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Home My WebLink About2007-P11044 - re-roof PERMIT CsTY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P11044 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterarions (952) 249-4600 Date Issued: 5/23/2007 SITE ADDRESS: 3580 North Shore Dr Unit# Wayzata,MN 55391 P�� 08-117-23-34-0020 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Pemut Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate pemuts required: NOTICES/REMARKS: Tear Off Inspection,But If Inspector Can't Make It,Take Pictures Off Underlaym FEE SUMMARY: Pernut Fee: $ 9�•25 Valuation: $ 4,000.00 State Surcharge Fee: $ 2.00 TOTAL FEE: $ 99.25 APPLICANT: Evergreen Construcrion OWNER: Wade Davis 970 Raymond Ave#201 3580 North Shore Dr St.Paul,MN 55414 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 MINNESOT.�BUILDING CO E REQUIREMENTS. � � � �/ i"I" t��' / APPLICANT PERMITEE SIGNATURE ISSU BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 r 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 al[information) THE APPLICANT IS• ircle one) OWNER OR C TRACTOR JOB SITE ADDRESS: � SI'�R� lJ� ZIP: �� Will this be a P rade of Homes,Remodelers Showcase Home or other Display Home? ❑ Yes NO If yes, a special event permit ds reqa�ired with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be reguired unless applicant demonstrates su�cient on-site parking is available. Non permitted events will not be a!lowed. NAME OF OWNER: 1f��`U� ��Jl� PHONE: (home) 2 7�-2�p0 �Wo�� MAILING ADDRESS: 2� �D� Sf'�p�2E �1Z[ck`CITY: �� ZIP: �� CONTRACTOR: ��'iJ �' S'CCLIS�OIV PHONE: �0�)�Z��d CONTACTPERSON: C,L �t MOBILE/PA� '2 -?.�v- S'3Y MAILING ADDRESS: c) �"�twtc9�� 'I�/� 201 CITY: �I`�►�� ZIP: S� STATE LICENSE: # ?l��{f��p EXPIRATION DATE: ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding,Windows) � Any earth movement may requi e MCWD review and permits ! PROPOSED WORK(describe in detain�E�`Z � �t` '�a0 F STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTACHED DETACHED ESTIMATED CONSTRUCTION VALUATION(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 ordin nces and codes of the City and with the State Building Code;that I understand this is not a per it-and work s not to st without a permit;and that the work will be in accordance with the approved plan APPLICANT'S SIGNATURE: DATE: �� 2� � 31 . , � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. l. 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 himselfshall be informed o£ (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 known consequence arising from his supply ing or refusing to supply private or confidential data;and(d)the identiry of other persons or entities authorized by state or federal law W receive the data. This requirement shal I not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue ma�place the notice re�uired under this subdivision in the individual income tax or pro�erty 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 info�med whether he is the subject of stored data on individuals,and whether it is classified 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 infonned of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursua�it to this section is pending or additiona(data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority 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 the request,excluding Saturdays,Sundays and legal holidays,if immediate compl iance is not possible. If he cannot comply with the request within 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 himself.To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature ofthe disagreement.The responsible authority shall 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 corcect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry 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 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 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 reyuest)to review private data on yourself. 6. Your full name is required to process this application or permit. First ,/J�� Middlc Last r�� ! Address City State Zip Phonc � I un t�d my ts s at Sisnature Reset Form 32