The URL can be used to link to this page

Home My WebLink About2005-P09340 - re-roof PERMIT CITY OF ORONO 2750 Keiley Parkway- PO Box 66 Permit Number: p09340 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952)249-4600 Date Issued: 10/21/2005 SITE ADDRESS: 1290 Loma Linda Ave unit# Mound,MN 55364 P�� 07-117-23-41-0089 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Perrnit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: Tear off and reroof house and garage FEE SUMMARY: Permit Fee: $ 167.25 va►uation: $ 8,500.00 State Surcharge Fee: $ 4.25 TOTAL FEE: $ 171.50 APPLICANT: John Haley#1 Roofer OWNER: Jennifer&Jim Matasovsky 6321 Cambridge St. 1290 Loma Linda Ave St.Louis Park,MN 55426 Mound,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. _ e APPLICANT PERMITE SIGNATURE S UED BY SIGNATURE Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 7oEa1 Fee: $ Date Received: ' Entered By: Permit#: CITY OF ORONO - BUII.DING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information THE APPLICANT IS: (circle one) OWNER R CONTRACTOR JOB SITE ADDRESS: � �`�� (,o wlo, �i� � Zip; 5S3(g�--� 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 approva160 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: � tn� ��.SUC�S'�ci PHONE: (home)qSo�',�`U��p�j 1 (work) MAILING ADDRESS: j a-�[C� �,�L�'►�.t�h � • CITY: _�j y�v I•�b ZIP: ___�� CONTRACTOR: �� O� PHONE: � ��S 'Le/�� CONTACT PERSON: � ,., MOBILE/PAGER: • a-� �LQ � MAILING ADDRESS:CA�� b ' CITY: . ZIP: � � STATE LICENSE: # �I o�C�� ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration� Land Alteration PROPOSED WORK(describe in detai�: — � � � �- �-- STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ $�� 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 without a pernut;and that the work a-ill be in accordance with the approved plan. -- � APPLICANT'S SIGNATURE: DATE: f(, •1� 'v� Sea13.04 RIGHTS OF SUBJECTS OF DATA ` Subd.1. Type of data. T6e rights of Indlvidual on whom the data is stored or to be stored shall be as set forth ln thls section. Subd.2. Information required to be given individual. An indlvidusl asked to supply private or contidential data concerning himseltshall be Informed o[: (a)the purpose and intended use of t6e requested data withln the rnllecting state agency,political subdivision,or statewide system;(b) whether 6e may retuse or is legally required to supply the requested data;(c)any known rnnsequeoce arising from his supplying or retusing to supply private or contidential data;snd(d)t6e identity of ot6er persons or endties authorized by state or federal law to receive the data. This requirement shall not apply w6en an individual is ssked to supply investigative data,pursusnt to section 13.82,subdivislon 5,to a law enforcement officer. The commissioner ot revenue mav olace the notice reauired under this subdivision in the individual income tax or�rooertv tax refund Instructions instead ot on those forms. Subd.3. Access to data by individual. Upon request w a responsible authority,an individual shall be informed w6ether he is the subject of ' stored data on indlviduals,and whether it is classifled ss public,private or confidential. Upon hIs further request,an indlvidual who is the subject of stored private or public data on indlviduals shall be shown the data without any charge to 61m and,Ii he desires,shall be informed of the cootent and meaaing of that data. After an individual has been shown the private data and(nformed of its meaning,the data oeed not be disclosed to him for six months thereafter unless a dispute or action pursuant to this sectioo is pending or addltlonal data on the Individual has been collected or created. The responslble authority shall provide copies of the private or public data upon request by the individual subJect of the data. The responslble authority may require the requesting person to pay the actual rnsts ot making,certifying,and compiling the copies. The responsible authority shall comply immediately,If possibie,with any request made pursuant to this subdivision,or w(thln tive days of the date ot the request,excluding Saturdays,Sundays and legal holidays,lf immediate compliance is not possible.If he cannot comply with the request within that time,he shall so inform the lndividual,aad may have an additional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An indivldual may contest the accuracy or completeness otpublic or prlvate data concerning himselL To eaercise this right,an individual s6a11 notify in writing the responsible authority describing the nature of the disagreement. T6e responsible suthority shall within 30 days elther: (a)rnrrect the data found to be inaccurate or inrnmplete and attempt to notify past reciplents o[ inaccurate or tncomplete data,including recipients named by the Individual;or(b)notify the individual that he believes the data to be correct Data in dispute s6a11 be disclosed only if the indivldual's statement of disagreement is lncluded with the disclosed data. The determinatlon of the responstble authorlty may be appealed pursuant to the provislons of the administrative 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 confdential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or Gcense 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 eatent 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. First Mlddle Last Address City State Zip Phone I understand my rights as stated above. � _� /LY1�! _ C��' ( �l/./i�1��C:-iC-��s--�— Signature