HomeMy WebLinkAbout2000-P02781 - re-roof �
� PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Po2�81
Crystal Bay, Minnesota 55323 Pe►'mit Type: Minor Alterations
(612) 249-4600 Date Issued: si4i2000
SITE ADDRESS: 4205 North Shore Dr
MOLTND,MN 55364
PID: 07-117-23-43-0004
DESCRIPTION:
Proposed Use:
Permit Class: Building Census Code 434
Permit Type: Minor Alterations Permit Sub-type(s): Building Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 83.25
Valuation: $ 3,000.00
State Surcharge Fee: $ 1.50
TOTAL FEE: $ 84.75
APPLICANT: MIKE HINCK OWNER: MARY JO PETERSON
4738 GALWAY ROAD 4205 NORTH SHORE DR
MOUND,MN 55364 MOUND MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPEC�IED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA LTILDING CODE REQUIREMENTS.
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A LICA PE ITEE SIGNATURE ISSUED BY SIGNATURE
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Copies: City,Applicant,Assessor, Finance Page 1
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Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII.DING PERMIT APPLICATION
All information must be submitted in fiill before plan review will be started.
(please print all information)
TI� APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: �O�� �6�,�1 �sr p�1.c;u� ZIP:
NAME OF OWNER: � �- �c�✓ PHONE: (home) I�oZ � �7� �
(work)
MAILING ADDRESS: �ZQ S� ��1'h �e �i�e CITY: �j�.d ll� ZIP:
CONTRACTOR: � ��� ���� PHONE: �
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: y�3� G��hl �D� CITY:�d K hi�? ZIP: S—��
STATE LICENSE: # �� �el�b _
ARCffiTECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move RemodeUAlteration Land Alteration
PROPOSED WORK(describe in detain: �����r� t �i�-�� r
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLSs ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION(excluding land): $ ��Q� �
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 5tate 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: D�TE.
NOTE! Parade o ,Homes events require separate permit approval by Police Deparlment and
City Council 60 days prior to the event. Non permitted events will not be callowed.
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Sec.13.Q4 RIGHTS OF SLJBJECTS OF DATA
Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored sha11 be as set farth in this secuon.
Subd.2. Information reqirired to be given individual. An individual asked w supply private or confidendal data conceming himself shall
be informed of: (a)the purpose and intended use of the requested data within the collecting�tate agency,polidcal subdivision,or statewide systcm;
(b)whether he may refuse oY is legaily required to supply the requested data;(c)an3+laiown consequence arising from his supplying or refusing ro supply
private or confidentiai data;and(d)the idenriry of other penons or enudes authoriaed by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrigadve dara,punuant to secflon 13.82,subdivision 5,to a law enforcement officer.
The commissioner of revenue mav nlace the noace rewired under this subdivision in the individual income taac or prooertv raz refund
instructions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of smred data on individuals,and whethe�it is class�ed as public,private or confidential. Upon his further requesc,an individual who is the subject
of stored private or public data on individuals shall be shown the dara without any charge to him and,-if he desires,shall be infarmed of the content
and meaning of rhat data. After an individual has been shown the private data and informed of its meaning.the data need not be disclosed to him for
su months thereaf[er unless a dispute or acrion pursuanc to this secrion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall 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,cerodying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or withia five days of
the date of the request,excluding Saturdays.Sundays and legal holidays,if immediace compliance is not possible. If he cannot compty with the request
within that time,he s6all so inform the individual,aaci may have an addidonal 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 ar private
data conceming himself. To exercise this right,an individual shaii norify in writing d►e responsible authority describing rhe narure of the disagreement
The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipients of
inaccurate or incomplete data,including recipients named by the individual;or(b)notify�►e individual that he believes the dara to be correcc. Data
in dispute shall be disclosed oaly if the individual's statemenc of disagreement is included with the disclosed data.
The decerminadon of the responsible authority may be appealed pursuant w the provisions of�e administradve 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 shazed 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 Middle �i
Address
Ciry Srate Zip Phone
I understand my rights as stated above. .
Signaatce