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Home My WebLink About2002-P04905 - re-roof � PERMIT CI�� Y OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Poa9os Crystal Bay, Minnesota 55323 Permit Type: MinorAlterations (952) 249-4600 Date Issued: 2ii9i2oo2 SITE ADDRESS: 4730 North Arm Dr W MOUND,MN 55364 PID: 06-117-23-23-0016 DESCRIPTION: LTBC Occupancy R3 Proposed Use: Residential Pemut Class: Building Census Code O/S-Building Perxnit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 125.25 Valuation• $ 5,980.00 State Surcharge Fee: $ 3.00 TOTAL FEE: $ 128.25 APPLICANT: Western Cedar Supply OWNER: R JAMES&KAREN F HOFFMAN 9700 13th Ave 4730 NORTH ARM DR W Plymouth,MN 55441 MOLJND 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 ORDINANCFS AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �� `� ""�', �� APPL[CANT PERMITEE SIGNATURE IS BY SIGNATURE - Covies: 1-File(SiQnitures Required), 1-Auvlicant 1-Monthlv Reuorts, 1-Assessine, 1-Finance Page 1 ; TAtal Fee: $ ��$ ��.� Date Received: � — �-� Z-- Entexed By: , Permit#: o �yo.� CITY OF ORONO - BUII.DING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all inforniation) ..��__=__---_---- _----------------------- ---------------------------------------------------------------- - THE APPLICANT IS: (circle one) OWNER CONTRACTOR� JOB SITE ADDRESS: �` �� "'. ' ZIP: �� - NAME OF OWNER: J �s� �7�iti!`�� PHONE: (home) y 7a �5�� (work) MAII.ING ADDRESS: ��`f!'!/1�-- CITY:��) ZIP: � CONTRACTOR: ��'1 � l( PHONE: � 6l� ��- -�la�S CONTACTPERSON: /l�loq-/L O E/PAGER: MAIIrING ADDRESS: � �CITY:� ZIP: SS<<� STATE LICENSE: # � ARCHITECT/ENGINEER: PHONE: MAILING ADDItESS: CITY: ZIP: NAME: REGISTRATION# TYPE OF WORK: New � Addition Accessory Structure Move . Remodel/Alteration Land Alteration PROPOSED WORK(describe in detain: �cr'�'c�F,��o� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIlVIATED CONSTRUCTION VALUATION(excluding land): $ �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: ,��( DATE:��1gP�-Z NOTE! Parade Qf Homes events require separate permit approval by Police Department and Ciry Council 60 days prior to the event. Non permitted events will not be allowed. < � Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the dara is stored or to be stored shall be as set forth in this section. Subd.2. Information req�rired to be given individual. An individual asked to supply privau or confidenrial data concerning himself shall be informed of: (a)the purpose and in[ended use of the requesced dara wi[hin the collecting�state agency,political subdivision,or stauwide sysum; (b)whether he may refuse oY is legatly required to supply the requesud data:(c)any lmown consequence arisiag from his supplying or refusing w suppty private or confidential data;and(d)the idendry of other persons or enades authorized by state or fedetal law to receive the data. This requirement s6all noc apply when an individual is asked to supply investigadve data,punvant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of re�enue mav alace the nodce rewired under this subdivision in the individual income tax or propertv tax cefund instructions instead of on those 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 class�ed as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any c6arge to him and;if he desires,shall be informed of the coatent and meaning of chat data. After an individual has been shown the priva[e data and informed of its meaning.the data need not be disclosed w him for six monrhs thereafter unless a dispute or acrion pursuant to this secdon is pending or addiuonal data on the individual has been collected or created. The responsible authoriry shail provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require 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 this subdivision,or within five days of the date of ihe request,excluding Saturdays,Sundays and legal holidays,if immediau compiiance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,exciuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. M individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in wriang the responsible authority describing�he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt 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 dispute shall be disclosed only if the individual's statemenc of disagreement is included with[he disciosed data. The determinadon of the responsible auchoriry may be appealed pursuant to the provisions of the adminisaarive procedure act reladng to conusted 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 permit or license. 3, The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. g, 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 City State Zip Phone I understand my rights as stated above. /�/ � _ Signaare