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Home My WebLink About2001-P04257 - re-roof CITY OF ORONO PERMIT 2�0 Kelley Parkway- PO Box 66 Permit Number: Poa2s� Crystal Bay, Minnesota 55323 Pe�mit Type: Minor Alterations (952) 249-4600 Date Issued: ai29i2ooi SITE ADDRESS: 3685 Lyric Ave Wayzata,MN 55391 P I D: 17-117-23-34-003 9 DESCRIPTION: UBC Occupancy R3 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 permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 9�•25 Valuation: $ 3,740.00 State Surcharge Fee: $ 1.90 TOTAL FEE: $ 99.15 APPLICANT: Williams Contracting OWNER: Curtis Robins 5501 Bass Lake Road ' 3685 Lyric Ave Crystal,MN 55428 Wayzata MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI-]E 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. �jl�� --�,.. (��Y`�.e�l �� D� APPLICANTPERMITEESIGNATURE ISSU DBYSIGNATURE Couies: 1-File(SiQnitures Required), 1-Annlicant 1-Monthlv Renorts. 1-Assessin¢, 1-Finance Page 1 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 infor�nation) ---------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: _ � � � �j L �/ /` i � ZIP: . ��`? ", ,� �1��, > � -/ � �� ' � NAME OF OWNER: I� U 4 2 �`� PHONE: (home) � (work) MAILING ADDRESS: SG�r, 2 CITY: ZIP: CONTRACTOR: (�J� / f � ��1�.�7 CU ti� �r�� PHONE: CONTACT PERSON: (��c�•,i 2 MOBILE/PAGER: („/,Z � 5,5�{—u iC � MAILING ADDRESS: �y`�'G i /'�s 5 iK,�� CITY: C�� ZIP: � � STATE LICENSE: # � c; � � 7 7 �, 5- 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�: �,e�! v�f� �� ,�c;��' STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ � �4�� 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: � DATE: C6 Z G � � NOTE! Parade of Homes events require separate permit approval by Police Deparlment and City Counci160 days prior to the event. Non permitted events will not be allowed. • . ` Sec.13.04 RIGH'TS OF S[JBJECTS OF DAT.+� Subd. 1. Type of data. 'Ihe rights of individual on whom the data is stored or to be stored shall be as set for[h in rhis secuon. Subd.2. Information req�red to be given individual. An individual asked to supply private or confidendal da[a concerning himself shall be infotmed of: (a)the purpose and inrended use of the requesud darn within the collecting�tate agency,poliucai subdivision,or statewide rysum; (b)whe[her he may refuse oY is legally requiced to supply rhe requested data;(c)any imown consequence arising from his supplying or refusing to supply privace or confidential dara;and(d)the idenriry of orher persons or enrides authorized by state or federnl law to receive the data. This requirement shall not apply when an individual is asked to suppiy invesdgadve dara,punuanc to section 13.82, subdivision 5, to a law enforeement officer. The commissioner of revenu� mav place the notice rewired under this subdivision in the individual income tax or aroaem tax refund instrucrions inscead of on chose forms. Subd. 3. Access to data by individual. 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 ctassified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or pubtic data on individuals shall be shown[he dara wichout any charge to him and,-if he desires,shall be informed of the content and meaning of chat data. After an individual has been shown the private data and informed of its meaning,the dara need not be disclosed to him for siz months thereafter unless a dispuu or action pursuanc to this section is pending or additional data on the individual has been coilected 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 roquesring person to pay the actual cosu of making,cerafying,and compiling the copies. The responsibie authoriry shall comply immediacely,if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal halidays,if immediace compliance is not possible. If he cannot comply with the request within�hat time,he shall so inform the individual,and may have an additional five days within wtuch 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 accuncy or completeness of public or private data concerning himself. To exercise[his right,an individual shall noafy in writing the responsible authoriry describing che nature of the disagreemeat. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispuce shall be disclosed only if[he individual's statement of disagreement is included with the disclosed dara. The decerminarion of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri¢hts 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 fumish certain private or confidential information. You are notified that: 1. The information you fumish 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 shazed 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. - S� G U First Middle Lasc Address City State Zip Phone I understand my rights as stated above. � Signature '