HomeMy WebLinkAbout2003-P06462 - windows PERMIT
CITI�' �F ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P06462
Crystal Bay, Minnesota 55323 Pet-mit Type: Minor Alterations
(952) 249-4600 Date Issued: 6i24i2oo3
SITE ADDRESS: 3850 Shoreline Dr
Wayzata,MN 55391
PID: 17-117-23-33-0006
DESCRIPTION:
Proposed Use: Commercial-Business
Pernut Class: Building Census Code O/S-Building
Pernut Type: Minor Alterations Pernut Sub-type(s): Windows
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 38.75 Valuation: $ 1,000.00
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 39.75
APPLICANT: 7ay Sandgren OWNER: Jay&Barbara Hensley
M� 3850 Shoreline Dr
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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APP ANT RM[TEE SIGNATUR ISSUED SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Annlicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
Total Fee: $ Date Received.
E�terzd By: Permit#:
�`CITY OF ORONO - BUII,DIlVG PE�RMIT APPLICATI�N
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPL�CAN'I` IS: (circle one} � OWNER R CONTRACTOR �� ^
JOB s�� AnnxEss: ,���C� ��-�� r�/��� .� r� znP: 5 S 3 9/
NAME UF OWNER:_�i1��'�� ✓+�. y�� Y► ���.'�l PHONE: (home) ��,�: � IC� �'.���
(work) S�Z. �
MAILING ADDIZF�,SS: '✓�j`5� �i�f' i�'����� r.�f � CITY: G? y"'p i�U ZIP• �:�a �/
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cort�c�roR: �y 5a.r�d a r7 e`�� rHorrE_ Q�`� 93� ��69
CONTACT PERSON: � , �����Q���MpBILE/PAGER. �p„$"f ���J�' ��f��
MAILING ADDRESS: T CIT"Y: ZIP:
STATE LICENSE: #
A,RCHITECT/ENGINEER: pHONE;
MA►ILING ADDRESS: CITY: ZIP:
NAME: REGISTRATIQN#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration� Land Alteration
PRUPOSED WORK(describe in detail}: p�GC�. �,, /n C1 �S � �' -'
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STORIES: / Z- SQ.FEET OF EACH FL(�4R:
NO. OF BEDRO6MS: GARAGE STALLS: ATT. DET.
ESTIMAI'ED CONSTRUCTION VALUATION (excluding laad): � �� D a D �
I hereby apply for a building permit and I acknowtedge that the infomiation above is complete and
accurate; that the work wil1 be in conformance with the ordinances and codes of the City and with
tYie 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 pian.
A.PPLICANT`S SIGNATURE. DATE: � 07� D�
NOTE! Parade of Homes eve s reqr�ire separate permit approval by Police Department and
City Council 60 days przor to the event. Non permitted events will not be allowed.
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Sa_13.04 RIGHTS OF'SUBJECTS OF DATA
Subd. 1. Type of data. "Ihe rigtits of individual on w6om fie data is stored or m be sm�ed s6all be as set focth m this secaoQ.
Subd_2. Information required to be given iodividoai. pn iadividuai asked�o supplY Private or oonfideuaal data co�eruit�g himseif shall
be iaforoud of: (a)the putpose and iatended use of thc�da�withia t6e cot(ecnng 3tau agoacy.Potrocal acbdivision,or statewide sysoem:
(b)whefier he may refuse ot is legally required to supply che requested dara;(c)any Imown consecp�ence arising from�is supP�Y�B or refusing to suppty
private or confideatial data;arni(d)the ideatity of other pe�soos or entities authorized by state or faknt faw in receive the data. This require�nt s6all
�t apply when an individuat is asl:ed w svpply imesti�adve data,pacs�ant to secaon 13.82,svbdivision 5,w a�aw enforeemem offtcer.
'Fhe commissioner of revenue mav plact the ao6ce reauircd under this snbdivision in the individual income Cax or orooertv taz rtfiind
inst�uctions ins[ead of on[hose forms.
