HomeMy WebLinkAbout2004-P07517 - re-roof PERMIT
CITY OF O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P07517
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 5/20/2004
SITE ADDRESS: 4685 North Shore Dr
Mound,MN 55364
PID: 07-117-23-32-0056
DESCRIPTION:
Proposed Use: Residential
Census Code O/S-Building
Permit Class: 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: $ 251.25 Valuation: $ 14,500.00
State Surcharge Fee: $ 7.75
TOTAL FEE: $ 259.00
APPLICANT: Allstar Construction OWNER: Christinson
8401 73rd Ave N-Suite 80 4685 North Shore Dr
Minneapolis,MN 55428 Mound,MN 55364
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
MINNESOTA BUILDING CODE REQUIREMENTS.
APP E E SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Sienitures Required). 1-Applicant,1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
ti
Total Fee: $ Date Received:
Entered By: Permit#: R0 7
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER O CONTRACTOR
JOB SITE ADDRESS: �®� /G�" J ��j /��.e 4 /Y, ZIP:
Will this be a Parad Homes,Remodelers Showcase Home or other Display Home?
❑ Yes No If yes, a special event permit is required with Police Department and City
Council approval 60 days prior to the event. Non permitted events will not
be allowed.
NAME OF OWNER: �y�j �`j y��S IX dol, PHONE: (home)
(work)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: X//'�'/fir GGA PHONE:163
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: k 4ve / 73 "e Al. CITY: &LOA ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Accessory Structure
Addition Move
Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detail): ,g
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding land): $1/
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
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: DATE: G
a
Sea13.04 RIGHTS OF SU8JECTS 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. Infoation required to be given individual An Individual asked to supply private or confidential data concerning himself shall be
Informed of (a)the perp se and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)
whether he may refuse or legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply
private or confidential da ;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 indivi ual is asked to supply Investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer.
The commissf ner of revenue may lace the notice required under this subdivision in the individual income tax or property tax refund
instructions instead of on those forms.
Subd.3. A to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of
stored data on Individu and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of
stored private or publi 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. er an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six
months thereafter u a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The
responsible authority all provide copies of the private or public data upon request by the individual subject of the data The responsible authority may
require the requestin person to pay the actual costs of making,certifying,and compiling the copies.
The respo le authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the
date of the request,ex uding Saturdays,Sundays and legal holIdays,if Immediate compliance is not possible.If he cannot comply with the request within
that time,he shall so form the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays
and legal holidays. i
Subd.4. cedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data
concerning himself.(fo exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The
responsible authorf' 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 dis osed only if the individual's statement of disagreement is included with the disclosed data
The det,rmivation of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
I 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 permitr license from the City of Orono or any of its departments may require you to furnish certain private or
confidential i formation.
You aro notified that:
1. i 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 request)to review private data on yourself.
6. Your full name is required to process this application or permit.
Firstl Middle Last
Address
City 1 State Zip Phone
I understand my rights as stated above.
nate
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