HomeMy WebLinkAbout2000-P02520 - addn/remodel/repair/ t' pERMIT
CITY OF ORONO
2T50 Kelley Parkway - PO Box 66 Permit Number: Po2s2o
, Crystal Bay, Minnesota 55323 P2('CYllt Type: Addition/RemodeURepair
(612) 249-4600 Date Issued: 6isioo
SITE ADDRESS: 3265 Sixth Ave N
LONG LAKE,MN 55356
P ID: 29-118-23-44-0002
DESCRIPTION:
Proposed Use:
Buildin Census Code 434
Permit Class: g
Permit Type: Addition/RemodeURepair Permit Sub-type(s): Building Re-Roof
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 167.25 Valuation• $ 9,000.00
State Surcharge Fee: $ 4.50
TOTAL FEE: $ 171.75
APPLICANT: WF. SMITH CONSTRUCTION OWNER: M M CALLAHAN&D T CALLAHAN
5985 LYNWOOD BLVD 3265 SIXTH AVE N
MOUND,MN 55364 LONG LAKE MN 55356
THE UNDERSIGNID HEREBY REQUFSTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND
STATE OF MINNESOTA BUII.,DING CODE REQUIREMENTS.
ISSLTED BY SIGNATURE
Copies: City,Applicant,Assessor,Finance Page 1
� �
Total Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BiJII�DIvi G PERMIT APPLICATION
All information must be submitted in fiill before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTR.ACTOR �
JOB srrE annx�,ss: 3 �- � � �,+�` J�- z�:
NAME OF OWNER: �p*�-�y� G►�I� �1-.a r� PHONE: (home)
(work)
Niaa.�vG annxEss:3 a-6 s 6�^,�-„�`- crrY: z�:
CONTRACTOR:�JV, � �M�V�' ��. PHONE: �7 � - 6�.3�
CONTACT PERSON: '3 �D _MOBILE/PAGER: .
MAII..ING ADDRESS: CITY: ZIP: � ..
STATE LICENSE: � S 3 a�j
ARCHITECT/ENGINEER: pA���
�IAILII�'G ADDRESS: CIT'Y: ZIP:
NAi1�: REGISTRATION#
TYPE OF `i�ORK: New Addition Accessory Structure
Move Remodel/Alteratic� Land Alteration
PROPOSED WORK(describe in detain: 1�►-✓L- �'F '� '�--sl��� .
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROONIS: GARAGE STALLS: ATT. DET.
. �
ESTI�i IAT'ED CONSTRUCTION VALUATION (excluding lancn: $ � 66G --
I hereby aoply for a building permit and I acknowledge that the information above is complete and
accurate; �hat 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 i the approved plan.
APPLICANT'S SIGNATLTRE: DATE: C� --� C "'' �U
NOTE! Parade of lYomes events require separate permit approval by Police Deparlment and
� City Councit 60 days prior to the event. Non permitted events will not be allowed.
`+ j
Sec.13.0t RIGHTS OF S[iB.TECTS OF DATa
Subd. 1. Tvpe ot data. 'Ihe righrs of icdividual on whom che data is stored or m be stoced shall be as set focth in this secrian.
Subd.2. Informatioa req�rired to be gven iadividual. An individual asked w supply privatt or confideadal data conceraing himself shali
be informed of: (a)rhe pucpou and inrended use of che cequesud dam wirhin�he coliecdng�are agenry,political subdivision,or srncewide syatem;
(b)whedier he may refuse or is legally cequired w supply the tequesud data:(a)aaY Imu`a°ca°x4ueace arising from his supplying or refusing to supply
privare or conndendal dara;and(d)the idendcy of o�er pe�saas or enddes au[horized by scarL or fedecal!aw to�eceive che daea. 'Ihis requiremenc shall
not apply when an individual is uked to supply incarigadve dard,pursuant�o secrion 13.83,subdivision S,w a law enforeemeac officer.
'Ihe commissioner af inenu mav ola, che nodce reauired under d►is subdivision in the indiv_idual income tax or orooertv taz refur.d
instrucdons inscexd of on chose forms.
Subd.3. Access to data bg individuaI. lipon requesc m a responsibte aurhoriry,an individual shail be informed wheeher he is the subjecc
of stored data on individuals,and whecher ic is cius�ed as public,private or confidendal. Lipon his fusher request,aa individual who is the subjecc
of smr:d private or pub(ic dan on individuals shall be shown the dan wichout any charge tq him and;if he desires,shall be iniormed of the contenc
and maaniag of that dara. Aher an individua!has bem shown che privare dara and informed of ics meaning,the data need noc be disclosed to him for
siz mondu ehereafur unless a d'upute or acrion pucsuanc w [ius secrion is pending or addidonal dara on che individual has been collecud or creamd.
The tesponsible authoriry shall provide copies of die privace or public data upon cequesc by[he individuai subjecc of[he dacn. Tne responsible aurhoriry
may require che requesring person ro pay the aca�al coscs of cnaking.certifying,and compilinS the coQies.
The responsible au[horiry shall comply immediately,if passible,wieh any eeqnesc made pursuanc to this subdivision,or within five days oi
the da�of die requesc,e�ciuding Saturdays.Sundays and legal holidays,if immedia�e compliaace is noc possible. If he cannoc comply with che requesc
wirhin chac dtne.he sh�ll so infocm the individuai,and may have an addidoaal five days wirhia which to comply wirh[he request,excludiiig Saturdays.
Sundays and legal hotidays.
Subd.4. Procedure when data u not accurate or complete. M individual may contest etu accuracy or completeness of public or pri�ate-
dara conceming himsdf. To exercise�his righc,an individual shall nodfy in wridng rhe respoasbie auehoriry dacribing rhe naeure o£the disagreement. ..
The cesponsible aurhoriry shall wichin 30 days eid:er. (a)correct the dara found ro be inaccurere or incomplete and atumpt to nodfy past recipienu of
inaccurace or incomplete dact,inciuding recipiencc named by the individual;or(b)nodfy ehe individual that de believes rhe data to be correcc Da[a
in d"►spuce shall be dise:osed only if the individual's stacemenc of disagreement is induded wich[he disclosed data.
The dearminadon of the responsible au�horiry may be appealed pursuant to the provisions of[he adminis�rive procedure act mlatiag co
concesced cases.
DATa PRIVACY r�►DVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your requesc
for a permit or license from the Ciry of Orono or any of its depaz[ments may require you to furnish certain private or
confidencial information.
You aze notified that:
1, The infarmation you furnish will be used to decermine your qualification for the permit or license requested.
?. You may refuse to supply data, buc refusal may require thac the City deny the permit or license.
3, The information may be shared wich other local, scate or federal agencies co the extenc necessary 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 request) to review private data on yourself.
(, Your full name is required to process this application or permit.
Firsc �tiddle Lasc
�.ddress �
Cicy Stau Zip Phane
I understand my ri;hcs as stated above. .
Signamre