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Home My WebLink About2001-P04447 - addn/remodel/repair � PERMIT , �I��'Y OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: Po444� ,�;� ( Crystal Bay, Minnesota 55323 Pe►'mit Type: Minor erations/�' �, (952) 249-4600 Date Issued: iois oo� SITE ADDRESS: 2341 Shadywood Rd WAYZATA,MN 55391 P I D: 17-117-23-44-0079 DESCRIPTION: uBc o��up �y R3 Proposed Use: Kesidentiai Buildin Censu Code O/S- Building Permit Class: g Permit Type: Minor Alterations Pe it Sub-type(s): Addn/Remodel/Repair DETAILS: � Approved per resolution#: � 1 Separate permits required: ,� NOTICES/REMARKS: r 1 � � FEE SUMMARY: Permit Fee: $ 29.60 Valuation: $ 675.35 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 30.10 APPLICANT: OWNER: 1-ouisE a �arr�ELxoFF 2341 SHADYWOOD RD WAYZATA MN 5�391 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. � ,;% �� '�� ;�,z,� _ a � � ,��y�•-C�.2L � �� APPLICANT PER ITEE S NATUR ISSUED BY SIGNATURE Copies: 1-File(Signitures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing, 1-Finance Page 1 ' � 3��ia , ` �'otal Fee: $ Date Received: 1�'g-0 � - Entered By: ��WL� Permit#: �°D c(�(�(7 CITY OF ORONO - BUILDING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) --------------------------------------------------------- ---�--- ------ - ----------------------- THE APPLICANT IS: (circle one) OWNER R ONTRACTOR JOB SITE ADDRESS: � � � ZIP: ��3� J ) � ( NAME OF OWNER: L..DU,j S� �G��1 E� CU� � PHONE: (home)�Sa- 'd j o�ef (work) `�le 3 - �`")� - � MAILING ADDRESS: a3� L S�-�e-c�v wr��cQ CITY: � rb y�, ZIP: g�3 � CONTRACTOR: _��,,�l� PHONE:_ 1�rs��^�/'(�S a� CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: �3 � �5l� �,odcQ CITY: Qvo�w ZIP:;5�3�� STATE LICENSE: # S�e/ ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# � �m.ov�- �.�+�� -�v iv�Su,(1�� -��vr Jost TYPE OF WORK: New Addition Accessory Structure Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: �f� 5�,�,�ec� e w,�`h, �� . sc, u,�� ►IM. o s I" �r.r' STORIES: _�_ SQ. FEET OF EACH FLOOR: DD_�5c�.0 � � NO. OF BEDROOMS: � GARAGE STALLS: AT�T.� DE'�'. ESTIMATED CONSTRUCTION VALUATI,ON (excluding land): $ ��Q�S- ��j 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: y DATE: �(,�-��OJ NOTE! Parade of Homes events require separate permit approval by Police Deparlment and City Council 60 days prior to the event. Non permitted events will not be allowed. 5 � • , Sec.13.04 RIGHTS OF SUBJECTS OF DATA - Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be givea iadiridual. An individual asked to supply private or confidential 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 legally 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 endaes authorized by srate or federal law to receive the data. 1'his requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav olace the norice reqtaired under this subdivision in the individual income tax or orocertv tax refund instrucrions instead of on those 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 icidividuals,and whether it is classified as public,private or confidenaal. 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 disclosed ro 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 authoriry shall provide copies of�e private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays a�legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that dme,he shall so inform the individual,and may have an addidonal five days within which to comply with the request, excluding Samrdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comploteness of public or private data co�eming himself. To ezercise this right,an individual shall notify in writing the responsible authoriry describing the tiature of the disagreement. The responsible suthoriry shall within 30 dayS either: (a)correct the data found to be inaccurate or i�omplete and attempt to notify past recipients of inaccurate or i�omplete data,irncluding 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 disclosed data. The determinaaon of the respoasible authoriry 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 would like to inform you that your request for a permit or license from the �ity 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 eztent 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. b �S�- �/l First / Middlne I,ast �r�i y� �N�J/(�AJ[l O C� C! � Address ��,� M l(/ �3-��l ys a- y��-dsa� Ciry State Zip � Phone I understand my rights as stated above. Sig re F 6