HomeMy WebLinkAbout2003-P06831 - windows `� � PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Po6s3i
Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations
(952) 249-4600 Date Issued: 9i29i2oo3
SITE ADDRESS: 1720 Shadywood Rd
Wayzata,MN 55391
PID: 17-117-23-21-0019
DESCRI PTION:
Proposed Use: Residential
Permit Class: Building Census Code O/S-Building
Pernut Type: Minor Alterations Pernut Sub-type(s): W�dows
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 363.25 Valuation• $ 23,000.00
State Surcharge Fee: $ 12.00
TOTAL FEE: $ 375.25
APPLICANT: Alan Kozicky OWNER: Alan Kozicky
1720 Shadywood Rd 1720 Shadywood Rd
Wayzata,MN 55391 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENT'S 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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APPLICANT PERMITEE SIGNA ISSUED BY SIGNATURE
Couies: 1-File(Si�nitures Required), 1-At�ulicant, 1-Monthlv Revorts. 1-Assessin¢, 1-Finance Page 1
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Total Fee: Date Received: /���—�
Entered By: Permit#: . t� (p��J
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 CONTRACTOR
JOB SITE ADDRESS: �� � C� ��� �y C�e�o� �'�ZIP: �-3�/
NAME OF OWNER: ,�/r,Y"/� � f� o��'� k/ PHONE: (home) .l�/��.SaFf-/�33
(work) �sa a-�g-3 2 o v
�IAILING ADDRESS: ��a o sh•��ywo� �: o�� �o z�: � .s��i
CONTRACTOR: ' PHO��TE:
CONI'ACT PERSON: MOBILE/PAGER:
MAII.ING ADDRFSS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: . PHONE:
MAILING A.DDRESS: CITY: ZIP:
NAME; REGISTRATION# •
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detain: ��"����-S
STORIES: � SQ.FEET OF EACH FLOOR:
� NO. OF BEDROOMS: GARAGE STALLS: �ATT: � DET. � _ � •� ��- - -• � :
ESTIMATED CONSTRUCTION VALUATION (excluding land): S o�� � °�3°U�
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= 9��`"Q�
NOTE! Parade o Homes events require separate ermit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF D?►T.+i
Subd. 1. Type of data. The righcs of individual on whom che data is stor�or to be stomd shall be as set for[h in this secaon.
Subd.2. Information reqirired to be givm indiridual. .1n ir.dividua!asked to supply private or confidenrial data concerning himself shall
be informed of: (a)[he purpose and iacended use of the enquested data wi3un the collecang State agency,polidcal subdivision,or sracewide sysum;
(b)wheet►er he may refuse oY is legally requicod to supply ehe requessed dats:(c)any l�own consequence arising from his supplying or refusing to supply
privace or confidenriai daa;and(d)the idenriry of other persons or enddes auchorized by srate or federal law to receive the data..This requiremenc shall
not apply whan an individuai is asked to supply invesdgaave data,pursuaar to secaon 13.82,subdivision S,co a law enforcement o�cer.
'ihe commissioner of re�enue r�av place the noace reauired ender this subdivision in the individual income_tax_or prooern tax refund
instructions instead of on those forms.
Subd.3. Access to data by indi.idual. Upon requesc to a resgonsible aa�hority,an individual shall be informed whether he is the subject
of stored data on individuals,and whe�her it is class�ed as public,priva�or con6denrial. Upon his further requesc,an individual wha is the subject
of scored private or pubiic data on individuals shall be shown che dara wi�:out any c'aarge to him and,-if he desires,shall be informed of the concenc
and meaning of chat data. Aftec an individual has been shown che priva::dan and iaiormed of its meaning,the dara need not be disclosed to him for
six monrhs chereaiter unless a dispute or acdon pursuan�to ehis secdon is y:nding or addidooal data on the individual has been collected or creaced.
The responsible auchoriry shall provide copies of the private or public data Lron requ:s:by the individual subject of[he daca. The responsible au[horiry
may require che requesting person to pay[he actual cosu of makin¢,cerying,and compiling the copies.
The responsible authoriry shall comply immediately,if possibi=,wich any r_quest made pursuant to this subdivision,or wi[hin five days of
the date of the request,excluding Saardays,Sundays and legal holidays,if imrnediace compliance is not possible. If he cannot comply with the request
wi[hin�hac time,he shall so inform the individual,and may have an addidoaal five days wiehin which to comply wich ehe request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data Ls not accurate or complete. An individual may conust the accuracy or completeness of pubiic or pri�•ate
dars conceming himself. To exercise chis righ4 an individual shall nodfy ia wridng r�e responsible authoriry describing che nacure of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data fcund to be inaccucaee or incomplete and aaempt to nodfy past ncipienu of
inaccurace or incomplete data, including recipienes named by che individi:al:or(b)eodfy the individual thac he believes the data to be cocrecc. Dara
in dispu�e shall be disciosed only if the individual's stacemenc of disagr:c�ent is ir.cl•ided with[he disclosed dara.
The de�erminadon of the responsible aurhoriry may be appeal:3 pursuac�to the provisions of ehe adminisaarive procedure act relating to
concested cases. .
DATA PRIVaCY ADVISORY
In accordance with M.S. 13.04,Subd.2, "Rights of subjects oi data", we would like to inform you that your request
for a permit or license from the Ciry of Orono or any of i�s deparments may require you to fumish certain privace or
confidential information.
You are notified that:
1, The information you furnish will be used to de;ermine}•our qualification for the permit or license requested.
2. You may refuse to supply data, buc refusal may require that the City deny the permit or license.
3, The information may be shared with ocher loc�l, state or federal agencies to the extenc neeessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
. , public.
�. You have certain rights under M.S. 13.04 (available upon requestj to review private data on yourself.
6. Your full name is required to process this aoplica[ion or permit.
l��i✓ � �oZ/�Gi��/"
First �tiddie Lasc
1�aG s���� ��G�` ,��
Addres �JVI 0 �� ��J�� ��02 ".����.3�
Ciry State Zip Phone
I understand my rights as stated above.
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