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Home My WebLink About2000-P03118 - re-side � �� t � PERMIT . � CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po3 i is Crystal Bay, Minnesota 55323 Per'mit Type: MinorAlterations (612) 249-4600 Date Issued: io�i3i2o SITE ADDRESS: 1795 Shadywood Rd WAYZATA,MN 55391 PID: t�-i i�-23-2i-000s DESCRIpTION: f, Proposed Use: � r' Permit Class: Building :' Permit Type: Minor Alterations 1'ermit�uub-type(s): Building Re-Side /� /, DETAILS: ,,'\ Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 111.25 Valuation: $ 4,700.00 \ State Surcharge Fee: $ 2.35 \l TOTAL FEE: $ 113.60 APPLICANT: HOME IMPROVEMENT OF MN OWNER: L&D PILGRAM 13789 FORDHAM CT 1795 SHADYWOOD RD APPLE VALLEY,MN 55124 WAYZATA MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WTI'H ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � �� .�_�,, �'O�tf.`'�_..Y 7 NT PERMITEE 'I NA URE ISSUED BY SIGNATURE Copies: City,Applicant,Assessor,Finance Page 1 � h . , � � �Total Fee: $ Date Received: Entered By: Permit#: CITY OF ORONO - BUII.DING 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 OR ONTRACTO JOB SITE ADDRESS: �7�� '�by�a�'O �� ZIP: 5��3 1`�2-- ' 4�7/�y z �. NAME OF OWNER: o , ��9 PHONE: (home) � (work) MAILING ADDRESS: �1�.S��i,?f�/Jiwl/o/J ��TY: �/�/2�Cr ZIP: �S".�.� T�- � �zz B.� CONTRACTOR: ��'l �� l� PHONE: �l Z �f/ CONTACTPERSON: —�, d,e.�-� MOBILE/PAGER• MAII.ING ADDRESS: �.3 � foQ.b � CITY: � ZIP: �z STATE LICENSE: # a.o/�"��y ARCHITECT/ENGIl�'EER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME; REGISTRATION# TYPE OF WORK: New Addition �ccessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detain: �S'!!� /yC � �'�'� STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. ��a -.� ESTIlVIATED CONSTRUCTION VALUATION(excluding land): $ 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: i�� DATE: /� -1.3- o0 NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be aZlowed. � j . , . � Sea 13.04 RIGfiTS OF S[JB.TECTS 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. Information reqirired to be givea individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and inrended use of the requested dara wichin the collecdng�tate agency,potidcal subdivision,or srauwide system; (b)whether he may cefuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply privace or confidenaal data;and(d)the idenriry of other persons or endaes authorized by state or federal law to receive the data. This requiremenc s6ai1 not apply when an individual is asked to supply invesdgadve data, pursuant to secdon 13.82, subdivision S,to a law enforcement o�cer. The commissioner of re�enue mav p(ace the nodce re4uired under this subdivision in the individual income tax or propeccv tax refund instructions instead of on rhose forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her ic is classified as public,private or confidenaal. Upon his further requesc,an individual who is the subject of stored private or pubiic data on individuais shall be shown the data wirhout any charge to him and;if he desires,shall be informed of the content and meaning of rhat data. After an individual has been shown the private dara and informed of its meaning,the data need not be disclosed to him for siz months thereafter unless a dispute or acrion pursuant to this secdon is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shal!provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesdng person to pay the acrual cosu of making,certifying;and compiling the copies. The responsible authoriry shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the requesc within that ame,he shall so inform the individual,and may have an additional five days within wluch to comply with the request,excluding Samrdays, Sundays and legal holidays. Subd.4. Procedure whea data is aot accurate or complete. An individua!may contest the accuracy or completeness of public or private data conceming himself. To exercise this righ4 an individuat shall nodfy in writing the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, inciuding recipients named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed on(y if the individual's stacement of disagreement is included with the disclosed data. The determinadon of the responsible authority may be appealed putsuant to the provisions of the administrative procedure act reladng 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 Ciry 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 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. C. Your full name is required to process this application or permit. First Middle Last Address City State Zip Phone I understand my rights tated above. Si mre