HomeMy WebLinkAbout2003-P06213 - re-roof CITY F R PERMIT
� � �N� Permit Number:
27�,p Kelley Parkway- PO Box 66 P06213
� Crystal Bay, Minnesota 55323 Permit Type: M�or Alterano�
(952) 249-4600 Date Issued: ai2i�2oo3
SITE ADDRESS: 1000 Loma Linda Ave
Mound,MN 55364
PID: 07-117-23-14-0071
DESCRIPTION:
Construcrion Type VN
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#:
Sepazate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 139.25 Valuation• $ 6,885.00
State Surcharge Fee: $ 3.95
TOTAL FEE: $ 143.20
APPLICANT' Sela Roofmg&Remodeling,Inc. QWNER' Bill&Mary Ulrich
� 4100 Excesior Blvd. � 1000 Loma Linda Ave
St.Louis Park,MN 55146 Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMEN'I'S SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA B LD G CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Capies: 1-File(Sir;nitures Required), 1-Atmlicant 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
1
Total Fee: $ Date Received:
� Entered By: Permit#:
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CITY OF ORONO - BUII.,DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information) .
THE A.PPLICANT IS: (circle one) OWNER OR ONTRACTOR �
JOB SITE ADDRESS: /(�d � L o Yv� � L j t� [�Ct �v• ZIP: ������—
NAME OF OWNER: g j�� (J�Y i L� PHO�TE: (home) cI.S�- y 7 a-7/�5
(work)
1�TATLI�i 1G�.DDRESS: . CTTY: �t�I� U t-� �,1 ZIP:
SELA ROOFING&REMODELING,INC.
4100 EXCELSIOR BLVD. b� `�_��
CONTRA.CTOR: � PHO�TE: a3�kay ,�
COiv'TACT PERSON: ���AS� 1�IOBII.E/PAGER:
MAII.,ING ADDRESS: CTI'Y: ZIP:
STATE LICENSE: #
ARCHIT'ECT/ENGliYEER: PHO\TE:
MAILI�IG ADDRESS: CITY: ZIP:
I�1AME: � REGISTRATION# •
TYPE OF tiVORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
. PROPOSED tiVORK(describe in detai�: iT� � ,��-T�►o6� /-�-�-4�cf��d �tYq,c��
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF B�DROOMS:� GARAGE STALLS: ATT: � DET. � �- = _••-. ..
ESTMATED COtiTSTRUCTION VALUATIO\ (exclud.ing land): � � f( $,��`
I hereby apply for a buildin�pernut and I acknowled�e 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 Buildin� Code; that I understand this is not a permi[and work is not to start without a
permit; and that the work will be in accordat�cz with the approved plan.
APPLICANT'S SIGNAZ'URE: � , �- DATE: ��1��
14'OTE! �..._Parade of hTomes events require separate permit c�proval by Police Dep�rtment and
City Council 60 days prior to the event. Non permitted events will not be allowed.
�.�o,� i a ��
Sec.13.04 RIGFiTS OF Sti'BJECTS OF DaTA
Subd. 1. Type of data. 'Ihe righcs of individual on whom t�e data is scn:�or to be swrcd shall be u sec forth in chis secaon.
Subd.2. Iaformation requdred to be givea individual, ,�ir.��.zdual asY�to supply privam or confidenaal dara coacerning himself shall
bc informed of: (a)the putpose and intended nse of the requesud da�u;��e collecang State agency,poliacal subdivisioa,ar scatewide rystem;
(b)whe�her he may refuse oY is legally required[o supply[he tequested dan;(c)any 1co7vn coasequence arising from his supplying or refusing to supply
priva�e or conndendal data;az:d(d)che idenary of o�herpersons orenad:s zechorized by state or fedaai law ro roceive the da�a..This requiremen�shall
not apply when an individual is asked to supp(y investigaave dara,purs�:c to seccoa 13.83,subdivision S, to a law enforcement office�. '
'It�a commissioner of r��eaue mav lace the norice reauircd er.der this subdivision in ihe individual ir.come tax or ro em mz refund
in:truccions ins�ead of on those focros.
Subd.3. Access to data br•Indiridua(. Upon requesc to a r,roasible a��oriry,an individual shalt be informed whether he is the subjecc
of scor:d data on individuxls,and wheeher it is classificd as public,priva�or confider.tial. Upon lus furcher request,an individual who is the s�bject
of scored private or public daca on individuals shall be shovm che dara wiu ouc any e'eLarge to him and;If he desires,shall be infocmed of�he conten[
ar.d meaning of[hat dara. After an individuai has been shown che priva��ac►and iz.'ormed of ics meaning,the dara need not be disclosed to hirn for
six mon�hs ehereai[er unless a dispute or acdon pursuant to ihis secQon is Fending or addiaoaal data on the individual 6as been collected or creamd.
The responsible authoriry shall provide copies af the private oc public dau�;on requs;by the individua!subject of[he data. The cesponsible auchoriry
nay r:quire che requesang person to pay the accua!costs of making,ce_.ling,and compiling the copies.
The �esponsibla aucho�ry shall comply immediaetly,if possib(e,wi�h any trquest made pursuant to this subdivision,or wi[hin five days of
the daco of the request,ezcluding Saiurdays,Sundays and legal holidays,if ir..medixte compliance is not possible. If he cannot comply with the r.quesc
wi�hin�ha�ame,he shall so inform che individual,and may have an addicec.al Five days wichin which to comply wi�h the request,exctuding Saturdays,
Sundays and legat holidays.
Subd.4. Ptocedure when data Ls aot accurate or complete. An indivituzl may contest the accuracy or completeness of public or pri�•ate
data concerning himself. To ezercise this right,an individual shall nodfy ia wriang ce responsible authoriry d:scribiag[he nantre of the disagretmeat.
The responsible auchoriry s6a11 wi�hin 30 days eithec: (a)correct the da�tcvnd to be inaccutate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete dau, including recipients named by the individi:ai;or(b) eodfy the individual that he believes the data to be eoaec� Da[a
in dispu�e shall be disclosed only if the individual's statement of disagree�ent is�.c:u3ed wi[h t6e disclosed data.
The decerminarion of the rasponsible auehoriry may be appea;:�pursuacc to [he provisions of tha adminisaarive procedure act teladng to
contes:ed cases. .
DATA PRI'4'�CY AD�ZSORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects o[data", we would like to inform you tha[your reauest
for a pemut or license from the City of Orono or any of is depar.�.ents may require you to furnish certain privace or
confidential information.
You are notified that:
1. The informacion you furnish will be used to d�:ermine�•our qualification for the permit or license requested.
2. You may refuse to supply data, but refusal eiay require that the Ciry deny the permit or license.
3. "I�e information may be shared with other Ioczl, state or federal agencies to the extent necessary to process
the pecmit or license.
4. If your requested permit or license requires Council action to approve, some information mav become
� . public. . -
�. You have certain riQhts under M.S. 13.04 (a�ailable upon request) to review�private iiata on yourself.
6. Your full name is required to process this zp�lication or perm.i[.
F��� ,LSiddle
Last
Address
Ciry State
Z�P Phone
I understand ri hts as stated above.
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Signature