HomeMy WebLinkAbout2001-P03967 - re-roof PERMIT
C���Y�` O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P03967
Crystal Bay, Minnesota 55323 Pe►'mit Type: Minor Alterations
(952) 249-4600 Date Issued: 6�2s�2ooi
SITE ADDRESS: 4041 North Shore Dr
Mound,MN 55364
PID: 07-117-23-44-0077
DESCRIPTION: UBC Occupancy R3
��, c '�r�K r--* � �� � Construction Type VN
Proposed Use: Otke`r
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Building-Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 153.25 Valuation: $ 7,200.00
State Surcharge Fee: $ 3.60
TOTAL FEE: $ 156.85
APPLICANT: Dave Berry Construction Inc. OWNER: Dale McCurdy
20625 Co. Rd 30 4041 North Shore Dr
Rogers,MN 55374 Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES'I'O DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIG ATURE I SUED BY SIGNATURE
Cooies: 1-File(SiQnitures Repuired), 1-Applicant. 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
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Tot�r Fee: $ j �� " Date Received:
•Entered By: � . - Permit#:
CITY OF ORONO - BUII,DING PERMIT A.PPLICATION
All information must be submitted in full before plan review will be started.
' (please print all information)
THE A.PPLICANT IS: (circle one) OWNER CONTRACTO
JOB SITE ADDRESS: �f O Lf� �0��, S �%�(S ��' ZIP:
I�TAME OF OWNER: 1J�-L� �C����1 PHONE: (home) �S� - L�7 a— '��5 3
�- (work)
1�IAII�Pi 1G ADDRESS: �I�� � �(/o✓�{� Sha��(�r. CITY: 0 �o u�� ZIP:
CONTRA.CTOR: "L��t1i�/3�., C� �/�''�- PHONE: 7(���'Lla� � �'to�
CO�ITACT PERSON: w-�-��1 ��� BIL AGER: W/� -�? -��S 3
1VIAILING ADDRESS: � 0�02� �-G (zc t� CITY: jet�C��S ZIP: SS 3 7�
STATE LICENSE: # �
ARCHITECT/ENGINEER: PHO\TE:
MA.IL�1G A.DDRESS: CIT'�': ZIP:
N��: REGISTRATION# �
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED`VORK(describe in detai�: /�E (�c�o(� ( �� £'F�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF B�DROOvIS: GARAGE STALLS: ATT�. � DET. - - � --
�,v
EST 1MA'I`ED CO�'STRUCTION VALUATIO\ (exclud.ing land): S `�,� a 0 , —
I hereby apply for a buildin;permit and I acknowled�e that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the Ciry and with
the State Buildin� Code; that I understand this is not a permit and work is not to start without a
pernnit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE�` � � DATE: fv -02 5 '� 1
1VOTE! Parade of Homes events require separate permit approval by Police Deparhnent and
City Council 60 days prior to the event. Non permitted events will not be allowed.
. ,.
Sec.13.04 RIGFiTS OF S[JB.TECTS OF D�T.�i
Suhd. 1. Type of data. The righcs of individual an whom the data is swred or to be swred shall be as set forch in[his secdan.
Subd.2. Infarmation required to be given individual. An ir.dividual asktd w supply privace or confidendal data conceraing himself shall
be informed af: (a)the purpose and iacended use of the requesced data�ci�ia the collecang�tate agency.poliacal subdivisian,or sratewide rystem;
(b)whe�her he may refuse oY is legally required to supply che requested dac3:(c)any lmowa consequence arising from his supplying or refusing to supply
privace or conndendal data;and(d)the idendry.of ocher persoas or cnrides ac[horized by state or federal law to receive the data..This requiremenc shail
not apply whan an individual is asked w supply invesdgadve daa,pursv±:c to seccon 13.82,subdivision 5,to a law enfarcement officer.
The commissioner of re�enua mav olace the noacc reauired crder chis suvbdivision in the individual income rax or orooem tax refund
insavctions inscead of on those forms.
Subd.3. Access to data by indit-idual. Upon request to a responsible aurhority,an individual shall be informed whether he is the subject
oF stored data on individuals,and whe�her it is cius�ed as public,privac�or conFtdenrial. Upon his further request,an individual who is the subject
of s�orni private or public data on individuals shall be shown the dara wia.ouc any c'"a�e to him and:if he desires,shall be informed of the content
and meaning of[hat data. After an individua!has been shown the privam Caca and i�ormed of its meaning,the dara need not be d'uclosed to him for
six mon�hs chereaner unless a dispuce or acdon pursuanc to�his secdon is Ftnding or addidonal data on the individual has been collected or creaced.
The responsible auchoriry shall provide capies of the private or public dac�cYon requ-x.by the individual subject of the daca. T[te responsible authoriry
may require[he requesting person to pay the actuat cosu of makin$,cerying,and eompiling the eopies.
The responsible au[horiry shall comply immedia[ely,if possible,wi�h any r:quest made pursuant to this subdivision,or wi[hin five days of
the da�of�tte requesc.excluding Saturdays,Sundays and legal holidays,iF i�mediate eompliance is not possible. If he cannot comply with the request
w;�hin thac time,he shall so infarm rhe individual,and may have an addiceeal five days within wluch to comply with the request,ezcluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. �n individual may contest the accuracy or complereness of public orpri�ate
data concerning li�rnself. To exercise this righG an individual shall noafy ia wridng c�e respoasbie authoriry descn'bing che nature of the disagreemeat.
The responsible authoriry shall wi[hin 30 days eithec: (a)correct the dat3 fcund to be inaccurate or incomplete aad attempt to nodfy past reciplent�of
inaccurate or incomplete data, including recipients named by the individral;or(b)codfy the iadividual that he believes the data to be correct Dac�
in dispute shall be disclosed only if the individual's statemenc of disagre��ent is ir.crided with the disclosed dara.
The dececminadon of the rasponsible authoriry may be appea:e3 pursuac�w che provisions of the administrarive procedute act reladng to
contested eases. . � �
DATA PRIV�CY ADSTSORY
In accordance with M.S. 13.04,Subd.2, "Rights of subjects ot daca",we would like to inform you that your rec}uest
for a permit or license from the City of Orono or any of ia depar�encs may require you co fumish certain private or
confidential information.
You aze notified ihat:
1, The information you furnish will be used to de:�mune}our 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 ocher Ioc�l, state or federal agencies to the extent necessary to proeess
the permit or license.
4, If your requested permit or license requires Council acdon to approve, some information may become
� . , public.
S, You have cercain righcs under M.S. 13.04 (available upon request) to review�private data on}►ourself.
(, Your full name is required to process this aoplication or permic. �
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stand my righu a5 stated above. .
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Signacure