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Home My WebLink About2001-P04256 - re-roof CITI� �F ORONO PERMIT 2750�Kelley Parkway- PO Box 66 Permit Number: Poa2s6 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: ai29i2ooi SITE ADDRESS: 3675 Lyric Avenue Wayzata,MN 55391 P I D: 17-117-23-3 4-0040 DESCRIPTION: UBC Occupancy � Proposed Use: Other 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: $ 9�•25 Valuation: $ 3,740.00 c�, State Surcharge Fee: $ 1.90 � J l'� � TOTAL FEE: $ 99.15 APPLICANT: OWNER: DouglasNieland 3675 Lyric Avenue 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. � ��_ t/�e- ��`� �� APPLICANT PERMITEE SIGNATURE ISS D BY SIGNATURE Conies: 1-File(SiQnitures Required). 1-Annlicant 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1 To�al Fee: $ Date Received: . Entered By: Permit#: CITY OF ORONO - BI.TII.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 OR CONTRACTOR JOB SITE ADDRESS: .3 ;� � S L `/ /� , C ZIP: NAME OF OWNER I' G �, c„ /V � 1� � PHONE: (home) (work) MAII.ING ADDRESS: S C, h, -� CITY: ZIP: corrrRacTox: C�� /l��,,�, s C o^- S � r�r PHONE: 7� 3- S 3 3 ^S`G � CONTACT PERSON: 1��4�.-� MOBILE/PAGER: G'/z � 5��G l G 3 MAILING ADDRESS: ��vt !jG-Ss C� /Z� CITY: C �tif l�a 1 ZIP: STATE LICENSE: # �o� 7 7 ?� j' 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 detain: �,o u r 6,�'�e �G�� _ STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIlVIATED CONSTRUCTION VALUATION (excluding land): $ ?j, 7 �'�j 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 permit and work is not to start without a permit; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: �.,� 1!�� DATE: � � 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 SLJB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom[he data is scored or[o be stored shall be as set forth in this section. Subd.2. Information reqirired to be given individual. An individuai asked to supply private or con6dendal data conceming himself shall be informed of: (a)the purpose and inttnded use of the requested data within the collecdng 3tate agency,poliacal subdivision,or statewide system; (b)whether he may refuse oY is legaUy required to supply the requested data;(c)any Irnown consequence arising from tus supplying or retusing w supply privace or confidenaal data;and(d)che idenriry of other persoas or endaes authorized by state or federal law to receive the data. This requ'uemenc shall � not apply when an individual is asked to supply invesugadve dara,pursuanc to secdon 13.82, subdivision 5,to a law enforcement o�cer. The commissioner of re�enue mav place che noace rewired under this subdivision in the individual income rax or oroperry tax refund instrucdons instead of on those forms. Subd.3. Access to data by indiridual. Lipon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public dare on individuals shall be shown the data without any charge to him and,-if he desires, shall be informed of the content and meaning of[hat data. After an individuat has been shown the private data and infarmed of its meaniag,the data need not be disclosed ro hitn for six months thereafter unless a dispute or acdon pursuant to this section is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible aurhoriry shall comply immedia[ely,if possible,with aay request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individuai,and may have an additional five days within which to comply with the request,exciuding Saturdays, Sundays and tegal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conust the accuracy or completeness of pubiic or private data conceming himself. To exercise this right,an individuai shall nodfy in wri[ing rhe responsible authoriry describing[he naturo of the disagreement. The responsible authority shall within 30 days either: (a)correct[he data found to be inaccurate or incomplete and atxempt to norify past recipients of inaccurate or incomplete data, inetuding recipiencs named by the individual;or(b)notify the individual thac he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The decerminaaon of the responsib(e au[hority may be appealed pursuant to the provisions of the administ�aave procedure act reladng 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 pemut 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. � V Fint vf' d1e Last Address City State Zip Phone I u derstand my rights as stated above. Signamre •