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Home My WebLink About2004-P08020 - re-roof PERMIT CITY -rJF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 Pogo2o Crystal Bay, Minnesota 55323 Pet-mit Type: MinorAlterations (952) 249-4600 Date Issued: lo�i�2oo4 SITE ADDRESS: 1361 North Arm Dr MOUND,MN 55364 PID: 07-117-23-41-0066 DESCRI PTION: Proposed Use: Residential Permit Class: Building Census Code O/S-Building Permit Type: Minor Alterations Permit Sub-type(��: Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 97.25 Valuation: $ 3,600.00 State Surcharge Fee: $ 230 TOTAL FEE: $ 99.55 APPLICANT: Owner/Self OWNER: S W MALCHOW&N MALCHOW � 1361 NORTH ARM DR MOLJND MN 55364 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESO A BUILDING CODE REQUIREMENTS. I'�— APP I AN P RMITEESIGNATURE SSUEDBYSIGNATURE Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1 Total Fee: $ ��• S 5� Date Received: �D '' /"d`f Entered By: � Permit#: l�8'D o�-� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all infarmatiorz) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: � 3 w � �1J � �� r �� ZIp; S S �(� �—/ Will this be a P de 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 approval 60 days prior to the event. Non permitted events will not be allowed. NAME OF OWNER: s C 4Tt' V�J • M��--�f�✓ PHONE: (home) �� .�-~23 �-( � � �o f �J . (work) (Z- � '' 8`�� MAILING ADDRESS: �"R-r^'t .�2 CITY: O ��✓o ZIP: CONTRACTOR: PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New Accessory Structure Addition Move RemodeVAlteration Land Alteration PROPOSED WORK(describe ifi detai�: 1�0��'v� STORIES: � SQ. FEET OF EACH FLOOR: ' NO. OF BEDROOMS: 2- GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ ��4� � f� I hereby apply for a building permit and I owledge that the information above is complete and accurate;that the work will be in conformance with the o i ances and codes of the City and with the State Building Code; that I understand this is not a permit and work' ot to start without a permit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: DATE: I� t �'I ' � - �. Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type ot data. The rfghts of individual on whom the data is stored or to be stored shall be as set forth tn thls section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed 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 legslly required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or conFdential duta;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivlsion 5,to a law enforcement ofticer. The commissioner of revenue mav olace the notice reauired under this subdivision in the Individual income tax or arooertv tax refund instructions tnstead 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 classiTied 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,shall be informed of the content and meaning of that data. After 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 uuthority shall provide copies of the private or public data upon request by the iadividual subJect of the data. The responsible authority may require the requesttng person to pay the actual costs of making,certifying,and compiling the rnpies. The responsible suthority shall comply immediately,if possible,with any request made pursuant to this subdlvision,or within tive days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [the cannot comply with the requestwithin that time,he shall so inform the individual,and may have an additional 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 private data concerning himselL To ezercise this right,an individual shall notify in writing the responsible suthority describing the nature of the disagreement.The responsible sut6ority shall within 30 days either: (a)correct the data found to be inaccurste or incomplete and attempt to notify past recipients of inaccurate or Inrnmplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be carrect. Data in dispute shall be disclosed only tf the individusl's statement oC disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions 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 wouid 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 permit 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. First Middle Last Address C State Zip Phone I und sta my rights as stated above. Sig ature