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Home My WebLink About2003-P06978 - re-roof � . CITY OF ORONO PERMIT 2750 Kelley Parkway- PO Box 66 Permit Number: P06978 Crystal Bay, Minnesota 55323 Permit Type: �inor.vt�ations (952) 249-4600 Date Issued: 11/13/2003 SITE ADDRESS: 4191 North Shore Dr MOUND,MN 55364 P I D: 07-117-23-44-0046 D ESCRI PTION: Proposed Use: Residential Census Code O/S-Building Permit Class: B��S Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernrit Fee: $ 111.25 Valuation• $ 4,300.00 State Surcharge Fee: $ 2.65 TOTAL FEE: $ 113.90 APPLICANT: Owner/Self OWNER: DANAH L MCCAMMON M� 4191 NORTH SHORE DR MOUND MN 55364 TFIE UNDERSIGNED HEREBY REQUESI'S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN SfRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF MINNESOTA BUILDING CODE REQUIREMIIVTS. � ��) APPLICANT P ITEE SIG ISSUED BY SIGNATURE Coni�:1-File(Si�nitures Required),1-Anplicant 1-Monthlv Revorts, 1-Assessine,l-Finance Page 1 SENT BY: FOUR SEASONS ROOFING & SIDING I; 952 352 8808; NOV-5-03 12:17PM; PAGE 1/1 � � q�a-a�q-��G �4�n Total Fee: $ /r�• 9� Date Rece�ved: ��J�'0�----- Entered By: Permit#: i90�9 7� CITY QF ORONO - BUILDIIVG PERMIT AP'PLICAT[ON A11 information must be submitted In full before plan review wtll be started. (please prinf aUinformatioa) THE APPLICANT IS: (cirde ane) OWNER ONTRpCTOR JOB SfTE ADDRESS: �I�1 �Of'��'1 S�o1''�1�. � ZIP: �J�?c3��"� NAME OF OWNER: �,YI�`�1 ��'�°VZ� PHONE: (home}�5�?-'�17a-�14d (work) /�/,�- $��-d dl!o� MAYLING ADDRESS: �e- CITY: ZIP: CONTRACTOR: t-OU.� �G�-SGY�.S s Sl� �PHONE: t�il•�`�d��`�C�j' CONTACT PERSON:� MOB1L AQER: � - 7 MAII.INQ ADDRESS: 3a r CITY: ZIP: ��3a STATE LICENSE: # �,2C3I o"�5C5�5 ARCHITECT/EN[i1NEER: PHONE: MAILING ADDRESS: C1TY: ZIP; NAME: REGISTRATlON# 'CYPE OF WORK: hlew Addition Accessory Structure ________ , Move Remafel/Alteration,�,_ Land Alteration PROPOSED WORK (descrlbern detailj: 1 er�' o�r and �e.Rcx�� 1'�t�se- an��j STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTItNATED CONSTRUCTION VALUATION (excluding land): $ ��'� I hereby appiy for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conforniance with the ordinances and codes of the City and with the State Building Cade; that I understand this is nat a permit and work is not to start without a penait; and that the wark wiU be in acx;or •e with the oved Lan. APPLICANT'S SiGNATUR . DATE: f I"�'�� NOTEI Parade offifames events requ�r•e separate perm.�t app�oval byPolice Deparlment and Clly Cnuncl!60 days prr+or M the event. Non permilted events wlll�ot be aUowed. Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. 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. In[ormation 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 legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;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,subdivision 5,to a law entorcement officer. The commissioner of rev_enue mav ulace the notice required under this subdivision in the individual income tar or oroaertv tax refund instructions mstead of on those forms. Subd.3. Access to data by individuaL L'pon request to a responsible authority,an individual shall be informed 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 pri��ate or public data on individuais 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 t6ereafter unless a dispute or action pursuant to this section is pending or additional 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 t6e requesting person to pay the actual costs of making,certi[ying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,orwithin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance 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 authority describing the nature of the 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 correct. Data in dispute s6a11 be disclosed only if the individual's statement of 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 11.5.13.04,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 notitied that: 1. The information you furnish will be used to determine your qualitication 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 iVtiddle Last Address Cih� S[ate Zip Phone I underst�d my ri hts �tat bove. . l � � Signatu li' Total Fee: $ ��.3. 9� Date Received: ��'s �3 � Entered By: Permit#: fi�D�9 7� CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submi ted in 1 before plan review will be started. (please int all in ation) --------------------------------------------------------- ----------------- -------------------�--------------------------- THE APPLICANT IS: (circle one) O ER OR CON CTOR �� JOB SITE ADD SS: � 9 � �� ZIP: Will this be a Para of Homes, R odelers Showcase e or other Display Home? ❑ Yes No If yes, a s ial event permit is r uired with Police Department and City Council appro l 60 days prior to th event. Non permitted events will not be allowed. NAME OF OWNER: �� /�C C'Q�-i n. P • (home) � (wor ) MAILING ADDRESS: 5��g � S�� '�-� CITY: ZIP: CONTRACTOR: PHONE: CONTAC N: MOBILE/PAGER: MAILIN ADDRES . CITY: ZIP: STATE CENSE: # , ARCHITECT GINEER: ONE: MAILING ADD SS: CITY: ZIP: NAIVIE: REGISTRAT ON # TYPE OF WORK: New Accessory Structure Addition Move RemodeUAlterati Land Alteration PROPOSED WO scribe in detain: �a� STORIES: SQ. FEE F EACH FLOOR: NO. OF BEDROOMS: GARA TALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excludi nd): $ I hereby apply for a building permit and I aclrnowledge 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 pernut 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: