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Home My WebLink About2001-P04596 - re-roof ' � PERMIT C I TY O F O RO N O permit Number: 2750 Kelley Parkway - PO Box 66 P04596 Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: 1 v�i2oo1 SITE ADDRESS: 1082 Loma 1,inda Ave MOUND,MN 55364 PID: 08-117-23-23-0009 DESCRIPTION: UBC Occupancy R3 Proposed Use: ttesidentiai Permit Class: Building Census Code O/S-Building Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 4,200.00 State Surcharge Fee: $ 2.10 TOTAL FEE: $ ll3.35 APPLICANT: Coates Roofmg OWNER: DEAN&LISA JOHNSON 5812 Wooddale Ave. S. ]082 LOMA LINDA AVE Edina,MN 55424 MOLJND,MN 55364 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. -� .�.�--� � '' � C z,�--- .� � � APPLI NTPERMITEE I NATURE ISSUEDBYS GNATURE Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1 �* // .�.� Y `/ �� Total Fee: $ � Date Received: ��- �� Entered By: ��.-- Permit#: ,�G'�� - CITY OF ORONO - BUILDING PERNIIT APPLICATIOleT �U G/�� All information must be submitted in full before plan review will be started. (please print all information) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER O CONTR.ACTOR ,� �..__.__ - _ JOB SITE ADDRESS: f�� Q M� ;�,�., ,a U�-- ZIP: ,S�3 S�� NAME OF OWNER: �(��=A ,�.; �� ti�c>��ti� PHONE: (home).1,�-z-y�T�-�z<<�� (work) MAILINGADDRESS: ,f�; ��- c.�.y� �,� oa ,� c,�� " CITY: �:�<'c„�-� ZIP: J ;',�-. CONTRACTOR (�c'd 7 c;S /Z��.r=�.� �- PHONE: j�-z � y Z�>��i 4/ CONTACT PERSON:/%-�;.,.,� C��a r�-s MOBILE/PAGERL��/Z � Z 7 z -��'v�-- MAILING ADDRESS: ��rz ��x�n,��,�- e��-. CITY: �--a�- a ZIP: ��h STATE LICENSE: # Z��T�,�7 �' ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New�(_ Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: -T�-«i� ��;rr l-��,� .��c.�'-,= ,�{c:c��s r_- _�� i . > - �. ;,��.<� � c — STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ! , l�%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 City and with the State Building Code; that I understand this is not a pernut and work is not to start without a permit; and that the work will be in accordance with the approved plan. , APPLICANT'S SIGNATURE: ;�,��c.� (�cr�-'�- DATE: jt- � - n / ; NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. � � Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom che data is stored or co be stored shall be as set forth in this section. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data conceming himseif shall be informed of: (a)the purpose and intEnded use of the requesced dara wichin the collecdng'state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising fmm his supplying or refusing to supply private or confidentiai data;and(d)[he idenciry of ocher persons or enrides au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investieadve data, pursuant to secdon 13.82, subdivision 5, ro a law enforcement officer. The commissioner of re enue mav place the notice reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data b�indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public, privace or confidenrial. Upon his further request, an individual who is the subjec[ of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content and meaning of�hat data. After an individual has been shown the private data and informed of ics meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secaon is pending or additional data on the individual has been collected or created. The responsible auchority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acrual costs of makine, cerafying,and compiling the copies. The responsible authoriry shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Sa[urdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an addilional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise[his right,an individua(shall notify in writing the responsible authoriry describing�he narure of the disagreement. The responsibie authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of inaccunte or incomplete data, including recipients aamed by the individual: or(b)notify the individual that he believes the data to be corcect. 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 authoriry may be appealed pursuant to the provisions of the administrative procedure act relaring to conte�.ed 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 reauest 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become pubiic. 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. First �liddle Last Address Ciry State Zip Phone I understand my rights as stated above. i , ; 1f--�-- C�`�_-�-�-_ Signature