HomeMy WebLinkAbout2003-P06224 - siding * ` y PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P06224
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: ai2a�2oo3
SITE ADDRESS: 2216 Shadywood Rd
Wayzata,MN 55391
P I D: 17-117-23-42-0004
DESCRIPTION:
Proposed Use: Residenrial
Permit Class: Building Census Code O/S-Building
Permit Type: Minor Alterations Permit Sub-type(s): Siding
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: PernutFee: $ 265.25 Valuation: $ 16,000.00
State Surcharge Fee: $ 8.50
TOTAL FEE: $ 273.75
APPLICANT: Fred Groth Construction OWNER: Mr. &Mrs. Keefe
142 N. Grunberg Ave 2216 Shadywood Rd
Wolflake,MN 56593 Wayzata MN 55391
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.
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APPLICAN ERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
APr-22-2003 01:24pm From-CITY OF ORONO � +9512494616 T-324 P.003/004 F-489
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Total Fee: $_ � r%�;, � Date Received: �� ��" � � ��
Encered By: �'� Percnit#:
- CITY �F URQNO - BUILDING PERMIT APPLICATYON
All inform�teon must be submitted in fl�l! before plan review wili be started.
(please prini all informaiion)
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'l'HE A,PPLICANT IS: (circle one) OW1VE �_ ,
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aog srrE Annx�;ss: �Z� �' S►� iuG2�C� I2C,�a��C z�: 5r�"�3� 1
NAME qF OVPN�:�t: �G�� �2� PHONE: (home)�f S Z- t-{'� - � ()� �
Cr II (work) 3 - 57 ls� — � (
�an.nv��,nnx�.ss: Z 1 ���1 ��� �v��I���: % z�: 5s � ►
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CONTRACTOR: ,�I/2C� C 12;�I/� ��S/�������P�OlYE: ZI`�-5�,�- 7 �
CONTACT PERSUN: MOBILE/PAG�: ^ � • -3 2
MAIY.YNG AriDRI� : CITY: �I ZIP: S(�
STATE LICENSE: #Zc;�Z 3ZZ�
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ARCHIT'ECT/ENI�IlV�EIt: PHONE:
MAT�.ING ADDRLSS: CTT'Y: ZTP:
NAME: REGISTRATIQN#
T'YPE OF WORK.: New Addition Accessory Structure
Move Remodel/Alteration Land Altecation
PROPOSED WQRK(describe in detai�: � (�G��{��l� S i 011�Vl� v"�.1' e`F�S�I�'� �vd�;C��
si`���j�� (J�
STORIES: Z SQ.FEET 4F EAC�T�'Y.00R: ? - �l l�(�I'L'X. I�U� ���-+'Q� j
NO. OF BEDRQC)MS: ? GARAGE STALLS: AT'T. DET, 1C
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ESTIIVIATED C4NSTRUCTYON'VALUATYON(excluding land): $ ��Co, l.7��.�
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I hereby apply for a.building perrnit and I aclaiowledge that the information above is complete and
accurate; that che work will be in conformance with the ordinances and codes of the City and with
the State Building (,ode; ihat I understand this is not a permit and work is uot to start without a
permit; and that th�: work will be in accordance with the approved plan.
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APPLICANT`S SYGNATUYtE: DATE: ��Z��U� _
NOTE! 1°arade of Homes events require eparate pernut apprnval by 1'olice Depa,rtment and
City Council 60 days prior to the event. Non permitted events will rtot be alYowed.
Apr-21-1003 01:14a� Fra�-CITY Of OROl10 +9522494616 T-314 P.004/004 F-489
„Scc.13.03 RIGFIfS OF SUBJE:CTS Of OATw
Subd. 1. Type of dsta. 71►e rigba of indi�on whwn me dm is s�ored or ro bc soored shaD be as se�tonh io tbis tec�n.
Subd.3. Iatora�sdon reqaired to be q�m i�i�Idnal. M iodividual as�ed�o wPP�Y Priva�or eot�Cidendal dea cooce�ni�hiraseif tEall
be intbemed ot: (a)me P�epox and iotdyded use of du requested dam wi�io dte wlkcm+E��6e�Y.Po�subdivisiee.or aaawide ryso�m;
(6)whedier he may�eFuse or is Ir.gaity�equiccd w suPP1Y�e�4���a;(c)any bwwn coasequence arising f�m his s,+pPb�B or rctusing w svpp�y
ptivsu or tonfidenual�ep:�nd ld)d�e►de�cY of or�r persons or et�rieas authorised M su�e oe fedecallaw to meivt�he dau. Tlsis reQuiretsent s6alt
noc appty when an individual is asked w wpply iwasdyacve dao,punnan<<o secrion 13.63,suDdivision S,to s taw eaforcemeot otiieer.'
