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Home My WebLink About2002-P05860 - re-roof CITI� O� ORONO PERMIT 2750 Kelley Parkway - PO Box 66 Permit Number: Poss6o Crystal Bay, Minnesota 55323 Pe►'mit Type: Minor Alterations (952) 249-4600 Date Issued: li�2oi2oo2 SITE ADDRESS: 3175 North Shore Dr Wayzata,MN 55391 PID: 09-117-23-33-0009 DESCRIPTION: UBC Occupancy R3 Proposed Use: Residential Pernut Class: Building Census Code O/S-Building Permit Type: Minor Alterations Pernut Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: PermitFee: $ 125.25 Valuation: $ 5,875.00 State Surcharge Fee: $ 3.45 TOTAL FEE: $ 128.70 APPLICANT: �'• F. Smith Construction OWNER: Micheal&Catherine Russin 5975 Lynwood Blvd 3175 North Shore Dr Mound,MN 55364 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. � -� ' �� ,i� (;/'�(� ��'�:l v � l r f��l�/� APPUCANT PERMITEE SIGNA RE [�SUED BY S]GNATURE Cooies: 1-File(Si�nitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 �Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUILDING PERNIIT APPLICATIOIeT All information must be submitted in full before plan review will be started. " (please print all information) ---------------------------------------------------------------------y--c==---------- --- ---------------------- THE APPLICANT IS: (circle one) OWNER�OR CONTRACTOR > _ . _._ .... ._ _ � _ _ JOB SITE ADDRESS: � � � S ��_ J��'lQ ��1_. ZIP: J S 3 �� NAME OF OWNER:�\kC �l�S�,�� PHONE: (home) (work) MAILING ADDRESS: Sl'� � CITY: ZIP: CONTRACTOR: V� , �_ �i'VI �`� �..�✓�;� �, PHONE: � ? — �o S� � ' � CONTACT PERSON: �v,� MOBILE/PAGER (�� -�6-7 - 3 1 � �7 MAII.ING ADDRESS: S� `7 S" L..';r''N u;-:ro v� �l�l. ITY: �✓1��i y��ZIP: S S� STATE LICENSE: # 5 3 � �� ARCHIT'ECT/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: (��},r�. C��-� �' �,t��V�-z 1�J� �.1�,' STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. — ESTIMATED CONSTRUCTION VALUATION (excluding land): $ -� �� I hereby apply for a building pernut 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 �uilding Code; that I understand this is not a pernut and work is not to start without a permit; and that the work wi 1 be in accorda�ce with the approved plan. APPLICANT'S SIGNAT . - DATE: � � �`�' -' � � NOTE! Parade of Homes events require separate perntit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. i • Sea 13.04 RIGHTS OF SUB.TECTS OF D�TA Subd, i. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself sha11 be informed of: (a)�he purpose and intended use of the requested data within the collecring"state agency, poliacal subdivision,or statewide system; (b)whether he may refuse or is legally requimd co supply rhe requested data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persoas or enrides autborized by state or federal law to receive the dara. This requirement shall not apply when an individual is asked to supply invesrigarive data, pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the noace reauired 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 inforraed whether he is the subject of stored data on individuals,and whecher it is classified as public, private or co�denaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wi�hout any charge to him and:if he dzsires, shall be informed of the content and meaning of that dara. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hirn for six monrhs thereafter unless a dispute or acnon pursuanc to this secaon is pending or addidonal data on the individual has been coliected or created. The responsib(e authority shall provide copies of the private or public data upon request by the individual subject of rhe data. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible au[horiry shall comply immediately, if possibfe, with any 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 caanot comply with the request within that time,he shall so inform the individual,and may have an addiooaal 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 mdividual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shail nodfy in wridng the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct che data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by[he individual; or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemen�of disagreemenc is inciuded with the disc(osed data. The decermination of the responsible authority may be appealed punuant to the provisions of the administrarive procedure act reladng 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 tha[your request for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: i. 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� Z-t'�.,��J � G`�'1 l �� G First Middle � �� Lasc S'� �7 � L�G��.c�;� �` iii�� Addre�5 - r��1 �� 11y� F�� -��y L�� -��- �s�� City Srate Zip Phone I und tand my rights stated a ove. �� _� ` �� , "�� Signature