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Home My WebLink About2008-00014 - roofing � i �� CITY OF ORONO PERMIT NO.: 2oos-000�4 t �' 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 07/03/2008 952 249-4600 FAX: 952 249-4616 ADDRESS : 4240 NORTH SHORE DR PIN : 07-117-23-43-0014 LEGAL DESC : SAGA HII.,L REVISED : LOT 000 BLOCK 014 PERMIT TYPE : NIlNOR ALTERATIONS PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING-ASPHALT ACTIVITY : O/S BUILDING-UNDEFINED VALUATION : $ 4,200.00 APPLICANT pERMIT FEE SCHEDULE 118.00 J BENSON CONSTRUCTION STATE SURCHARGE(VALUATION) 2.10 3230 GORHAM AVE ST LOUIS PARK,MN 55416- TOTAL 120.10 (612)920-0717 Minnesota State License#:4740 OWNER SCHWARZKOPF,PETER&JENNIFER 4240 NORTH SHORE DR MOLJND,MN 55364 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if constrvction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any rime after work has commenced The applicant is responsible for assuring all required inspections are requested' confo w i t Building Code.This permit may be revo d at y ti e cause. �1 i U�i C� � i � Applicant Permitee Signature Date ssue y ignature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . � Total Fee: $ ��• �v 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 pr�int all infopsnation) THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: 7' �` �a /�/ooe� � ,� !vl U/Q.e ,�1� � ZIp: S� �� Will this be a Parade of Homes,Remodelers Showcase Home or other Display Iiome? ❑ YeS ❑No If yes,a special event permit is required with Police Depar�tment and City Council approval 60 days prior to the event. Shuttle bus ses-vice will be required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. NAME OF OWNER: ��P/��/L �C.�t-�//�,��Z l�e� � PHONE: (home) ��^ ��7- 7/3 D MAILINGADDRES5: �a �d �v�Q7��J ..�h�,�CITY: /y�Qu�l Y�''r��rZIP: �'��7�� CONTRACTOR: � -Q��d� �j./t�'.(� � PHONE: 9.�a^�%�"��(/ CONTACTPERSON: �S � �G� �� MO�ILE/PAGER: ,�a- a9�� JelS/( MAILING ADDRESS:�d�i� ,A�l L��, CITY: �> �z,�r°��P: �s 5`�(� STATE LICENSE: # �� f b EXPIRATION DATE:�,�ll o?od� 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 require MCWD review and permita! PROPOSED WORK(describe i�detai�: STORIES: � SQ.FEET�F EACH FLOOR: �DO NO. OF BEDROOMS:� GA�AGE STALLS: ATTACHED� DETACHED_ L' 00 ESTIMATED CONSTRUCTION VALUATION(ezcluding land): $ �7 � �d 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 State Building Code;that I understa.nd 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• DATE: � � d� �� 31 � , � Sec.13.04 RIGH1'S OF SUBJECTS OF DATA � Subd.1. 'fype 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 co�dential data conceming himself shall be informed of: (a)the purpose and intended use of the requested data witliln 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 privaYe or confidendal data;and(d)the identity ofother 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 enforcement officer. - 1'he commissioner of revenue may�lace the notice rec�uired under this subdivision in the individual inwme tax or prooeriy tax refund instructions instead of on those forms. Subd.3.Access to data by individual.Upon request to a responsible suthority,an individual shall be infomied whether he is the subject of stored data on individuals,and whether it is classified as public,private or ponfidential.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 informed of its meaning,the data need not be disdosed to him for six months thereafter unless a dispute or action pursuant to tivs 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 the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority s}iall comply immediately,if possible,with any request made piusuant 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 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 cor�test the accuracy or completeness of public or private data conceming himself.Ta exercise this right,an individual shall notify in writing the responsible suthority 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 shall be disclosed only if the individual's statement of disagreement is included with the disalosed data. . . The determination of the responsible authority may be appealed pursuac�t to the provisions ef the administrative procedure act relating to wntested 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 t process this applicat' n or permit. �-� �j �C c� � �,6 �� U.N' � First Middle Last Address City State Zip Phone I un r tand m 'ghts as sta ed a o Sign ure *�--^ m� �- � � 3 ��5�#F��I - � �� 32 � ��