursuant to section 13.82,subdivislon 5,to a law enforcement offlcer. The commissioner of revenue mav alace the notice reauired under this subdivision [n the individual income tax or arooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individuat. Upon request to a responsible authority,an individual shail be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or rnnflidentisl. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wtthout any charge to him and,if he destres,shall be in[ormed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pendtng or additional data on the individual has been collected or created. The responslbte authority shall provide copfes of the private or publlc data upon request by the individual subject of the data. The responsible authority may requtre the requesting person to pay the actusl costs of making,certifying,and compiling the coples. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot rnmply with the request 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,Sundays and legal holldays. Subd.4. Procedure when datn is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall not[fy in writing the responsible author[ty describing the nature of the disagreement. The responsible suthority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past reciptents of inaccurate or inrnmplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data In dispute shall be dlsclosed only ff the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the admintstrative 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 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 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 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 application or permit. Lp r-b i� ��/h'►o o'1ct j'✓,�a.rf� r./ First iddle Last 3��' ��'v t��-� � S -�U r� �-V Q . Address j,a,�.�c�71-4�o� �'1� �S�`t � � �1 �� -�l?� —� 7 �� City f State Zip ` Phone I understand y rights as stated above. ) Signature