'11►e Cammissioner o1 rcvenue mav ! t the naece rc i n e�shis subd'I�isian in the itldividu8l il+come �or ro aut refund
i�s�cueeions ins�ead ol on rhnse_Pom►s.
Subd.3. Access�o daca by iadi.idusl. Upon requeA oo a rcsponsibk awhorib.aa iodividaal shall be inforr�d Whemer Ife is du subject
of�'roeed daia on individuals,aM whetLer ic is classifEcd ss public,priraa u�coefidential. Upon his further erquesC�n iodividpa!who is d�e subjecc
of smred priv.a or public dan on individwls ShaU be showo d�e dsta wvho�c any ch�rge m him end;i!he desire�,s1u�U be intbcn�d af�e couaeat
��mzaoing of�hac dan. Afur an individuu 6as bcen sAown�he privarc dau and infom�d of as mewung,me dan�ed aot Oe d'aciosed m him for
six canchs�hereaher udess a dispute or acdoa porsua�u w rhis seccon is pend'mg or addidoaa!dere oa du individurl das been collecud ar creamd.
't�e respomibk autboriry shull provide coPies of fie p�vaoe or public daa upon eequest 6y dte individud subjae oP d�e dsm. 11►e iespoadble wd�oriry
e�sy requi�e We requesdng parson co pay rhe aenwl cosa of inekin6.cerdfymg.and wmpiling me copies.
. Tha respotuibk wttwcicy shsll comply u+�taediaaly,if pessible,W rth vu7[lQYt9L Illade pttrfuiOL W dd5 9Obdivision,or wi�hia fivc days o!
rhe dax of rhe requou,eseludin�5so�rdayt.Sund�ya w�d legal holidsys.if iromediace complianee is noc pouible. It he uneo�co�nply wirh�e rcq�usc
wid�in�Au ame.he sha11 so iNbrm the individud.and may have an addidoaal C,ve diye Widtin which w¢omply widi tl�e request.exch�ding Samtdays,
Sue�ays a�kgs!hol'edays.
Subd.4. Procedure.�+heo dae■is oot aceWrate or camplae. M iodiridual ma�r eon�ess�he ucuracy or comylednass of puMic os privarc
daa eoneeming himsell. To ea:rcise d�is righc.an iadividual sha11 noufy in w�icing drc respons�ble surhociry descn"bing dw aamre of d�e disxgeeemene.
The responsiblt aud►orisy shall wi�hin 30 dars einc�r. (■)eomec�r!►e dsn found m bc iaaceunre or incompk�e aed ame�ap�m�rodfy pas<<ecipieers of
insc�vrs�e or incomple�e dwu,ioeludtng rteipienrs mmed by rhe i�ividwA:or(D)aoufY dw i�i•iaual�u he belie•es�Ae d�n m be corKcc. Dan
in dispud shnll6e disclosed only U tbe individp�tl's sm�Esnetu of disagtiement is includzd with dte d'uclosed dan.
The decermi�rion or�hc nsponsibk Audwsity maY be APP�ated P�rsu�x to�e provisions af drc�dminis�radve pmcedu�s acc mluing w
eonasoee rases. �
DATa �'RIVACY VISORY
In aecordanee with M.S. 13.04, Subd.2, "Rin.,,h�s of subjeecs of data",we would like�o inforw you chaL your requtst
for a permit or license from ihe Giry of Oroao or any of its depanmencs may require you to furnish cenaia private or
confidential informa�ion.
You are notified th�u:
1, The informa�ion you furnish wiII be used to decermiae your qualifieacion for che permit or Iieense requesced.
2_ You may cefuse tn supply data, buc refusal may require that the Ciry deay zhe permit or license.
3. The info�nacion may be shared wiih ocher Ioca1,s�su or federal ageeieies co the exient aeeessary co proeess
the permit or licease.
4. If your requested permit ot liceqse requires Council �tion to approve, some iuformatioa may become
public.
5. You have �;ertain righrs under M.S. L3.04 (available upon requesc) to review private da�a on yourself.
6. Your full uame is required to prvicess this applicacion or permi�.
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Ciry Swa Zip Phone
I underscand my rip,bts as scated abo�e_ .
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Signaure