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Home My WebLink About2004-P08238 - re-roof � i�Y F RONO PERMIT � O O Permit Number: 2750 Kelley Parkway - PO Box 66 Pog23s Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: iii3oi2oo4 SITE ADDRESS: 2730 Pheasant Rd Excelsior,MN 55331 PID: 21-117-23-23-0053 DESCRIPTION: Proposed Use: Residenrial Buildin Census Code O/S-Building Pernut Class: g Permit Sub-type(s): Building-Re-Roof Pernut Type: Minor Alterations DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 181.25 Valuation: $ 10,000.00 State Surcharge Fee: $ 5.50 TOTAL FEE: $ 186.75 APPLICANT: W.F. Smith Consn-uction OWNER: William Smiley III 6585 So. Saunders Lake Dr. 2730 Pheasant Rd Minnetrista,MN 55364 Excelsiar MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO�4LL,WORK IN STRICT'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � � �' �� APPLICANT PERMI"I'E SIGNATURE SSUED QY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports. 1-Assessins, 1-Finance Page 1 � Total Fee: $ 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 pri�zt all i�zfornaation) ------------------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle orze) OWNER OR CONTRACTOR JOB SITE ADDRESS: Z 7 �� l (f�-lS-,�v-r�' �� ZIP: -1 J�_ � � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No If yes, a special everrt permit is i�equirecl with Police Departf�ient and City Coi,rncil czppr-oval 60 days prior to tlie evefat. Non per��2ittecl events will not be allowed. NAME OF OWNER: y/t' l- �= S/� � � (�C PHONE: (home) � (work) MAILING ADDRESS: �� -S`J ��'�'��` � � CITY: ZIP: CONTRACTOR: V �► � 1-. S� , f �I Cn i� I ' PHONE: � S,�- - �f �3 - �S 1 �, CONTACT PERSON: (� �� MOBILE/PAGER: MAILING ADDRESS: (�,S 6 S �. Siiti �. w, �_�� C k j,;��, CITY: (ti'��r��f r_s�z. ZIP: �S=� � C � STATE LICENSE: # S"3 =�`j ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION # TYPE OF WORK: New Accessory Structure Addition Move Remodel/Alteration x Land Alteration � � PROPOSED WORK(describe i►z detai�: � �_�/-� ��J � {'2 rS��-, � �---�� ..�.___, STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ESTIMATED CONSTRUCTION VALUATION (excluding land): $ \� , �� =- "—� I hereby apply for a building permit and I aclmowledge 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: ` � ' . � Sec.13.04 121GHTS OF SUBJECTS OF DATA Subd.l. Type of data. Thc rights of individual on whom the data is stored or to be stored shali be as set forth in this section. Subd.2. Intormation required to be given individuaL An individual asked to supply private or conFdential 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 Iegally 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 authoriud 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 la�v enforcement of(icer. The commissioner of revenue mav alace the notice required under this subdivision in the individual incomc taa or propertV tax refund instructions instead of on those fonns. Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be informed whether he is the subject of sfored data on individuals,and�vhether it is classified as public,private or confdential. Upon his further request,an individual wlio is the subject oC stored private or public data on individuals shall be sho�vn the data without any chaige to him and,if he desires,shall be in(ormed of the wntcnt and mcaning of that data. Aftcr an individual has been shown the privatc data and informed of its mcaning,the data necd not be disclosed to him for six months thereafter 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 autl�ority may requice the requesting person to pay the actual costs of maldng,certifying,and compiling tlie copies. Thc responsiblc authority shall comply immediately,if possible,with any requcst made pursuant to this subdivision,or within fivc days o[the date of the request,excluding Saturdays,Sundays and Iegal holidays,if immcdiatc compliance is not possiblc. If hc cannot comply with thc requcst within that time,hc shall so inform the individual,and may havc an additional[ivc days within which to comply with the requcst,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 himsclf. To exercise this right,an individual shall notify in writing tlie responsible authority describing the nature of the disagreement. The responsible authority shall witliin 30 days cithei: (a)wrrcct the data found to bc inaccurate or incompletc and attempt to notify past recipicnts of inaccurate or incomplete data,including recipients named by the individual;or(b)noti(y the individual that he belicves the data to be correct. Data in dispute shall bc discloscd 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 M.S.13.04,Subd.2,"Rights of subjects of data",we�vould like to inform you that your request f'or a permit or licer�se from the City of Orono or any of its departments may require you to furnish certain private or cont"idential information. You are notified 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 tlie City deny the permit or license. 3. The inforn�ation 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. ��I� r i c 1�'_' �� ,� , '�- �� First Middlc Last C�S- � S— S� S �t��_Y, %J �:�ta- L� . /,��"; Address � �'L� � �, ,��.-��, , 5 �� i�% �s(, c_� i�s�-.�� - �/7� 6s� � City State Zip Phone I nderstand my rights stated above. Signature �