Subd.3. Acoess to data hy individuaL Upon ra�ucu oo a respons�bk aut6ority,an individual�all be i�ormed whether he is the sub�ect
of stoced data on individuats,and whether it is classified as public,privau or coafidential. Upon Lis fucther request,an individuat who is the subject
of stoced private or pub[ic data on ic�ividuals shall be shown the data without aay c6arge to him aad:if ha desires,sbal!be infoLmed of the content
and meaning of[hat data. After an indiv9dual has been shown[he privane data ard informed of its meaning,t6e data need not be disclosed to him for
six mondu theceafter unless a dispute or acdon pursuant to d►is secdon is pending or additional data on We individuai has been collected or created.
The nsponsible audwriry shatl provide copies of the privarr or public data npon requac by the individuaI subject of the data. The responsible authoriry
may require the requesting person w pay the acwal costs of making,cenifying,and compiGng the copies.
The responsible audwriry shail compty irtu�dia�ely,if possible,with sny request made puesuaat to dus subdivision,or within five days of
�he date af the request,ezcluding Satucdays,Svndays and legal holidays,if immediate compliance is not possib[e. If he cannot�mpty wiih the request
within thac time,he shall so inform rh�ind"evidual,and may have an addidonai five days withiu which to comgly with tt�reques�ezcluding Saturdays,
Sundays and legat holidays.
�bd.4. Procedure when data ss mt accorate or complete. Aa individual tmy co�aest the ac,curacy or coaepleteness of public or private
data concerning himself. To exercise this righi,an individual s6at1�tify ia writing d►e rcspoe►s�'ble suthoriry describmg the na[ure of d�e disagceement.
1he responsibie authority shall within 30 days either: (a)coriecc[he dara found oo be inaccurate or incomplete aad atrempt oo noddy past recipients of
imccuraae or incomplete data,inciuding recipients named by the indiv�uai;or{b)notify the individual thac he believes the dara to be cocrecL Data
in dis�wte shall be disclosed on(y if the individual's sratement of disagreement is included with ffie disclosed data.
T6e deurminadon of the responsibte authoriry may be appealed pursuaat w the provisions of the admimsnative procedure act relating to
oonoested cases.
DATA PRIVACY ADYISORY
In accordance with M.S. 13.Q4,Subd.2, "Rights of subjects of data",we wonld like to inform you that your request
for a permit or licease from the City of Orono or any of its departments may require you to fiunish rertain private or
wnfidential information.
You are notified that:
1. The information you f�rnish will be used to deterntine yot2r qualification for the permit or Iicense 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 iicense.
4. If your requested permit or license requires Couucil action to approve, some information may become
public.
5. You have certain righcs under M.S. 13.04 (available upon cequest) to review private data on youiself.
b. Your full name is required to process this application or permit.
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First Middle Lasc
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I understand my rights as stated above.
�p-JI�-G � .
s�gnaaue
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION TICE SCHEDULED ��L � c�.�vc7
PERMIT NO. Q ���s COMPLETED
ADDRESS S
OWNER �-' �
TELEPHONE NO. �- -
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� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING ��MECHANICAL FINAL , 19 L4KESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD NER/ I PLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMM S:
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W� ❑WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRA E ACCESS.
Ca11 for th next inspecti 4 urs i va ce. (952� 249 4 00
Own or on site:
Inspector. � ?
hite Copyll�spector's File Canary CopylSite Notice
Cs�-� ✓
D T TIME
CITY OF ORONO CALLED IN �� �
INSPECTION TIC SCHEDULED <� ,' �
PERMIT NO. � COMPLETED
ADDRESS ��D �y�%LD"LP.P��t �
OWNER CONTR.�ZS�Qt�,��1, GJH'l9�OZcZS
TELEPHONENO. 7sZ �7I g�Ov
� DESCRIPTION r��'��'�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z ALL BD• 12 WATER HOOK-UP 17 SITE INSPECTION
Q/�L 14 SEWER HOOK-UP O6 PROGRESS
�r OEMO-SITE 27 SEPTIC MAINT. 21 COMPUUNT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
ti COMMENTS:
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� RKSATISFACTORY:PROCEED ❑PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERINCa PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTEO.CALL INSPECTOR
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for t next inspection 24 hours in advance. (g52) 249-46��
Owner/C r on site:
inspector.
White Copylln tor's File Canary CopylSite Notice