HomeMy WebLinkAbout2005-P08819 - re-roof LIT1� OF ORONO PERMIT
2750 Keiley Parkway- PO Box 66 Permit Number: p08819
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued:
6/8/2005
SITE ADDRESS: 1317 North Arm Dr Unit#
Mound,MN 55364
PID: 07-117-23-41-0032
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: Building
Permit Type:
Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#: �
Separate pernuts required:
NOTICES/REMARKS:
Re shingle front half of garage
FEE SUMMARY: Permit Fee: $ 23.50 valuation: $ 450.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 24.00
APPLICANT: Owner/Self OWNER: Ann Carlson
1VIN 1317 North Arm Dr
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 BUILDIN DE REQUIREMENTS.
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AP CANT PE E S ATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Sepric, 1-Septic) Page 1
Total Fee: $ oZ T � 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 pri�zt all inforrazation)
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: ! l �� / / � ZIP:
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home?
❑ Yes �NO If yes,a special evend per•mit is required with Police Department and City Council approval
60 days prior to the event. Slzuttle bars service will be reqarired unless applicant demonstrates
sufficient on-site parkir�g is available. Non permiited events will not be allotved.
� �
NAME OF OWNER: � PHONE: (home) Jr}- �I�a ',��¢
(work) � - — ��3 6
MA.ILING ADDRESS: ���1+,.�_ CITY: ZIP:
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: # EXPIRATION DATE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION: #
TYPE OF WORK: New Addition Accessory Structure
Move Home RemodeUAlteration
PRO OSED WORK(describe in detai�: /�l� ��„�� �r�,�1 j ��—.
2�A Co � �'
STORIES: � SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED
f_�
ESTIMATED CONSTRUCTION VALUAT'ION(excluding land): $ ��
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 or ' s and codes of the City and with the State Building
Code;that I understand this is not a permit an or ' not to start without a pemut;and that the work will be
in accordance with the approved plan.
J �
APPLICANT'S SIGNAT DATE: 6 a0 ��
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Sec.13,04 RIGI�TS OF SUBJECTS OF DATA
Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given individual.An individual asked to supply private or confidential data conceming himself shall be
informod of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or is legally required to supply the requested data;(c)any kno�vn consequence arising from his supplying or refusing to supply
private or confidential data;and(d)the identiry of other persons or entities authorized by srate or federal law w receive che data.This requirement shall
not apply when an individual is asked to supp(y investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer.
The commissioner of revenue mav nlace the notice required under this subdivision in the individual income tax or propertv tax refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on individuals,,and whether it is classifiod as public,private or confidential. Upon his further request,an individual who is the subject of
stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,sha(1 be infonned of the content and
meaning of that data. ABer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six
months thereafter unless a dispute or action pursuant to this section 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 authority
may roquire the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to[his subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate comptiance is not possible.If he cannot comp(y with the request
within that time,he shall so infortn the individual,and may have an additional five days within which to comply with the raquest,excluding Saeurdays,
Sundays and legal holidays.
S¢bd.4.Procedure when data is not accurate or complete.An individual may contest the accuracy or completeness of public or private data
conceming himself.To exercise this right,an individual shall notify in writing the rosponsible attthority describing the nature of the disagreement.The
respansible suthority shatl within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be co�rect.Data in
dispute shall be disclosed only if the individual's statement of disagreement is included wich the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrdNve procedure act relating to
contested cases.
DATA PRIVACY ADVISORY :
In accordance with M.S.13.04,Subd.2,"Rights of subj ects of data",we would like to infomi 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 fuinish 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 permit or license.
3. The information may be shared with other tocal, state or federal agencies to the extent necessary to
process the pernut 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. our full name is required process this application or permit.
7?i�,/ � �C�-��
Firs� � Middle Last
, r .
Address
`�� .�.,� �,� �3�, � ��a - ¢.�� �a��c
C�ty State Zip Phone
I understand my rights as stated above.
Signature
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